Cancer of the ovaries, fallopian tubes, or peritoneum (lining of the abdomen) is hard to detect early. By the time it has been diagnosed, cancer cells may have already metastasized (spread to other parts of the body).

Ovarian cancer commonly metastasizes to the lymph nodes. For this reason, people often have their lymph nodes surgically removed when undergoing ovarian cancer treatment. However, this practice is becoming less common as new research shows that removing lymph nodes may sometimes be harmful rather than helpful.

What Are Lymph Nodes?

Lymph nodes are small structures that are part of the lymphatic system. Lymph (extra fluid that is not needed by tissues) flows throughout the body and passes through the lymph nodes. These glands filter out germs, damaged cells, cancer cells, and other harmful substances from the lymphatic fluid. There are about 600 lymph nodes located all around the body.

Lymph Nodes and Ovarian Cancer

Cancer cells can break off from an ovarian tumor and spread into near or more distant lymph nodes. The most common lymph nodes that ovarian cancer spreads to include:

• Abdominal lymph nodes
• Pelvic lymph nodes
• Para-aortic lymph nodes (nodes in the lower back)
• Mediastinal lymph nodes (nodes between the lungs)

There are a few reasons to remove someone’s lymph nodes over the course of their ovarian cancer treatment. One is to determine their ovarian cancer stage (how far cancer cells have spread within the body).

Knowing the stage allows doctors to determine what chemotherapy treatments may work best. Additionally, taking out the lymph nodes may be part of ovarian cancer treatment — it can help ensure that no cancer cells are left behind after surgery.

Staging Ovarian Cancer

Doctors typically use the International Federation of Gynecology and Obstetrics (FIGO) system to stage ovarian cancer. There are three main factors that help determine the cancer stage that a person might fall into:

• Size of tumors — Early-stage tumors may be smaller compared to later-stage tumors, which are capable of spreading into nearby tissue and cells.
• Status of lymph nodes — Cancer in a lymph node indicates the presence of advanced-stage tumors, as those are more likely to have spread through the lymphatic system.
• State of metastasis — Stage 1, stage 2, and stage 3 tumors have not spread to other parts of the body, while stage 4 tumors have.

Surgery is the first treatment that most people with ovarian, fallopian tube, or peritoneal cancer receive. Surgery has two main purposes: removing as much of the cancer as possible and determining the stage of a person’s cancer.

During surgery, doctors will typically perform biopsies (remove samples) of several different types of tissue. This often includes removing multiple lymph nodes in the pelvis and abdomen. The biopsy samples are sent to a laboratory in order to determine whether the tissues contain cancer cells.

The likelihood that cancer has spread to the lymph nodes varies based on the cancer stage. About 13 percent to 20 percent of people with early-stage ovarian cancer have cancer cells in the lymph nodes. On the other hand, over half of people with advanced-stage ovarian cancer have lymph node metastases.

Determining Cancer Treatment Options

Knowing whether cancer cells have spread to the lymph nodes can help doctors recommend treatment plans. This is important for people with early ovarian cancer who might avoid treatment if their lymph nodes were free of cancer cells. But it does not matter as much for people with advanced ovarian cancer as they will likely receive chemotherapy regardless of their lymph node status.

Very early-stage ovarian cancer is sometimes treated with surgery alone. More often, though, a person in the early stages of the disease also receives adjuvant chemotherapy (drug treatments following surgery). Drug options include Paraplatin (carboplatin) and Taxol (paclitaxel), among others. Carboplatin destroys cellular DNA, which stops the cancer from replicating. Paclitaxel also stops cells from reproducing.

The exact treatment someone receives can depend on if cancer cells are found in their lymph nodes, as well as other factors such as the type of ovarian cancer and the person’s overall health.

For people with advanced ovarian cancer, decisions about which cancer therapies to use are not usually based on whether the person has lymph node metastases. (Most people with advanced cancer receive chemotherapy regardless.) Depending on the type of cancer a person has and which gene mutations are found in their cancer cells, they may receive targeted therapy drugs. The main difference between the therapies is that in chemotherapy, healthy cells can be damaged, while those same cells can survive targeted therapy.

Removing Lymph Nodes During Cancer Treatment

Advanced ovarian cancer is often treated by surgically removing as much of the cancer as possible. This is called debulking surgery. During this surgery, doctors may remove several types of tissues and all or part of certain organs.

People with ovarian cancer may undergo several different types of procedures, including a bilateral salpingo-oophorectomy (removal of the ovaries and fallopian tubes) and a hysterectomy (removal of the uterus).

Debulking often includes the removal of some or all of a person’s lymph nodes. (The procedure is called a systematic lymphadenectomy or a lymph node dissection.) Doctors may take out all lymph nodes near a tumor, just in case cancer has spread to them. However, this type of treatment may not be as helpful as previously thought.

Do Lymph Nodes Need To Be Removed?

Removing lymph nodes is thought to be helpful for cancer staging in people who likely are in an early stage of the disease. However, a lymphadenectomy may be harmful as a treatment strategy for people with advanced cancer.

Past research has found that surgically removing a person’s lymph nodes in order to determine their ovarian cancer stage can improve their prognosis (outlook) when they have early ovarian cancer. When this strategy is used to guide treatment decisions, people are less likely to experience a relapse (have the cancer come back), and they often live longer. As a result, in people with smaller tumors that do not appear to have spread, most experts recommend a surgical staging approach. That means they would only remove some of a person’s lymph nodes at a time.

For people with advanced cancer, new research shows that removing all surrounding lymph nodes may not be a good idea as a standard part of treatment. The results of one recent clinical trial showed that lymphadenectomy did not lead to a better prognosis. Additionally, it showed that people who underwent this procedure were not only more likely to stay in the intensive care unit; they had more health problems than their counterparts.

Some of the health problems included:

• Infections
• Blood loss during surgery
• Death within two months of surgery

As a result of this and similar studies, some experts are now less likely to recommend lymphadenectomy. However, doctors may still suggest this procedure in certain cases.

Why Type of Ovarian Cancer Might Matter

Certain types of ovarian cancer are more likely to spread to a person’s lymph nodes. People with high-grade serous carcinoma and low-grade serous carcinoma have a higher chance of developing lymph node metastases. For that reason, doctors may be more likely to remove the lymph nodes to check for cancer in people with these ovarian cancer subtypes.

However, finding cancer cells in the lymph nodes is much less common in people with low-grade endometrioid or mucinous tumors. Those with a low chance of lymph node metastases may not need to have lymph nodes removed.

If you have ovarian cancer, your doctor may suggest removing lymph nodes as a part of ovarian cancer staging or treatment. Ask your doctor about the possible risks and benefits of the procedure. They can help explain whether lymphadenectomy is recommended, based on the stage and type of ovarian cancer you may have.

Talk With Others Who Understand

On MyOvarianCancerTeam, the social network for people with ovarian cancer and their loved ones, more than 3,700 members come together to ask questions, give advice, and share their stories with others who understand life with ovarian cancer.

Has your doctor suggested taking out your lymph nodes? Share your experiences in the comments below, or start a conversation by posting on MyOvarianCancerTeam.