Lymph Node Dissection

More than 8,000 men are diagnosed with testicular cancer each year in the United States. If this type of cancer is relegated to the testicles, the only treatment needed may be removal of the affected testicle. However, if it’s suspected that testicular cancer has spread, lymph node dissection may be necessary, or suggested as a preventative step.

The specific lymph nodes being removed will determine which procedure is performed.

Inguinal lymph nodes are tissues located in the groin. As part of the lymphatic system, all lymph nodes perform many important tasks, such as regulating the immune system. Lymph fluid from the cancerous testicle(s) sometimes transports cancerous cells to the nearby inguinal lymph nodes. If it’s believed that this has occurred, inguinal lymph node dissection (ILND) may be recommended. It might also be done to reduce the risk of recurrence.

Performed under general anesthesia, ILND is done through small cuts in the groin when less-invasive techniques are used. The tissues likely to be affected are removed. This may include superficial or deeper nodes. A skin flap is placed over the surgical site and a drainage bag is usually inserted and left in place for a few weeks. The removed tissues are tested to look for cancer cells.

A related procedure is a radical inguinal orchiectomy. During this type of operation, blood and lymph vessels are surgically tied off via an incision through the spermatic cord that connects the testicles to the abdomen. This is a common treatment for all types of testicular cancer.

Found between the kidneys behind abdominal organs along the vena cava vein and part of the aorta, retroperitoneal lymph nodes are usually the tissues where testicular cancer first spreads to if it goes beyond the testicles. As is the case with ILND, retroperitoneal lymph node dissection (RPLND) is usually recommended to keep testicular cancer from spreading or to minimize the risk of recurrence.

During a retroperitoneal lymph node dissection, a large incision is made in the middle of the abdomen to reach these tissues. A less-invasive laparoscopic version of this procedure uses smaller incisions and a lighted scope to remove the lymph nodes in the same area.

Since cancer that has spread beyond the testicles can affect tissues other than lymph nodes, chemotherapy and/or radiation therapy may be recommended as a follow-up to inguinal or retroperitoneal lymph node dissection. Involving oral or IV medication or intense beams of energy, both of these treatments kill cancer cells. Chemo and radiation therapy may also be recommended if cancer cells are found in the removed lymph nodes.

Lymph node dissection and other treatments for testicular cancer sometimes affect sperm production. Men wishing to be able to reproduce post-surgery are often advised to preserve a sperm sample prior to surgery. It’s usually best to take this step prior to the removal of the affected testicle prior to lymph dissection.

When lymph nodes need to be removed, it’s typically suggested that patients continue to be examined for further signs of cancer with periodic testing. Since testicular cancer often responds well to treatment in the early stages, it’s a good idea for men at risk for developing the disease to get in the habit of performing self-exams, which can be done while showering. Any suspicious abnormalities or lumps should be reason to see a urologist.