Lymph nodes are bean sized organs that are part of the immune system and are present throughout the body. There are lymph nodes lining all of the big arteries and veins in the abdomen and pelvis. When it spreads, endometrial cancer can spread to the lymph nodes; though this is uncommon in Type I cancers, it is more common in Type II cancers. In order to determine whether lymph nodes are involved with cancer, they must be removed surgically and looked at under the microscope.
This can be done at the time of hysterectomy for endometrial cancer. Gynecologic Oncologists are surgeons who can per-form this type of “staging” surgery for patients with endometrial cancer. Not all patients with endometrial cancer need to have their lymph nodes removed. Patients with grade I cancers that invade less than half of the uterine muscle probably do not have to have their lymph nodes removed because the risk of metastasis to the lymph nodes is very low. For higher risk endometrial cancers, for example Type II cancers, the status of the lymph nodes is very important in making decisions about more treatment after surgery.
If a patient is found to have positive lymph nodes, her doctor may recommend chemotherapy or radiation treatment to prevent future cancer recurrence. While there are some risks associated with removing the lymph nodes in the pelvis, these are fortunately rare. They include increased bleeding at the time of the surgery, risk of damage to the arteries or veins in the pelvis, or damage to nerves that run along with the lymph nodes.
In particular, the genitofemoral nerve can be damaged during removal of pelvic lymph nodes. If this occurs, the woman might have a small numb patch on the front of her thigh; there will be no effect on leg strength or mobility. After a lymph node dissection, a woman may experience swelling in her feet or legs.
This is called lymphedema and is fortunately not very common. There can also be a collection of fluid in the area of the lymph node removal called a “lymphocyst.” These are often asymptomatic but sometimes need to be drained.