New research is prompting a reevaluation of the traditional practice of removing lymph nodes during cancer surgery, which has been a cornerstone of treatment for numerous tumour types. This study raises significant questions about the long-term impact of such procedures on the body’s immune system.
Historically, surgeons have excised lymph nodes for two primary reasons: to determine whether cancer has spread and to prevent its further dissemination to other organs. For many years, this method was considered the best standard of care. Lymph nodes serve as biological filters, where cancer cells often travel through lymph vessels before settling. The presence of cancer cells in these nodes is a critical indicator that a patient’s cancer may return after treatment.
Yet, lymph nodes do more than merely filter out harmful cells. They play an integral role in the immune response, acting as hubs where immune cells, particularly the vital CD8 positive T cells, gather and share information to combat cancer. Recent findings suggest that the removal of these nodes may not only impede immediate cancer spread but could also diminish the body’s long-term immune defenses, especially as modern treatments increasingly depend on the patient’s natural immunity.
The study indicates that lymph nodes maintain a special environment essential for the upkeep of CD8 positive T cells, which are crucial for targeting and destroying cancer cells. Without these nodes, the effectiveness of the body’s anti-cancer immune reaction, particularly during immunotherapy treatments, may be compromised. Although these results are compelling, they have yet to be verified in human subjects.
Patients undergoing lymph node removal can experience several adverse effects, including swelling, known as lymphoedema, and an elevated risk of infections in the affected area. There may also be chronic pain or mobility issues. Consequently, there is increasing concern that while lymph node removal may reduce the immediate risks of cancer spread, it could inadvertently weaken the body’s immune response over time.
Despite these concerns, surgeons continue to remove lymph nodes due to the significant risk of metastatic spread in many solid tumours. Lymph node involvement remains one of the strongest predictors of cancer recurrence, and the removal of these nodes provides essential information for determining the most effective post-surgical treatments. For example, in breast cancer cases, doctors often perform a “sentinel node biopsy.” This procedure involves removing only the first lymph node that drains fluid from the tumour, helping to assess cancer spread while minimizing the number of nodes removed, thereby reducing potential side effects.
As medical research progresses, a clearer picture of the role of lymph nodes in chronic illnesses is emerging. They are not just passive structures but active training grounds for immune cells. This is particularly relevant in the context of treatments that enhance the immune system, such as checkpoint blockade treatments, which have been adopted for various cancer types.
The implications of these findings suggest that the removal of lymph nodes does not solely prevent cancer’s spread; it also eliminates critical hubs where the immune system is trained and reactivated to combat disease. Over the past decade, healthcare providers have begun to adopt less invasive surgical techniques, focusing on targeted lymph node removal to minimize disruption and preserve the patient’s immune function. In some instances, patients with early-stage cancers might avoid node removal altogether, opting for imaging and biopsies to monitor disease progression.
Emerging therapies offer hope to patients concerned about the consequences of lymph node removal. Immunotherapy drugs, targeted treatments, and cancer vaccines are being developed to “re-educate” the immune system, even when some lymph nodes have been lost. Still, evidence is mounting that patients fare better when a portion of these immune hubs remains intact, allowing the body to mount an effective defense against any lingering cancer cells.
Looking ahead, cancer surgery could become increasingly personalized. By mapping the activity within lymph nodes, physicians will be able to identify which nodes are essential for immune function and which are most likely to develop new tumours. This approach could enable doctors to tailor surgeries to maximize patient benefits while minimizing harm.
The latest research challenges medical professionals to carefully consider each surgical decision, weighing immediate actions against the long-term implications for patient immunity. While lymph node removal remains a critical aspect of cancer treatment for many, the evolving understanding of their role in immune protection suggests a need for a more nuanced approach in the future.
