dVH/RALH: Upcoming hysterectomy 8/30: Possible removal of lymph nodes

At my pre-op registration this week I learned that my doc wrote "possible removal of lymph nodes" on my paperwork. I'm needing info on this. Why would they need removal? When and under what circumstances would he make the decision to remove them? Does lymph node removal effect recovery?

Thanks sisters!

Is your surgery for cancer or suspected cancer? If so, your doctor may need to sample your lymph nodes to see whether or not the cancer has spread there. Once cancer gets into your lymph system, it's like a super highway to the rest of your body, so this is important to find out.

My surgery was for endometrial cancer. My gyn onc removed a few lymph nodes from my pelvic and abdominal area and had them analyzed while I was still on the table (and blithely unconscious). The samples were prepared for analysis by "frozen section," which is much quicker than the traditional paraffin-embedded samples and thus can be used during surgery.

Since the nodes that had been sampled were clear, my gyn onc didn't need to sample any additional nodes.

After surgery, I also had samples of my uterus and everything else prepared using paraffin, as this produces higher resolution samples. Frozen sections are sort of a quick and dirty way of getting some results while the patient is still on the table to assist in making decisions as to whether or not further sampling needs to be done.

I had a very easy recovery, with minimal pain and no complications from the lymph nodes or anything else. Because I had had lymph nodes removed, I'm now at higher risk of getting lymphedema at some future point. But higher risk doesn't mean it's going to happen. It means higher risk compared to someone who's never had lymph nodes removed. I'm three years out and so far, so good.

Hi Surprised,

My surgery is due to post menopausal bleeding, thickened uterine lining and growing fibroids. I had a uterine biopsy a couple of months ago (yikes that was painful) which was negative for cancer.

During my last office visit when my gyn recommended the hysterectomy, he said I should have the surgery within 6 weeks. He said "I'm not saying you have cancer" and even if you do have cancer, waiting 6 weeks to have the surgery is acceptable.

Apparently, at some point in time he may decide to remove some lymph nodes for pathology. I'm just wondering if he's already decided to do so and put "possible removal " on the paperwork so that he has my permission without having to tell me he suspects uterine cancer until he knows for sure from pathology. Or, if during the surgery he makes the decision to remove lymph nodes and if so, what would be the determining factor that informs his decision.

Is there any way to tell by looking at the uterus that it is cancerous? If so, it would make sense that he would then remove lymph nodes to see if it has metastasized.

Keep in mind that in the early stages, endometrial cancer is contained within the uterus. It wouldn't be visible from looking at the outside of the uterus. However, I think it *might* be visible if the uterus was cut open and the endometrial lining examined by the naked eye. It would certainly be visible if samples of the lining were prepared and examined under a microscope.

The reason I'm saying that about endometrial cancer possibly being visible with the naked eye is that at the time my gyn and I scheduled my D&C/hysteroscopy, she also scheduled a follow-up appointment to discuss the results six weeks later.

However, when I woke up from the procedure, the nurse handed me a slip for an appointment *one* week later. I have to wonder if my gyn saw something while she was in there that told her, yeah, this one is gonna say cancer when the pathology report comes back.

The other concern might be your fibroids. In a very, very small number of cases, presumed fibroids turn out to be uterine sarcoma (a different kind of cancer from endometrial adenocarcinoma). There's no way to tell without removing them and taking samples.

By adding "possible removal" to the paperwork, your doc is keeping his options open so that he can do the best job for you.

Thanks for the info. It has helped me to be more informed.