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Lymph node removal (lymphadenectomy)

Lymph  node removal is a surgery to remove the lymph nodes in your pelvis. It’s also called a lymphadenectomy or lymph node dissection.

On this page:

What is lymph node removal? 

The lymph nodes are part of the lymphatic system, which you can think of as the body’s drainage system. It’s made up of different tubes and nodes.  

All of our cells are bathed in a fluid called lymph. This fluid drains through the vessels and into the lymph nodes. In the lymph nodes, white blood cells can fight off any infections, bacteria, old cells or cancer cells. 

There are lymph nodes throughout your body, including in your pelvis near your cervix. These lymph nodes are a common place for cervical cancer to spread , because any cancer cells that break away from the cervix can be carried to the lymph nodes. 

A lymph node removal removes all the lymph nodes in your pelvis or stomach (abdomen). It’s quite a big operation. It will be done under general anaesthetic, so you will be asleep. It’s usually done as key hole surgery (laparoscopically) , which speeds up the recovery time and reduces side effects. 

Lymph node removal is usually done as part of another operation to treat cervical cancer. This includes surgery such as hysterectomy or trachelectomy, as well as radiotherapy given with chemotherapy (chemoradiation).

How is lymph node removal used?

If you have stage 1A2 or 1B2 cervical cancer, you may have your lymph nodes removed:

  • as part of surgery called a hysterectomy or a trachelectomy.  
  • before chemoradiation.

It can be difficult to see if there is cancer in your lymph nodes using scans. So sometimes you surgeon will want to remove the lymph nodes to see if there is any cancer in them. If there is, you might be offered chemoradiation to treat any cancer cells that might have travelled elsewhere.

Para-aortic lymph nodes are in your stomach. If your pelvic lymph nodes do not have cancer cells, it is rare for the para-aortic lymph nodes to have them.

If your healthcare team think the cervical cancer may have spread, they may suggest removing the para-aortic lymph nodes.

Cervical cancer in the para-aortic lymph nodes can also be treated with radiotherapy. This involves targeting a larger area of the body with the radiotherapy, so the stomach is treated as well as the pelvis. The treatment is planned in the same way as pelvic radiotherapy, and the effects during and after treatment are similar.

Read about radiotherapy >

A new procedure called sentinel node detection is being looked at in clinical trials as a possible alternative to lymph node removal.

This is where just a few lymph nodes are removed, as research suggests this is just as good at showing whether cancer has spread to the lymph nodes as the bigger operation. Your doctor will let you know if you could take part in a trial and give you more information.

Before lymph node removal

It can help to prepare for lymph node removal physically, emotionally and practically.

Read about preparing for treatment >

At the hospital

You will normally have to stop eating at least 6 hours before the surgery. You can usually keep drinking water until 2 hours before the surgery.

Having a general anaesthetic

You will have a general anaesthetic. This means you will be asleep for the surgery and won’t feel anything. Your healthcare team will check you are fit and well enough to have it.

Some people feel worried about having a general anaesthetic. If you feel this way, you could speak to your healthcare team and anaesthetist before, to find more about what will happen and talk through any concerns.

The anaesthetist will ask you to count to 10 and before you reach 7, you will drift off to sleep. When you wake up, you will be in the recovery room or ward.

During lymph node removal 

Your surgery will usually take between 2 to 4 hours, depending on the type of surgery you have. 

You usually have lymph node removal as part of another surgery:

If you are having the para-aortic lymph nodes removed as a separate surgery before chemoradiation, it will be done in the same way.

Types of lymph node removal

Lymph node removal can be done in different ways. Both types of surgery are as good as each other for removing the lymph nodes.

Your surgeon does the operation through small cuts (key holes) in your abdomen. They will use tools that have a tiny camera attached, so that they can see the inside of your body on a screen.  

In some hospitals, a robot will assist the surgeon. The surgeon is in the same room but sits away from you and controls the robotic arms to perform the surgery. It allows the surgeon to make more controlled and precise movements. The surgeon is still the one doing the surgery. This is sometimes called robotic surgery. 

Recovery after keyhole surgery is usually faster because there is less blood loss. This means your hospital stay may be shorter.

In an abdominal surgery, your surgeon will make an opening either along your bikini line or running down from your belly button. They will remove the lymph nodes through this opening. This is also called open surgery.

After lymph node removal

If you have keyhole surgery, you may only need to stay in hospital for 1 night. If you have abdominal surgery, you might need to stay in hospital for up to 5 days.

The time it takes to recover will depend on whether you have had other treatment as well as lymph node removal.

Read about recovery after treatment >

After your surgery, the lymph nodes that were removed will be sent to laboratory. A specialist called a histopathologist will look at it under a microscope. They will check whether there are cancer cells in the lymph nodes. This helps to decide the stage of the cervical cancer.

Read about staging and grading cervical cancer >

Sentinel lymph node biopsy (SLNB)

Sometimes your surgeon will only have removed a few lymph nodes to check if the cancer has spread. This is called a sentinel lymph node biopsy (SLNB). If the SLNB shows that cancer cells are in the lymph nodes, you may need to have another surgery to remove them all. 

Your follow up will depend on:

  • what other surgery you had alongside lymph node removal 
  • whether you are having chemoradiation afterwards. 

We have more information about follow-up after other treatments on the treatment type page.

Find your treatment >

Risks and side effects of lymph node removal

Lymph node removal can cause side effects. These may only last for a short time after treatment, but might last for weeks, months or years after treatment has finished. It is important to remember that not everyone gets all possible side effects and there are ways to manage any side effects you do get. 

If you had lymph node removal alongside another treatment, you may get side effects from those treatments too. 

Find your treatment >

You can expect to have some pain and discomfort straight away. This is because your wound from surgery is still healing.

Your team will give you some pain medication to help with this. It is important to tell them if the pain gets worse or doesn’t go away, as they will be able to assess the problem and support you.

You might have some swelling in your groin or one or both of your legs, called lymphoedema. Lymphoedema after cervical cancer treatment is known as secondary lymphoedema. This means it has been caused by damage to the lymphatic system – in this case, lymph node removal. 

If your lymphatic system has been damaged by treatment, you are at risk of lymphoedema for life. This means you could develop it at any time.

There are things you can do to reduce your risk, as well as ways to manage lymphoedema if it does develop.

Read about lymphoedema >

Sometimes lymphatic fluid can collect in the pelvis after surgery. This can form a lump called a lymphocyst. Research shows that most lymphocysts form between 2 weeks and 6 months after surgery .

A lymphocyst can cause the tubes that carries urine from the kidney to the bladder (ureters) to become blocked. It can also cause:

  • pain in your pelvis
  • bowel problems
  • infection 
  • blood clots in yours legs or veins in your pelvis.   

It is important to tell your healthcare about any of these symptoms. Lymphocysts can be treated with a tube that is put through the skin of the pelvis. This helps to drain the fluid. In some cases, you may be offered more surgery to get rid of a lymphocysts. 

More information and support about lymph node removal

Any type of surgery for cervical cancer can have a big impact on your physical and emotional wellbeing. Your healthcare team, both at the hospital and at your GP surgery, are there to support you with any questions or worries you have. 

Remember that we are here for you too, whether you are waiting to have surgery, are in recovery, or are years past it. Our trained volunteers can listen and help you understand what’s going on via our free Helpline on 0808 802 8000. 

Check our Helpline opening hours >

 

Sometimes connecting with others who have gone through a similar experience can be helpful. Our online Forum lets our community give and get support. You can read through the messages or post your own – whichever feels most comfortable.

Join our Forum >

 

Thank you to all the experts who checked the accuracy of this information, and the volunteers who shared their personal experience to help us develop it.

References

  • British Gynaecological Cancer Society (2020). Cervical Cancer Guidelines: Recommendations for Practice. Web: www.bgcs.org.uk/wp-content/uploads/2020/05/FINAL-Cx-Ca-Version-for-submission.pdf. Accessed October 2020.
  • Cibula, D. et al (2018). The European Society of Gynaecological Oncology/European Society for Radiotherapy and Oncology/European Society of Pathology guidelines for the management of patients with cervical cancer. Radiotherapy Oncology. 127;3. pp.404-416.
  • Sapienza, LG. et al (2017). Does para-aortic irradiation reduce the risk of distant metastasis in advanced cervical cancer? A systematic review and meta-analysis of randomized clinical trials. Gynecological Oncology. 144;2. pp.312-317.
  • Tam, K. et al (2008). Natural history of pelvic lymphocysts as observed by ultrasonography after bilateral pelvic lymphadenectomy. Ultrasound in Obstetrics and Gynecology. 32;1. pp.87-90.

We write our information based on literature searches and expert review. For more information about the references we used, please contact [email protected]

Read more about how we research and write our information >

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Date last updated: 
03 Nov 2020
Date due for review: 
01 Nov 2023
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