Hospitals Not Testing Enough Lymph Nodes

Despite the fact that removing and testing at least 12 nearby lymph nodes during colorectal cancer surgery improves accurate staging and survival, most US hospitals are not reaching that goal.

In a recent study of nearly 1,300 hospitals, only 38 percent tested at least 12 nodes in 75 percent of colorectal cancer surgeries performed in 2004 and 2005.

Testing improved from 1996-97 when only 15 percent of hospitals met the 12-node measure.  However, during that time, compliance actually went down in 310 hospitals.  980 hospitals improved, and 6 did not change.

The type of hospital influenced compliance rates with the following percentages meeting the goal after scientists adjusted for differences in cancer patients treated:

  • 78.1 percent of National Cancer Institute-designated Comprehensive Cancer Centers
  • 52.4 percent of other academic hospitals
  • 53.1 percent of Veterans Administration hospitals
  • 33.7 percent of community hospitals.

Karl Y. Bilimoria and his surgical colleagues concluded,

This study provides a national report card of nearly 1300 hospitals showing that more than 60% of institutions failed to achieve a compliance benchmark for the 12-node measure. Considerable improvement is needed in colon cancer nodal evaluation in the United States.

SOURCE: Bilimoria et al, Journal of the National Cancer Institute, advance access published online September 9, 2008.

Another article about the study is available from Reuters.


  1. Kate Murphy says


    There are lymph nodes nearby all along the colon and rectum that are part of the immune system. Lymph fluid drains from the colon and passes through these nodes.

    Lymph vessels and nodes are located throughout the body to respond to infections with an influx of white blood cells. If you’ve every had a strep throat, you’ve felt lymph nodes in your neck swell as the infection is fought by the body’s immune system.

    If cancer cells spread from the colon itself to the nodes, there is a risk that they will then spread farther into the liver or lungs.

    So when cancer cells are found in nearby lymph nodes, the risk that colon cancer will recur (come back in a distant site) is greater.

    This does not mean that the cancer has already spread to liver or lungs or another “distant” site, but that there is a risk it might do so.

    Chemotherapy reduces that risk.

    Lymph node staging is IIIA when there are fewer than 4 nodes with cancer cells in them and IIIB with more than 4 or more. Risk of recurrence is higher at IIIB.

    Thirty nodes is an excellent number, and only 1 positive node is also hopeful.

    There is a picture here that shows the lymph nodes. They are the small, green bean-shaped things along the outside of the colon.


  2. Ronda says

    I’m just beginning to educate myself about colon cancer. My best friend was just diagnosed with Stage III at the area where the large and small intestine merge. They removed 30 lymph nodes and found one that was positive. What does that mean? Is it likely that the cancer has spread, even though they say her liver and lungs look great? I don’t know how lymph nodes work! Thanks.

  3. Joy says

    My husband was diagnosed in late September. Between the CAT scans and the rectal ultrasound (not a pleasant procedure)he was found to have stage 3b rectal cancer. They could see 2 involved lymph nodes near the tumor site. He was treated at Duke during the fall with oral chemotherapy and radiation for about 6 weeks. He recovered from the radiation and then had surgery on January 7th. We just spoke with the surgeon yesterday. He told us that they “harvested” 38 lymph nodes – only two were positive. This downgrades his cancer to stage 3. He will have 6 months of chemotherapy once he recovers from the surgery – and an ileostomy for 3 to 6 months.

  4. Lynne says

    I can’t believe the benchmark number is only 12. My surgeon removed 106 lymph nodes with 2 positive. My oncologist was amazed that many were removed. It does make you wonder is it the surgeon or the pathologist. I was just diagnosed with rectal cancer in April of this year. Going through chemo and can’t wait for it to be done!!

  5. Karen says

    I am very grateful my surgeon removed 28 lymph nodes/with 8 positive. I feel confident that he removed all the affected area.

  6. Chris says

    Dusty, that is the question!

    In 2003 my surgeon claims that my hospital pathology dept “boils” the tissue to find the nodes, and there are as many as there are. Sounds sorta lame, doesn’t it?

    When I had my Rectal Cancer diagnosis in 2003, only 4 (negative) nodes were examined. I should probably be glad the tumor broke through the bowel wall, because I had same treatment I would have had if there were positive nodes.

    Still NED 5 years later, Yee Ha.

  7. Dusty says

    Is the removal and testing of at least 12 lymph nodes a problem with the surgeon not removing enough or the pathologist not examining the tissue enought to find them?

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