Enlarged Lymph Glands Surgery

What are lymph glands?

Lymph glands, also known as lymph nodes, are small, oval-shaped organs located throughout your body.They carry lymph fluid, nutrients and waste materials between your body’s tissues and the bloodstream.Lymph nodes are regional and each group corresponds to a particular region in your body and reflects abnormalities in that region. Lymph glands are not usually visible or palpable.

Lymph glands form part of your body’s immune system. Lymph glands enable your body to recognise and fight infections. Lymph nodes filter lymph fluid as it flows through and trap bacteria, viruses and foreign substances. By containing white blood cells, these pathogens are destroyed by the white blood cells, thus helping the body to defend against diseases.

What are enlarged lymph glands?

Lymph glands only get enlarged or swollen in response to an infection in your body, and usually go down when you recover. However, sometimes they may be caused by more serious problems and need to be checked by your doctor.

These glands may swell up to more than a few centimetres as a response to infection or disease. They are commonly felt under the chin or in the neck, underarms or groin area where they are found in larger groups.

What causes enlarged lymph glands?

Enlarged lymph glands are caused by a viral infection such as the common cold in most cases.

Other common causes of enlarged or swollen lymph glands may include:

  • Tonsilitis
  • A throat infection
  • A ear infection
  • A dental abscess which is an infection
  • Cellulitis which is a skin infection

Less common causes include:

  • Mononucleosis which is a viral infection transmitted through saliva
  • Sexually transmitted disease such as HIV or syphilis
  • Tuberculosis
  • Lupus, where the immune system attacks the skin, joints, blood cells and organs
  • Rheumatoid arthritis, where the immune system attacks the tissues that line the joints

Enlarged lymph glands may also be caused by cancer. The uncontrolled division of lymphocytes in lymphoma or leukaemia results in masses of cells that form a malignant tumour.

How do I know if I have enlarged lymph glands?
Common symptoms include:

  • Swelling in the lymph nodes that is pea-sized or kidney-sized or is even larger
  • Pain and/or tenderness in the lymph nodes
  • Redness or streaking of the skin
  • Symptoms of an upper respiratory infection such as a sore throat, runny nose or fever
  • General swelling of lymph nodes all over the body which may indicate infection, inflammation or cancer

Do take note especially if the enlarged lymph glands do not shrink in a few weeks or gradually get bigger, do not cause pain, are firm or hard to the touch or occur along with other symptoms such as a fever, night sweats and unintentional weight loss. Lymph nodes in these cases are more likely to be caused by cancer.

How is enlarged lymph glands diagnosed?

Your doctor will perform a physical examination to check the size, tenderness, warmth and texture of the lymph nodes close to the surface of your skin. He or she will ask you the symptoms that you are experiencing. The location of the enlarged lymph node and your symptoms will help your doctor find out the underlying cause of the enlarged lymph nodes.

You may be scheduled for further tests such as:

  • Blood tests, in particular, a complete blood count (CBC). This is to test for infections and leukaemia and help your doctor determine and rule out the underlying cause of your swollen lymph glands
  • Diagnostic imaging tests such as an X-ray or CT scan. These find tumours and determine the source of infection
  • Lymph node biopsy, where a tissue sample of your lymph node is taken and sent to the laboratory for testing.

Why surgery for enlarged lymph nodes?

Surgery for enlarged lymph node in the form of a lymph node biopsy enables your doctor to find out the underlying cause and tailor the appropriate treatment for your condition.

Should an abscess (infection) be present, the collection of pus may be drained by cutting open your skin,draining the infected fluids and packing the wound. This clears your infection.

For enlarged lymph glands caused by cancer or malignancy, surgical treatment to remove the entire lymph node may be done as part of a larger surgery for cancer removal. This will be accompanied by chemotherapy or radiotherapy to shrink the cancer cells and stop the growth of cancer.

What is enlarged lymph glands surgery?

Surgery for enlarged lymph glands is lymph node biopsy. It is a simple outpatient procedure where your surgeon can take a sample from your lymph node or remove your entire lymph node. After the lymph node is removed, it may be tested if you have infection, cancer or other medical concerns. The results of the tests can aid your surgeon to decide if you need further tests or suitable treatments.

There are three main types of surgery for enlarged lymph glands, needle biopsy, open biopsy and sentinel biopsy. (refer to ‘what to expect during the procedure’)

Why surgery for enlarged lymph glands?

Enlarged lymph glands that do not return to normal size on their own are a cause for concern.

The results of the biopsy will help your surgeon find the exact cause of the swelling and enable him to decide on further tests and treatments. Normal test results on the lymph node removed mean that surrounding lymph nodes are probably normal as well. Abnormal test results, meanwhile, may indicate infection, inflammation, HIV or cancer. Many cancers are linked to swollen lymph nodes which makes it especially crucial for a biopsy to be carried out to test for signs of cancer. Lymph node removal for cancer removes the cancer completely and prevents the cancer from spreading to nearby lymph nodes.

What to expect?

Before the procedure

  • You may be asked to stop blood thinning medications or aspirin 5 to 7 days before the procedure.
  • You may be given contrast liquid should you be required to undergo an MRI.
  • Fast as instructed.

During the procedure

In needle biopsy:

  • Your surgeon will clean the biopsy site.
  • Anaesthesia is applied to numb the affected area.
  • A tiny needle is inserted into your lymph node and a small sample of cells is taken.
  • The needle is then removed.
  • A bandaged is used to cover the site of biopsy.
  • This procedure takes 10 to 15 minutes.

In open biopsy:

  • Your surgeon will remove either a portion of your lymph node or the entire lymph node.
  • Local anaesthesia may be applied to numb the affected area, or you may request general anaesthesia to help you fall asleep during the procedure.
  • Your doctor will make a small cut.
  • The lymph node is removed.
  • The biopsy site is stitched and a bandage used to cover the affected area.
  • The procedure takes 30 to 45 minutes.
  • This is usually preferred over needle biopsy as the results yield are more helpful.

Sentinel biopsy is performed for those with cancer to see if your cancer is likely to spread.

  • A blue dye or tracer is injected near the cancer site.
  • This liquid will move to the nearest lymph node, called the sentinel node.
  • Your surgeon will remove this lymph node and possibly two other lymph nodes to test if they are cancerous.

After the procedure

  • The nurses will keep watch on you till you are fully awake and your pain is under control.
  • You may experience bruising and swelling at the biopsy site.
  • You may be discharged on the day of the procedure.
  • Keep the biopsy site clean and dry at all times.
  • You may resume most daily activities one day after your surgery.
  • You will likely be able to return to heavy exercise after a week.
  • Do schedule a follow up appointment with your doctor within the next one to two weeks.