Penile Cancer

Lymph node removal

Lymph nodes (sometimes called ‘lymph glands’) are small oval shaped organs that form part of a network, called the ‘lymphatic system’, for moving fluid around the body. The lymph nodes are important for keeping the body healthy and because they take in fluid from around them, they are likely to pick up any cells that break away from a nearby cancer. In such cases, the lymph nodes will swell and become enlarged. The lymph nodes near the penis are in the groin and inside the stomach or ‘abdomen’. In the groin, there are sets of lymph nodes on both the left and right sides. When swollen, the lymph nodes in the groin will feel like little lumps that usually have a rubbery texture. Swollen glands inside the abdomen can’t be felt by touch and can only be examined with the aid of a scanner.
If there is evidence of the cancer spreading to the glands in the groin, then the treatment often involves removal of the surrounding lymph nodes. This may involve removing the lymph nodes in the left or right of the groin, or on both. Occasionally, surgery is also performed to remove the lymph nodes within the abdomen. The procedure for removing the lymph nodes can be undertaken before, during or after the treatment of the primary cancer of the penis although it is usually undertaken afterwards.
Sometimes the lymph nodes are removed as a precaution without any swelling of the glands being apparent. This is because it is possible for small amounts of cancer to spread to the lymph nodes without them becoming enlarged.
 
 
Also, in some cases a sample lymph node is taken to test whether a small amount of cancer is present within it. This procedure is called a “sentinel node biopsy” and follows injection of a radioactive substance into the tumour. This procedure is a smaller operation since it only involves removal of one or two glands. If the gland removed is found to have cancer within it then another operation to remove of all the glands in the groin is usually necessary.
When surgery is performed, it is usually undertaken under general anaesthesia. The operation can take up to 3 hours, depending upon whether the surgery is to one or both sides of the groin, and whether it is necessary to remove glands from inside the abdomen.
The men we interviewed usually found that they had a problem with their lymph nodes because they, their partner or health professional felt a lump in the groin. After identifying the lump, the men would have the part of the body checked by a CT or ultra-sound scan, which are different ways of looking inside the body. For some scans, the man would have a dye injected, which occasionally helps to show the lymph nodes better.
 
At initial diagnosis and treatment of the penile cancer, it can sometimes be difficult to be sure whether or not the lymph nodes are affected, which means that they may require more than one operation. This is because there is often some infection in the cancer on the penis, and infection can also cause the glands in the groin to be enlarged. Only after the cancer has been removed from the penis will the infection settle. If the swollen lymph nodes get smaller after surgery to the penis, it may be possible to avoid surgery to the glands in the groin.
In the men we interviewed, the number of lymph nodes removed varied. Some had a single lump removed. Others had a large number of nodes removed from one or both sides of the groin.  The first sign of John’s (Interview 5) penile cancer had been a lump in his groin and his doctors did a series of tests and procedures before finding the primary source of the cancer' a red patch under his foreskin. He had an operation to remove some of the lymph nodes in his groin but he resisted having surgery on his penis, choosing radiotherapy instead (see Additional treatments).
 
Removal of the lymph nodes can sometimes cause problems in how the lymphatic system moves fluid around the body, which means that this fluid builds up in the area treated. This swelling is called ‘lymphoedema’ (see ‘Lymphoedema and the impact of lymph node removal). For men who have had the lymph nodes in the groin removed, the swelling usually affects the penis and scrotum or the ankles and legs.

For information about swollen lymph nodes (also called ‘lymph glands’), see' www.patient.co.uk/health/Lymph-Glands-Swollen

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