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Surgery for non Hodgkin lymphoma

Men and women discussing non Hodgkin's lymphoma

This page tells you about surgery for non Hodgkin lymphoma. You can find the following information

 

A quick guide to what's on this page

Surgery for non Hodgkin lymphoma

Surgery is not really used as a treatment for NHL. This is because even the best surgeon is not able to accurately identify all areas of lymphoma and remove them. And because these days chemotherapy usually works well. But you may have an operation to remove a lymph node for testing (biopsy).

For a lymph node biopsy your doctor may remove a whole lymph node while you are under anaesthetic and sends it to the laboratory. This is a very small operation. These days doctors sometimes use ultrasound 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 your spleen

If you have a very rare type of NHL called splenic marginal zone lymphoma, doctors may remove the spleen. But this type of operation is not very common. Occasionally the spleen may also be taken out in other types of NHL. You will be more at risk of infection without a spleen. You will have to take antibiotics for the rest of your life to help stop infection. You should carry a card saying you have no spleen in case of medical emergencies.
 

CR PDF Icon You can view and print the quick guides for all the pages in the treating NHL section.

 

 

Surgery for NHL

Surgery is not really used as a treatment for non Hodgkin lymphoma. This is because non Hodgkin lymphoma can affect the whole body. Doctors call it a systemic disease. So treatments usually need to treat the whole body, such as chemotherapy. Radiotherapy may be used to treat the affected area of the body.

We have included some information about surgery because you may have an operation

  • To make sure of the diagnosis by removing a lymph node for testing (biopsy)
  • To remove limited disease from an affected organ (for example the stomach or small intestine)
  • To remove the spleen (splenectomy) in a rare type of lymphoma called splenic marginal zone lymphoma
  • To remove a testicle if you have testicular lymphoma  ̶  this is called an orchidectomy
 

Lymph node biopsy

This is covered in the section about tests to diagnose non Hodgkin lymphoma. 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 the microscope to see if it contains non Hodgkin 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. The only side effects are a few stitches and possibly some stiffness. You will have your stitches taken out 7 to 10 days after the surgery.

These days doctors sometimes use ultrasound 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.

 

Surgery to remove a tumour

If there is a large tumour mass in the abdomen, your surgeon may take it out during an operation. This is called debulking. You may have chemotherapy or radiotherapy once you have recovered from the surgery. But most patients don't need major surgery before having treatment with chemotherapy or radiotherapy or both. 

 

After surgery

When you wake up after the surgery, you will probably have a few tubes in place. These are

  • An intravenous infusion (drip) to give you liquid
  • Drainage tubes from the wound to help it heal

Your nurse will take your drip out as soon as you can start eating and drinking again. This may take a couple of days. Your doctor will listen to your abdomen with a stethoscope. As soon as the doctor can hear your bowel working again, you will be able to start taking sips of water. Gradually you will work up to eating and drinking normally.

The drainage tubes usually stay in as long as they carry on draining fluid. This is normally a couple of days.

The nurses will help you to get up and gently move around as soon as possible. This helps you to get better and makes complications such as chest infections or blood clots much less likely.

You can usually go home a few days after this type of surgery. You will need to have your stitches out about 2 weeks after your operation. You may go back to the hospital or to your GP's surgery for this.

Your nurse will give you an outpatient appointment before you leave the hospital. You will need to begin any further treatment for non Hodgkin lymphoma as soon as possible after your surgery.

 

Removing the spleen (splenectomy)

If you have a very rare type of lymphoma called splenic marginal zone lymphoma, the doctors may decide to remove the spleen. Although not very common, your spleen may also be taken out in other types of lymphoma if it is swollen and contains lymphoma cells, or to diagnose a lymphoma which appears to only be in the spleen.

You may be able to have the spleen taken out by keyhole surgery. This means the spleen is removed through a small wound using 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. A surgeon trained in this type of operation can use 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 and you may end up having open surgery after all. Your surgeon will explain all this to you when you sign the form agreeing to the operation.

If you have your spleen removed, you will be more at risk of infection afterwards. You will have some vaccinations before your spleen is taken out (or just after). And you will have to take antibiotics for the rest of your life to help stop you getting infections.

You should carry a card saying you have no spleen in case of medical emergencies. Before you go abroad, talk to your doctor. You may need extra vaccinations because you have no spleen.

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Updated: 31 October 2012