Penile Cancer

Lymphoedema and the impact of lymph node removal

Men who have had treatment for penile cancer may have some, or all, of the lymph nodes (or glands) in their groin removed if there is evidence that the cancer has spread (see ‘Lymph node removal’). Lymph nodes form part of the body’s immune system and play an important role in fighting infection and illness.
 
When lymph nodes are surgically removed, or damaged by radiotherapy, the lymphatic system can struggle to drain lymphatic fluid. This can create a build-up of this fluid, which leads to swelling. In patients with cancer of the penis, swelling usually affects the ankles, legs or scrotum. This condition is known as ‘lymphoedema’ and commonly results in discomfort and pain which makes it difficult to move about. Not everyone whose lymph nodes are removed or damaged by treatment will experience lymphoedema. In addition, with time, as the body adapts to removal of the lymph nodes, the swelling often reduces. While David is still waiting for things to settle after having his lymph nodes removed, he doesn’t feel that it has affected his life.
 
The men we spoke to reported a range of experiences relating to the removal of their lymph nodes. One of the most common experiences they talked about was the build up of lymphatic fluid under the wound in the groin and the need to have fluid drained away. A number of men expressed surprise at the amount of lymphatic fluid that was drained from their bodies. For instance Benjamin, said that 400 millilitres per day was drained off while he was in hospital and in subsequent outpatient appointments a nurse drained off about a litre per week.
 
Some men reported that lymph node removal and lymphoedema had a profound impact on their mobility and social activities. One man talked about the leakage from the drains to which he was attached not long after surgery. This leakage was a source of embarrassment to him as it resulted in wet patches on his trousers, meaning he was reluctant to leave the house. Another man reported having to walk with a stick because his lymphoedema caused him to become unsteady on his feet.
 
Removal or damage of the lymph nodes makes infection more common and can place stress upon a weakened lymphatic system. In order to tackle infection, the body will produce more lymphatic fluid, increasing the risk of lymphoedema. In describing such an infection, one man talks about swelling and a red discolouration of the skin, soreness and heat in the leg. Another man talked about his wound not healing and swelling up ‘like a football’.
For some men the lymphoedema may clear up after a while, whereas for others it may be a permanent problem that they have to learn to live with and manage as best they can. There are things that can be done to help reduce the swelling and discomfort of lymphoedema, which a lymphoedema specialist can advise on.
Lymphoedema is a swelling that can be caused by many different conditions, not just penile cancer. While the cancer will be managed by a specialist penile cancer centre, lymphoedema can be managed by specialists who work in other hospitals. If a man has to travel far for his penile cancer centre or has difficulty moving about, he may be able to see a lymphoedema specialist closer to home. The most common method of treating the lymphoedema is the use of compression stockings.



Last reviewed January 2015.
 
 

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