What is a groin dissection?
The aim of a groin dissection is to remove the lymph nodes.
This is undertaken when the cancer cells have travelled from the original skin cancer site and settled in the lymph nodes in your groin.
What are lymph nodes?
Lymph nodes are present throughout your body. The largest numbers of lymph nodes are found in your neck, armpits and groin and are connected by lymph vessels. You may have felt swollen lymph nodes when you have had an infection such as a simple cold. As well as trapping infection, the lymph nodes can also trap cancer cells.
Have I got cancer in my lymph nodes?
When a lump is detected the first step is to have a sample taken. This is called an ultrasound core biopsy and is performed in the Radiology (X-ray) department. Once the sample has been taken, it is sent to the laboratory to be looked at under a microscope. Your doctor will also want you to have CT scans prior to surgery.
When will my groin dissection be carried out?
A groin dissection is carried out once all the test results are available. You will be admitted to hospital early on the morning of your surgery. You will be in hospital for about 2-3 days.
Pre-Assessment
The pre-operative assessment involves answering questions.
You may also have a physical examination and/or some medical tests. You will also receive a lot of information about your surgical pathway.
While the pre-assessment staff already have your background information, they will ask questions to help pick up any significant changes in your health or medication.
The medical tests may include blood pressure checks, blood tests to check your organs, ECG (a tracing of your heart) and skin swabs.
Sometimes, the assessment reveals a problem, such as a urinary tract infection (UTI) or high blood pressure, that needs treating before surgery. Should that be the case, your operation is likely to be deferred until the problem has been resolved.
Pre-assessment staff will liaise with you and your GP as to the best way of sorting out the issue.
What does the surgery involve?
The operation, which takes about 2-3 hours, is performed under general anaesthetic. All the nodes in the area and some tissue are removed leaving you with a scar across your groin and extending for a short way down the inside of your leg.
What can I expect after the operation?
At the end of the operation, one or two small plastic tubes are placed through the skin to drain any fluid that may collect inside the wound. The other ends are connected to bags with small openings at the bottom. Some discomfort is to be expected and is usually worse for the first few days, although it may take a couple of weeks to disappear completely. If required, you will be given regular painkillers.
On the day after surgery, you will be encouraged to gently walk around the ward. You may also need to see the physiotherapist for an exercise programme.
You will be discharged home with the drain once you have been taught how to look after it, and are happy to do so.
You will be able to contact your Skin Cancer Nurse, during the working week, who will arrange a clinic appointment to remove the drain when appropriate. The drain(s) can remain in for 8-10 weeks if needed. It will be removed once the fluid draining is reduced.
What are the possible complications immediately after surgery?
There are potential problems with any operation. With this type of surgery, complications are rare but you may experience some of the following:
- Numbness of the skin surrounding the groin
- Bleeding
- Collection of fluid around the wound
- Infection
- Wound break down
- Swelling of the leg
If any of these complications occur, please contact your Skin Cancer Clinical Nurse Specialist who will be able to advise
you if any treatment is necessary.
What are the possible long-term complications after surgery?
- A visible scar and hollowing of your groin
- Numbness of the skin around the operation site
- Swelling of the leg (lymphoedema)
Lymphoedema
Another risk after surgery is swelling in your leg, called lymphoedema. This happens when your lymphatic system is not doing its job properly. Your lymphatic system is made up of a network of small vessels and groups of lymph nodes which are located throughout the body. As the lymph fluid flows through the nodes, it should collect and filter out unwanted waste products such as bacteria or cancer cells.
Signs of lymphoedema
Lymphoedema can affect you in a variety of ways. If you notice any of the symptoms below, speak to your Skin Cancer Nurse or GP.
- Swelling
- Heaviness of your leg
- Tightness and stretching of the skin
- Reduced movement of the joints
- Thickening and dryness of the skin
- Discomfort or pins and needles sensation
Can you prevent lymphoedema?
While it is not known exactly what causes lymphoedema an infection or injury to the affected limb may slightly increase your risk of developing lymphoedema.
Therefore looking after your skin is vital:
- Clean even small cuts and grazes straight away. If there appears to be any sign of infection see your GP straight away.
- Use a moisturiser daily to keep your skin soft and supple.
- Take care when cutting nails to avoid breaking the skin.
- Avoid hot baths and saunas – these may increase swelling.
- Avoid sunburn by using a SPF30 sunscreen or above and wear loose fitting clothing.
- Avoid cuts when shaving and use an electric razor.
What to expect after you go home
At first you will feel rather tired and should spend the first week or so taking it easy. You will be able to work up slowly to your usual activities.
You will be able to start driving once you feel safe to do so. For most people this will take a few weeks. Do not drive if you are feeling unwell, are not fully alert or able to take emergency action when required, and it is advisable to check with your insurance company before driving again.
You will be able to start work again once you feel able. If your job involves a lot of lifting or heavy work, this will take longer. You should also ask your GP for a fit note for work.
Following surgery, you will be referred to your local oncology hospital to discuss drug options.
Exercise
- Avoid gaining weight and try to lose some if you are already overweight as this may place extra pressure on the lymphatic system.
- Avoid strenuous exercise. Heavy lifting and carrying heavy objects should be avoided.
- Gentle exercise is advisable but avoid excessive weight lifting. Walking or swimming will keep your joints supple and is important for lymph drainage.
- During long journeys you should try some gentle exercise.
References and further Information
Lymphoedema Support Network
www.lymphoedema.org/lsn
Tel: 0207 3514480
NGS Macmillan Wellbeing Centre, Southmead Hospital, Bristol BS10 5NB
Southmead Hospital has a drop-in centre offering a variety of activities/services. For more information telephone 0117 414 7051 or ask your Skin Cancer CNS.
Skin Cancer Research Fund (SCaRF)
Based at Southmead Hospital
Telephone: 0117 414 8755
www.skin-cancer-research-fund.org.uk
Macmillan Cancer Support
Europe’s leading cancer information charity with over 4,500 pages of up-to-date cancer information, practical advice and support for cancer patients, their families and carers.
Telephone: 0808 800 1234
http://www.macmillan.org.uk
CancerHelp
CancerHelp UK is a free information service about cancer and cancer care for people with cancer and their families. Cancerhelp believes that information about cancer should be freely available to all and written in a way that people can easily understand.
www.cancerhelp.org.uk
NHS Constitution: Information on your rights and responsibilities
www.nhs.uk/aboutnhs/constitution
How to contact us:
Specialist Nurse Team:
Lynda Knowles
Joanne Watson
Claire Lanfear
Samantha Wells
NGS Macmillan Wellbeing Centre
Southmead Hospital
Westbury-on-trym
Bristol
BS10 5NB
0117 414 7415
SkinCancerCNS@nbt.nhs.uk
If you or the individual you are caring for need support reading this leaflet please ask a member of staff for advice.
© North Bristol NHS Trust. This edition published October 2020. Review due October 2022. NBT002430