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Function of lymph nodes?

SV
Posts: 56
Joined: Sep 2010

Can anyone explain what is the negative aspect of removing lymph nodes during DaVinci surgery? That is, what is the function of lymph nodes and what happens when some of them are removed? Do we even need them? Is there a safe number to remove? Why don't surgeons just cut them all out while in there?

My surgeon removed a number of lymph nodes which turned out to not have cancer cells and I was wondering what the future side effects will be.

tarhoosier
Posts: 188
Joined: Aug 2006

SV:

The purpose of the lymph system is manifold, and at the same time not fully understood. To address your questions, nodes are removed during cancer surgery (of many kinds) in order to determine if tumor cells have spread. It is common to find tumor cells harbored in the lymph system at the nodes if this spread has occurred. Some nodes are easily accessible during prostate removal though most are not. Your doctor is taking the safe side to remove those he can see or detect in order to make maximum use of his time in your body. Removal of nodes has been shown to reduce the chance of recurrence of cancer in some cases. This is in addition to the information provided from pathological examination of the nodes. Men with highest risk disease often have more nodes removed. Open surgery offers more opportunities for node removal than laparoscopic or robotic. Side effects of this lymphedectomy are not common. For those who have many nodes removed the most common effect is lymphedema, or edema. This is an accumulation of fluids in the lower body which cannot circulate effectively because of the missing nodes. The lymph system can accommodate the removal of a few nodes by re-routing fluids in other directions. More nodes removed raises this risk of edema. You should have no problem in the future because of the surgery. If there is edema then pressure stockings and compression coverings for the legs while sleeping address the problem. there is no "cure" for edema.
Women who have major nodes removed in breast surgery often complain of swelling in the arm or elsewhere for this reason.
You should be pleased you surgeon removed the nodes and that the pathologist confirmed there was no detectable spread of cancer. That was a job well done.

VascodaGama's picture
VascodaGama
Posts: 1592
Joined: Nov 2010

Adding a word to the excellent explanation of Tarhoosier post; the lymphatic system (nodes) works as “filters” to remove waste (dead blood cells), cancer cells and toxins that will be drained from our body through the circulatory system. These will be the first “gate” where metastasized cancer can be found.
Your doctor found no cancer in the dissected nodes, which indicates a good diagnosis.

Take care.
VG

dakotarunner's picture
dakotarunner
Posts: 96
Joined: Feb 2004

The lymph node removal can possibly turn out to be a wee bit of a problem in the future. In my case, I had RP surgery in January of '04. In June of '09 I started to develop some swelling in my left leg, from the groin all the way thu my foot. It did not happen over night, and there was no pain invovlved, I just got a fat leg and foot. At the end of the day, my foot would swell up and look like some of the folks you see ant the nursing home whose feet almost puff out of their shoes.

After a trip to my home town doctor, I was sent back to my doctor at Mayo, where I had gone thru the RP. After rulng out any type of cancer, etc. I was diagnosed as having lymphedema in the left leg, due to removal of lymph nodes during the RP surgery. Comment was that it was strange to see it happen 5 years after the RP, but I figure that is the way the ball bounces as you get older (I am currently 61 yr. young). They were surprised there was no swelling in the right leg (no sweling in the center leg either, damn it). Now (June '11) I am starting to see the same happen with the right leg, but again, that is how the ball bounces. I wear a heavy duty, full length Jobst stocking during the day, and massage and a Reid boot at night. I do not let it interfere with any of my normal physical activies.

The good thing is that this seems to happen to only a samll number of men who have prostate surgery, so hopefully you have no worries.

Keep up the good fight, and enjoy life.

dr

SV
Posts: 56
Joined: Sep 2010

Thanks for the informative replies. Would it be correct to assume that if a significant number of cancer cells had escaped the capsule, or a tumor had formed outside of the prostate, that the first place to be affected would be the lymph nodes? And therefore if there was no cancer detected in the lymph nodes, it's highly unlikely there will be a reoccurrance?

VascodaGama's picture
VascodaGama
Posts: 1592
Joined: Nov 2010

SV

Your rezoning is correct.
The “traveller” cancerous cell first stop is at the lymph nodes servicing the prostate area, then they form colonies (in constant multiplications) which proliferate in the fatty tissue around the prostate shell The ones that infiltrated the “filter” and get a ride in the circulatory system, travel to distant places as far as the pulmonary.
Dr. Myers comments in his book “Beating Prostate Cancer”; “…I have seen prostate cancer in the nodes in the right and left armpits. When we find (positive) lymph nodes in the abdomen or else, but none in the pelvis, we call them ‘skip metastases”. (page 39; Spreading into the lymph nodes)
His book has a detailed description “How Does Prostate Cancer Spread?” (page 35).

Unfortunately there are many lymph nodes in the area but not all of them are dissected. Missing cancer when trying to detect metastases at the nodes is common and that leads to recurrence years after remission. Tests to check for localized micrometastasis or small tumours are also not perfect in revealing its presence.
CT and MRI, are in my opinion not advanced yet for analysis of micro curative cancer. PET and Prostasint are promising image studies if used together for a cross-image study. The latest USPIO-MRI may be the best choice together with the Combidex-MRI.

The challenge is to get your question “…if there was no cancer detected in the lymph nodes…” CORRECT.

Wishing you the best.
VGama

SV
Posts: 56
Joined: Sep 2010

Thanks. How big are the lymph nodes in the prostate bed and how many are there? That is, are they just a bunch of little bumps or are there a specific number of them? Is it possible for lymph nodes to grow back?

VascodaGama's picture
VascodaGama
Posts: 1592
Joined: Nov 2010

Dissection of lymph nodes was controversial at the times of my surgery (2000). There was the idea that without those “filters” to trap cancerous cells in its “nets”, the cancer later would freely metastasize at distant places via the circulatory system.
Still today, there exist nomograms to regulate dissection (or not) of nodes with basis on the PSA level, velocity and biopsy results.

My surgeon commented that; “….nodes (small extended “rugby” shaped-balls) are numerous all-over the body and that they would be “replaced” by lymphoid cells according to system “needs”. With the presence of cancer they are bigger and harder to the touch….”
I heard that in France some doctors do transplant of lymph nodes in breast cancer patients.

The idea is of dissecting the fewer number as it is possible, but I read about cases where surgeons have dissected 14 nodes. Maybe this is the maximum they can reach in a retro-pubic prostatectomy.

Regards.
VGama

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