Lymphadenectomy, also known as lymph node dissection, is a surgical procedure that involves the removal and dissection of lymph nodes. This surgery serves two primary purposes: it is both a diagnostic procedure and a treatment. If cancer cells are found in the dissected lymph nodes, not only is valuable information obtained about the extent of the cancer’s spread, but the removal of these nodes also prevents further metastasis or the spreading of cancer to other parts of the body. Thus, lymphadenectomy plays a critical role in both the assessment and management of certain types of cancers.
The role of lymph nodes in the body
Lymph nodes are small, bean-shaped structures that are part of the body’s lymphatic system. This system, which includes a network of vessels, tissues, and organs, plays a crucial role in the body’s immune response and fluid balance. Lymph nodes are scattered throughout the body and act as filters for the lymphatic fluid, or lymph. As lymph circulates through the body, it collects substances like bacteria, viruses, and even cancer cells, which are then filtered out in the lymph nodes.
The primary job of the lymph nodes is to produce and store cells that fight infection and disease. When a pathogen is detected, the lymph nodes produce more of these immune cells, leading to swelling, which is often the first sign of an immune response.
In the context of cancer, if a malignancy develops in a part of the body, it may spread through the lymphatic system. The lymph nodes nearest to the tumour are often the first place the cancer cells will spread to. This is why examining these local lymph nodes through a procedure like a lymphadenectomy can give doctors important clues about the extent of the cancer’s spread, which in turn, aids in determining the most appropriate treatment strategy.
Purpose of Lymphadenectomy
Importance in Cancer Staging and Treatment
Lymphadenectomy serves a significant role in the process of cancer staging, which involves determining how much cancer is in the body and where it is located. This information is crucial as it informs decisions about the most effective treatment strategies for the patient.
When cancer spreads, or metastasizes, it often first travels to the lymph nodes near the primary tumour. Thus, examining the lymph nodes through a lymphadenectomy can help doctors understand if the cancer has begun to spread and to what extent. This understanding can affect the stage of the cancer, which is a key factor in devising an optimal treatment plan.
Beyond its diagnostic utility, lymphadenectomy also has a therapeutic role. If the dissected lymph nodes contain cancer cells, removing these nodes can directly contribute to the treatment of the disease. Specifically, it reduces the number of cancer cells in the body and may slow or even stop the progression of the disease. The procedure may be used alone or in conjunction with other treatments like radiation therapy or chemotherapy, depending on the specifics of the patient’s condition and the nature of the cancer.
Role in Preventing Further Spread of Cancer
Lymphadenectomy plays a crucial role in preventing the further spread of cancer. As the lymphatic system is one of the primary pathways through which cancer can spread, removing affected lymph nodes can interrupt this pathway and reduce the risk of metastasis. By examining and removing lymph nodes, doctors can ensure that these nodes no longer serve as potential conduits for the spread of cancer cells to other parts of the body. This prophylactic effect of lymphadenectomy can be crucial in improving the prognosis for patients with certain types of cancer. For this reason, lymphadenectomy is a standard part of the treatment plan for various types of cancers that are prone to spreading via the lymphatic system.
When Is Lymphadenectomy Needed
Circumstances Under Which a Lymphadenectomy is Recommended
Lymphadenectomy is generally recommended for individuals who have been diagnosed with certain types of cancer, particularly those that are known to spread through the lymphatic system.
The procedure is typically carried out when there is a need to determine whether cancer has spread beyond the primary tumour. It is an important part of the cancer staging process, providing valuable information that can inform decisions about the best course of treatment.
Additionally, lymphadenectomy may also be performed at different points in the cancer treatment process. It can be an early diagnostic procedure before the commencement of treatment, or it may be part of a larger operation to remove a tumour.
Furthermore, a lymphadenectomy can also be carried out after the completion of a course of cancer therapy, such as radiation therapy or chemotherapy, to check whether the cancer is fully eradicated.
Types of Cancers That Commonly Necessitate Lymphadenectomy
Certain types of cancers have a higher propensity to spread to the lymph nodes, making lymphadenectomy a standard part of the treatment process. These cancers include, but are not limited to:
- Breast cancer
- Melanoma
- Head and neck cancer
- Thyroid cancer
- Lung cancer
- Stomach cancer
- Colorectal cancer
The determination of whether a lymphadenectomy is necessary is made on a case-by-case basis, taking into account the type and stage of the cancer, the patient’s overall health, and other factors.
Types of Lymphadenectomy
There are several types of lymphadenectomy, each serving a specific purpose and suited to different clinical situations. The main types are regional, radical, and sentinel node biopsy.
Regional Lymphadenectomy
A regional, or “selective,” lymphadenectomy involves the removal of a sample of the lymph nodes local to the tumour. These are the lymph nodes that are most likely to be first affected if the cancer has begun to spread from its original site. This approach enables the surgeon to assess the degree of cancer spread without needing to remove all of the lymph nodes in the region, thus minimizing the potential for complications and side effects.
Radical Lymphadenectomy
A radical lymphadenectomy, also referred to as a “complete” or “total” lymphadenectomy, involves the removal of all the lymph nodes in the region of the tumour. This approach is typically used in situations where cancer has been detected in the lymph nodes during a regional lymphadenectomy, or when there is a high suspicion of lymph node involvement based on other diagnostic tests. A radical lymphadenectomy provides a thorough assessment of the extent of cancer spread within the lymphatic system and can contribute to the elimination of cancerous cells.
Sentinel Node Biopsy
The sentinel node biopsy is a specialized type of lymphadenectomy that involves the removal and examination of the sentinel lymph node or nodes. The sentinel nodes are the first lymph nodes to which cancer cells are likely to spread from a primary tumour. If the sentinel node is free of cancer, it’s likely that the cancer has not spread to other lymph nodes. However, if the sentinel node does contain cancer, your surgeon may proceed with additional lymph node removal to determine the extent of cancer spread. The sentinel node biopsy is less invasive than other types of lymphadenectomy and can help avoid unnecessary removal of lymph nodes in cases where the cancer has not spread.
Lymph Nodes Targeted in Lymphadenectomy
The lymph nodes are located in clusters throughout the body. During a lymphadenectomy, a specific cluster is targeted, depending on the location of the cancer. Certain types of cancer have predictable pathways of spread, and they tend to affect specific lymph node clusters first. Each of these clusters has a name, which is used to identify the type of lymphadenectomy being performed.
Specific Lymph Node Clusters Targeted for Different Types of Cancers
Depending on the type and location of the cancer, different clusters of lymph nodes may be targeted during a lymphadenectomy.
- Axillary Lymphadenectomy: This procedure targets the axillary lymph nodes located in the armpit. It is often performed when dealing with breast cancer or melanoma of the arm, as these are the types of cancer that typically spread to this area first.
- Inguinal Lymphadenectomy: This involves the dissection of the lymph nodes located in the inguinal canal on either side of the groin. Penile and vulvar cancers may spread to these nodes. An inguinofemoral lymphadenectomy goes deeper to also target the femoral lymph nodes in the femoral canal beneath the inguinal canal.
- Cervical Lymphadenectomy: This procedure targets the cervical lymph nodes in the neck. It is typically performed for head, neck, and thyroid cancers. In this context, “cervical” refers to the cervical spine, the top of the spinal cord that runs through the neck, not the cervix, which is a part of the female reproductive system.
- Retroperitoneal Lymphadenectomy: This procedure targets the retroperitoneal lymph nodes located at the back of the abdominal cavity. Testicular and ovarian cancers tend to spread to these nodes.
- Pelvic Lymphadenectomy: This involves the dissection of the pelvic lymph nodes (also called iliac lymph nodes) located in the upper pelvis. Bladder, rectal, and prostate cancers commonly spread to these nodes.
- Mediastinal Lymphadenectomy: This procedure targets the mediastinal lymph nodes located in the centre of the chest cavity. Lung cancer and lymphoma may spread to these nodes. Sometimes, they also spread to the supraclavicular lymph nodes in the collarbone, which may also be included in the procedure.
Pre-Operative Preparations and Evaluations
Before a lymphadenectomy, your specialist will often conduct initial tests to evaluate the lymph nodes. They may use radiological imaging to examine the nodes and look for signs of swelling or abnormality. They may also perform a fine needle biopsy or a core needle biopsy to look for evidence of cancer in one node. If these tests indicate the presence of cancer, a lymphadenectomy is scheduled to investigate further.
Details of the Surgical Procedure
The surgical procedure for lymphadenectomy can be performed through open surgery, laparoscopic surgery, or with robotic assistance.
- Open Surgery: In open surgery, the surgeon makes one larger incision to gain access to the lymph nodes. This traditional approach provides a wide field of view and direct access for the surgeon. However, it often involves longer recovery times and more postoperative pain compared to minimally invasive techniques.
- Laparoscopic Surgery: Laparoscopic surgery is a minimally invasive technique that involves making several small “keyhole” incisions. A camera is inserted through one incision, which gives the surgeon a magnified view of the surgical area on a screen. The surgeon then operates through the other incisions using long, thin instruments. Laparoscopic surgery generally results in less pain, fewer complications, and a quicker recovery compared to open surgery.
- Robotic-Assisted Surgery: Some medical centres may perform a lymphadenectomy with robotic assistance. This involves the use of a surgical system that provides a high-definition, 3D view of the area and allows the surgeon to operate with enhanced precision and control. The surgeon controls the robotic arms from a console, translating their hand movements into smaller, precise movements of tiny instruments inside the patient’s body.
Conclusion
In conclusion, lymphadenectomy is a vital surgical procedure in the diagnosis, treatment, and management of various types of cancers. By removing and examining lymph nodes, doctors can gain valuable insights into the extent of cancer spread when devising an effective treatment plan. The procedure also plays a therapeutic role by directly reducing the number of cancer cells in the body and potentially slowing or halting disease progression.
