What Does “Radical” Mean in Cancer Surgery?

“Radical” is referring to cancer operations where the entire “packet” of lymph nodes is removed in addition to removing the organ with the cancer. Doing this stops the spread of cancer and allows the cancer doctor to stage the cancer with as much information as possible which guides treatment after surgery.

So what do lymph nodes do and where are they in my body?

Lymph nodes are small light pink/tan pea to lima bean structures that are basically the drain catches of the body. Small thin pipes lead into them and out of them. When healthy the pipes leading into them have protein and old cells from the body. When the body is fighting an infection, the lymph nodes will have bacteria or viruses and cells that are working on your behalf to rid the infection. If there is cancer, it will grab and confine cancer cells. Pipes leading out of the lymph nodes have “cleaner” fluids because the drain catch has trapped the bad stuff to keep it from going into the rest of the body. 

There are lymph nodes dispersed throughout the body, but there are a few specific “basins” where lots of them are located and connected to each other like a bunch of grapes. These include the armpit (axilla), groin, middle chest, middle abdomen, and the neck. Each one of these acts of the drain trap for that part of the body- arm, leg, lungs/heart, abdominal organs, and head. 

Why are they important to remove in some but not all cancers?

Not all cancers spread by the lymph nodes. Instead they spread by invading whatever is close to them, or they spread via the bloodstream. We sometimes test the lymph nodes by taking a few but not all to confirm that there is or is not cancer there. We can do this because only a few lymph nodes in the entire bunch of grapes drain the cancer before the other lymph nodes are exposed. I call these the gate-keeper lymph nodes. We call this a lymph node biopsy but we are taking the entire lymph node, not just a little piece. If there is a cancer that spreads via the lymph nodes, and there is evidence that it is in the lymph nodes or significant concern that it is, then the surgeon takes the entire lymph node basin (the entire bunch of grapes) to prevent spread of cancer to the rest of the body. When this is done at the same time the cancerous organ is also taken, the name of the operation includes “radical” in it.  

• Radical hysterectomy = taking the uterus and the pelvic lymph nodes

• Radical mastectomy = taking the entire breast and all of the underarm lymph nodes

• Radical prostatectomy = taking the prostate and all of the pelvic lymph nodes

These are big operations and can lead to long-term swelling in the parts of the body where the nodes were taken. Leg swelling and arm swelling are the most obvious and can affect daily activities of the patient. I am a big advocate for starting lymph massage before surgery when possible, but definitely afterwards, even if there is no apparent swelling. There are therapists who specialize in this, and to some degree patients can also perform this on themselves. Ask your surgeon about getting this lined up before surgery.

Check out my other blogs to learn how to get yourself as ready as possible for lymph node surgery and have the most successful outcomes.