Lymphatic system

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The treatment of draining cervical lymph nodes is an important part of tumour surgery.

Surgical treatment of lymphatic drainage regions

Lymph is tissue fluid outside the body cells and blood vessels. This fluid is drained and transported through lymphatic system with the lymph nodes acting as filters. Even a minor inflammation will lead to local swelling and accumulation of tissue fluid, causing the affected lymph nodes to enlarge.

However, the lymphatic system may also facilitate the spread of tumour cells. So-called lymphogenous subsidiary tumours (metastases) may develop. Certain malignant neoplasms may even originate directly in the lymph nodes.

If a lymph node enlargement persists for a prolonged period of time (about 3 weeks) without any apparent reason, it should be checked out by a specialist.

Lymph nodes can be measured accurately by ultrasound. Besides clinical examination results we can also use slice imaging modalities, i.e. CT (computed tomography) and MRI (magnetic resonance imaging), for diagnostic purposes. Additional procedures are available to assess the metabolic activity in lymph nodes, e.g. PET (positron emission tomography). These examinations enable us to evaluate the condition of the lymph nodes and ensure reliable monitoring.

If a lymph node swelling persists for a prolonged period of time and all common causes have been excluded, specimens must be collected for assessment. In general, the affected lymph node is entirely removed for this purpose (lymph node extirpation). The specimens are prepared for histological laboratory examination under a microscope by a specialized pathologist to establish a clear diagnosis. Depending on the location and size of the lymph nodes, surgical extirpation is carried out with the patient under sedation or general anaesthesia. The small surgical incision is made in an aesthetically convenient skin fold so that the scars will hardly be visible. These procedures can be performed on an outpatient or short-term inpatient basis.

Oncological lymph node removal

Malignant tumours have the capacity to metastasize. Depending on the tissue of origin, the metastatic spread may occur via the bloodstream (haematogenous spread) or via the lymphatic system (lymphogenous spread). Many types of cancer in the head/neck region metastasize by lymphogenous spread. Consequently, co-treatment of the lymph nodes is an essential part of the cancer therapy. This is why the treatment of the efferent lymph nodes is commonly included in tumour surgery in the head/neck region.

The so-called sentinel lymph node technique, commonly employed in the diagnosis of skin tumours (black skin cancer or melanoma), has not proved useful in the identification of tumours in the head/neck region. Based on our experience, a sentinel lymph node biopsy of the supposed sentinel lymph node in the head/neck region does not provide reliable information to exclude any lymphogenous spread of the tumour. The lymphatic drainage system in the head/neck region is very complex, which means that in many cases there is not one specific sentinel lymph node because lymph node stations are skipped.

The lymph node stations to be included in the treatment depend on the histological analysis of the tissue of origin of the malignant tumour and on the results of the clinical examinations and imaging procedures (e.g. ultrasound, magnetic resonance imaging (MRI), computed tomography (CT) or positron emission tomography (PET)).

It is crucial that an individual treatment regimen is established in consultation with the patient. Our philosophy is to personally provide individual care for our patients right from the very beginning. So you will see the same therapist throughout the entire treatment and oncological follow-up.

We will be happy to arrange a consultation.