Types of surgery

Surgery isn’t often used to treat non-Hodgkin lymphoma (NHL). This is because other treatments such as chemotherapy, targeted drugs or radiotherapy usually work well and are the main treatments.

Why you might have surgery

You might have surgery to:

• remove a lymph node for testing (a lymph node biopsy)
• remove limited disease from an affected organ, such as the stomach or small bowel
• remove the spleen (splenectomy) in a rare type of lymphoma called splenic marginal zone lymphoma

Lymph node biopsy

Your doctor removes part or all of a swollen lymph node under local or general anaesthetic and sends it to the laboratory. A pathologist looks at it under a microscope to see if it contains lymphoma cells.

They can also find out what type of NHL it is by looking at proteins on the surface of the cells and using special chemical stains.

Having the whole lymph node taken out (excision biopsy) is a very small operation. You will have a few stitches and possibly some bruising and stiffness. You usually have your stitches taken out 7 to 10 days after the surgery.

Doctors sometimes use an ultrasound scan or a CT scan to help guide a needle into the lymph node to take a sample of tissue. You usually have this under local anaesthetic.

Removing a tumour (debulking)

If there is a large area of lymphoma in the tummy (abdomen), your surgeon might use surgery to take it out. This is called debulking.

You might have chemotherapy or radiotherapy once you have recovered from the surgery.

Removing the spleen (splenectomy)

If you have a very rare type of lymphoma called splenic marginal zone lymphoma, your doctors might decide to remove your spleen. For other types of lymphoma, your spleen might be taken out if it is swollen and contains lymphoma cells. But this is not very common.

You might also have this type of surgery to diagnose a lymphoma which appears to be only in your spleen.

What happens

You may be able to have the spleen taken out by keyhole surgery. This means the spleen is removed through a small wound using an instrument called a laparoscope. Doctors call this operation a laparoscopic splenectomy.

A laparoscope is a flexible tube with a light and a camera at one end, and an eyepiece at the other. Your surgeon uses specialised surgical instruments through the laparoscope to remove the spleen safely.

You are likely to be in hospital for a shorter time if you have keyhole surgery than if you have open surgery. And you will probably recover more quickly too.

With any keyhole surgery there is a risk of complications. So you might have open surgery after all. Your surgeon explains all this to you when you sign the form agreeing to have the operation.