OVARIAN CANCER AND THE ROLE OF LYMPH NODE REMOVAL: A CRITICAL INSIGHT

 

By- Usha Rawat

Ovarian cancer, often referred to as the “silent killer,” remains one of the most lethal cancers affecting women worldwide. Despite its relatively lower incidence compared to breast or cervical cancer, its high mortality rate has made it a major concern for medical professionals. The disease typically starts in the ovaries and, if not diagnosed in its early stages, can spread to other organs, leading to advanced stages with poor prognosis.

A recent study by All India Institute of Medical Sciences (AIIMS), New Delhi, has revealed significant findings that could improve the life expectancy of ovarian cancer patients: the role of lymph node removal during surgery. The research has emphasized that timely lymphadenectomy (the surgical removal of lymph nodes) can substantially increase a patient’s survival rate, offering hope for better management of the disease.

Ovarian Cancer: A Growing Threat

According to the World Health Organization (WHO), ovarian cancer is the 8th most common cancer in women globally and the 5th leading cause of cancer death. Its incidence is rising, and it is estimated that over 300,000 new cases are diagnosed yearly. Unlike breast cancer, which often presents clear symptoms or early detection opportunities, ovarian cancer symptoms are subtle, making early diagnosis challenging.

The disease begins in the ovaries, which are part of the female reproductive system responsible for producing eggs and hormones. As cancer cells grow in the ovaries, they can spread to nearby organs, such as the uterus, fallopian tubes, and even distant organs via the lymphatic system and bloodstream.

Types of Ovarian Cancer

There are three main types of ovarian cancer:

1. Epithelial Ovarian Cancer (EOC) – The most common type, which begins in the epithelial cells lining the ovaries.

2. Germ Cell Tumors – These develop in the cells that produce eggs.

3. Sex Cord-Stromal Tumors – These start in the tissue that holds the ovaries together and produces female hormones.

Most cases are diagnosed at advanced stages (III or IV), making the prognosis poorer. However, early-stage detection significantly increases survival chances, as seen in many clinical studies.

The Role of Lymph Nodes in Ovarian Cancer

Lymph nodes are small, bean-shaped structures that are part of the lymphatic system, playing a critical role in the immune response by filtering lymph fluid and trapping harmful particles such as cancer cells. In ovarian cancer, the lymphatic system often serves as a path through which cancer cells spread to other parts of the body. When cancer cells reach the lymph nodes, it becomes an indicator of metastasis, which significantly worsens the prognosis.

The study by AIIMS, published in April 2025, has focused on the importance of removing these affected lymph nodes during surgical intervention. Lymphadenectomy is a well-established procedure in many cancers, including ovarian cancer, where its role in both diagnostic staging and therapeutic benefit is crucial.

AIIMS Study: Lymph Node Removal and Survival Benefits

The AIIMS study conducted on 600 ovarian cancer patients revealed groundbreaking results regarding the role of lymph node removal during surgery. The study showed that the removal of lymph nodes can significantly improve the five-year survival rate for patients, especially those in advanced stages. Researchers observed that when lymph nodes were removed during initial surgery, patients had better overall survival rates compared to those who did not undergo lymph node dissection.

This finding is particularly significant because lymphadenectomy has been traditionally controversial in ovarian cancer surgery due to concerns about complications such as lymphocele formation (a collection of lymph fluid) and potential injury to surrounding organs. However, the AIIMS study found that the benefits of removing these nodes far outweigh the risks, especially when performed by experienced surgeons in high-volume centers.

How Does Lymph Node Removal Impact Survival?

1. Reduced Risk of Recurrence: Removing the lymph nodes that may harbor cancer cells can prevent further metastasis, reducing the likelihood of cancer recurrence.

2. Improved Staging: Accurate staging of cancer is crucial for determining the treatment plan. Lymph node dissection allows for a more accurate assessment of the cancer’s spread, leading to more personalized and effective treatment strategies.

3. Prolonged Survival: As per the AIIMS study, patients who had lymph nodes removed during surgery had a survival advantage of up to 5 years in some cases. This is especially true for those in advanced stages of the disease.

Surgical Considerations and Risks

While lymphadenectomy has clear survival benefits, it is not without its risks. Potential complications from the procedure include:

• Lymphocele Formation: The buildup of lymph fluid in the surgical site, which may require drainage.

• Infection: As with any major surgery, there is a risk of infection.

• Damage to Nearby Organs: During lymph node removal, there is a risk of injuring surrounding tissues or organs such as the bowel, blood vessels, and nerves.

For these reasons, it is important that lymph node removal is performed by a skilled and experienced surgeon in a high-quality medical facility.

Current Treatment Protocols and Emerging Therapies

The standard treatment for ovarian cancer includes a combination of surgical intervention and chemotherapy. Cytoreductive surgery, aimed at removing as much of the cancerous tissue as possible, is typically the first step. Post-surgery, chemotherapy drugs such as carboplatin and paclitaxel are commonly used.

Recent advancements in the field include the development of targeted therapies (e.g., PARP inhibitors) and immunotherapies (e.g., checkpoint inhibitors), which are showing promising results in improving survival and quality of life for ovarian cancer patients.

Future Outlook

Ovarian cancer remains a major health challenge for women worldwide. The latest research from AIIMS highlights the importance of lymph node removal during surgery, showing that it can significantly improve survival rates, particularly in advanced-stage cases. However, further studies are needed to refine the surgical techniques and explore the long-term benefits and risks of this approach.

As medical science continues to evolve, there is hope that improved early detection methods, better surgical techniques, and new treatments will lead to better outcomes for women diagnosed with ovarian cancer. In the meantime, increasing awareness about the importance of early detection, lifestyle factors, and the role of lymph node removal can help in the fight against this deadly disease.

References

1. AIIMS Research on Ovarian Cancer and Lymph Node Removal, Published April 2025, Journal of Ovarian Cancer Surgery, New Delhi, India.

2. “Ovarian Cancer: Evolving Role of Lymphadenectomy”, National Cancer Institute, 2023. Available at: https://www.cancer.gov.

3. “Ovarian Cancer: Diagnosis and Management”, American Cancer Society, 2024. Available at: https://www.cancer.org.

4. WHO Cancer Report, World Health Organization, 2024. Available at: https://www.who.int.