Dynamic sentinel lymph node biopsy for penile cancer (DSLNB):
A dynamic sentinel lymph node biopsy helps find the first lymph node that penile cancer may spread to. The doctor checks if this node has cancer cells. If no cancer is found, it’s less likely the cancer has spread, allowing your doctor to avoid unnecessary removal of other lymph nodes.
This test may be done if there’s no obvious sign of cancer spread after a specialist exam or an ultrasound scan. Not every penile cancer patient needs a sentinel lymph node biopsy.
What is Lymph node:
Lymph nodes are small, bean-shaped parts of the lymphatic system, which is a network of tubes and nodes that move a clear fluid called lymph around your body. This system is key in your immune defense, helping to fight infections and destroy old or abnormal cells. Lymph nodes act like filters, trapping bacteria, viruses, and sometimes cancer cells in the lymph fluid.
Why you might have this test:
Sentinel nodes are the first lymph nodes where cancer may spread. There can be more than one. If the sentinel node doesn’t have cancer cells, it’s unlikely the cancer has spread.
Testing the sentinel node helps avoid unnecessary surgery by skipping the removal of all lymph nodes if it’s clear. If the sentinel node does contain cancer cells, further lymph nodes may need to be removed.
This process involves two steps: first, a sentinel node scan to locate the node, and then surgery to remove it.
Sentinel lymph node scan:
A sentinel lymph node scan, also called a lymphoscintigram, is done in the nuclear medicine department. Before the scan, you may apply a numbing cream to your penis. A small amount of radioactive fluid is injected near the cancer, which then drains to the sentinel lymph node(s).
You lie in front of a gamma camera, which detects the radioactive signal from the lymph nodes. Your skin is marked over the lymph node for surgery. Sometimes, if the fluid drains slowly, you may need to return after an hour or two for another scan.
Having your sentinel node biopsy:
During surgery to remove the sentinel lymph nodes, you will typically be under general anesthetic, so you’ll be asleep and won’t feel anything. The surgeon injects blue dye around the tumor site to help locate the sentinel nodes. They then use images from the lymph node scan, skin markings, and a probe to detect the radioactive signal in the sentinel node. A small incision is made to remove the nodes, usually from both sides of the groin. The procedure takes about 45 minutes, and you’ll wake up in recovery before being returned to the ward.
After your sentinel lymph node biopsy:
You will typically go home the day after the surgery. Since you’ve had general anesthesia, you’ll need someone to drive you home and stay with you for 24 hours after the procedure. The blue dye used during the surgery may cause your urine to appear blue or green for a few days, and for some, this might last longer, but it’s harmless. You may also notice that the dye leaves a blue tint on your skin, which can remain visible on your penis for several months.
Looking after your wound:
You will have a small wound (about 3 to 6 cm) in your groin where the surgeon removed the sentinel lymph nodes. There might be a dressing covering the wound, and your nurse or doctor will give you instructions on how to care for it. Wearing loose clothing during the first few weeks can help with comfort. The stitches used in the surgery will dissolve on their own, so no removal is needed.
Possible risks of a sentinel node biopsy:
A sentinel lymph node biopsy is generally safe, but there are potential risks, which your nurse will explain. These include:
– Allergic reaction to the dye: Rare, but your team will monitor and treat you if necessary.
– Pain: You may feel discomfort after the biopsy. Painkillers can help manage this.
– Bleeding: Minor bleeding is common, but heavy bleeding requires immediate medical attention.
– Swelling and bruising: Normal after surgery, but contact the hospital if it worsens.
– Fluid buildup: This may happen under the skin and can usually be treated.
Go to the hospital if pain, redness, or fever occurs.
Getting your results:
It typically takes about two weeks to receive the results of the biopsy, and your doctor will usually go over them with you at your next clinic visit.
Waiting for results can be stressful. If you have contact information for a specialist cancer nurse, feel free to reach out for support or information. Talking with a trusted friend or family member can also help you manage your feelings during this time.
What happens next:
A negative result means no cancer cells are found in the sentinel nodes, suggesting the cancer hasn’t spread to other lymph nodes. Therefore, you won’t need further lymph node removal.
A positive result indicates cancer cells are present in the sentinel nodes, meaning the cancer has begun to spread. Your doctor will discuss additional tests and treatments with you, which may include surgery to remove all the lymph nodes in the affected groin area.