Lymph node biopsy

You might have a lymph node biopsy to find out if your cancer has spread from the skin to the lymph nodes.

This is more likely to happen if you have a squamous cell skin cancer rather than a basal cell skin cancer. But it would still be unusual.

What is a lymph node?

A lymph node is part of the lymphatic system. This is a network of thin tubes (vessels) and nodes that carry a clear fluid called lymph around the body. This is an important part of the immune system. It plays a role in fighting infection and destroying old or abnormal cells.

The nodes are bean shaped structures that filter the lymph fluid and trap bacteria and viruses, and cancer cells.

You might need a biopsy because your doctor felt swollen (enlarged) lymph nodes when they were examining you. Or you might have had a scan that has shown that some lymph nodes look abnormal. This could be a sign that cancer has spread. 

Types of lymph node biopsies

Fine needle aspiration (FNA)

Your doctor takes out a sample of cells using a needle and syringe. You might have an ultrasound scan to help guide the needle. 

In the laboratory, a specialist (pathologist) looks at the cells under a microscope. 

Whole lymph node biopsy

Your doctor takes out the whole lymph node. This is also called an excision biopsy. You may have this if the FNA did not show up any cancer cells but your doctor still suspects there may be cancer there.

You might have a local anaesthetic to numb the area before they take the biopsy. Or you might have the biopsy under general anaesthetic, which means you are asleep. It is a small operation that most people have as a day case. 

Your doctor makes a small cut above the swollen lymph node and removes it. They then send it to the laboratory for testing.

There are many lymph nodes throughout your body. So removing 1 or 2 doesn't usually cause any problems.

What happens

Before your biopsy

You’ll get an appointment letter explaining how to prepare for your biopsy.

Take your medicines as normal unless you're told otherwise. If you're taking medicines to thin your blood, your doctor might ask you to stop them beforehand.

You meet with your doctor and sign a consent form before you have the test. This is a good time to ask them any questions.

If you’re having a general anaesthetic, you have to stop eating and drinking for a certain amount of time beforehand. You also need a friend or relative to take you home and stay with you overnight.

During your biopsy

You change into a hospital gown and lie on a couch.

Your doctor first cleans your skin on and around the lymph nodes. They then inject medicine to numb the area (if you're not having a general anaesthetic). The medicine can sting a little as it goes in.

Once the area is numb your doctor then finds the lymph node to take the biopsy from. They may be able to feel the swollen lymph node or they can find it using an ultrasound scan. They then put a fine needle through your skin and pull back some cells and fluid into a syringe. Or they make a cut and remove the whole lymph node. They close the cut with a few stitches.  

After your biopsy

Your doctor covers the biopsy site with a small dressing. Ask your doctor how best to look after this for the next few days. You should be able to go home the same day as your biopsy.

Check with your doctor if they have used dissolvable stitches or not. For non dissolvable stitches book an appointment with your GP surgery for the practice nurse to take out. Your doctor will tell you when is best to do this. 

Possible risks

A lymph node biopsy is a safe procedure but your doctor or nurse will tell you who to contact if you have any problems after your test. Your doctors make sure the benefits of having a lymph node biopsy outweigh any possible risks.

Pain

You might have some mild pain or discomfort around the site. Taking a painkiller such as paracetamol can help.

Bleeding

There is a small risk of bleeding. Your doctor can normally control this by pressing on the area. If there is a lot of blood from the biopsy site, let your doctor know straight away or go to your nearest accident and emergency department (A&E).

Infection

Contact your GP or the hospital if you have a high temperature or feel unwell. Or if there is redness, swelling or fluid (discharge) at the biopsy site.

Getting your results

You should get your results within 1 or 2 weeks at a follow up appointment. 

Waiting for test results can be a very worrying time. You might have contact details for a specialist nurse who you can contact for information if you need to. It can help to talk to a close friend or relative about how you feel.

You can also contact the Cancer Research UK nurses on freephone 0808 800 4040 for information and support. The lines are open from 9am to 5pm, Monday to Friday.

Contact the doctor who arranged the test if you haven’t heard anything after a couple of weeks.