Making Headway Against a Common and Disruptive Problem: Lymphedema
Debu Tripathy, M.D.
Many patients are not aware that lymphedema can be a consequence of surgery and radiation, common treatments used for many cancer types. Lymphedema refers to swelling — often chronic — of the arms, legs or other regions of the body because of damage to the lymphatic system. It is usually a result of surgery, often done to cure or treat cancer, and can be worsened when radiation is given to lower the risk of recurrence or to relieve cancer-related symptoms. Over the past few decades, we have been able to better under- stand the procedures and other patient factors that increase lymphedema risk. This can help with the complicated decision-making process that balances the benefit of the proposed treatment (such as better curability) against long-term consequences that may affect quality of life and function.
One of our feature articles in this issue of CURE® highlights newer therapies that can reduce lymphedema when standard physical therapy and compression protocols are not sufficiently effective. This may change the whole equation for the difficult balancing act, making it more feasible to choose therapies that, although effective, are likely to cause lymphedema. Newer approaches that can reestablish lymphatic flow are still being refined and studied and are showing favorable results. These require microsurgical techniques to splice tiny veins and bypass the lymphatic networks that are constricted because of local cancer treatments. One procedure actually transplants nodes and their microvasculature from an unaffected part of the body to the appropriate area, where it can help drain edema. These procedures are not yet widely available, but they are continually being innovated and, if longer-term results hold up, likely to be adopted by more centers.
Although the highly technical developments are very important, it is para- mount that, prior to surgery, patients fully understand the risks of lymphedema. As the article describes, it is possible to be more selective in recommending lymph node removal and reducing its use for several types of cancer. We are still not quite sure how to effectively prevent lymphedema after surgery, but there is evidence that a patient can begin exercise and stretching once surgical healing is mostly complete. Ongoing studies are examining whether nonstrenuous exercise and even structured weightlifting — once forbidden for at-risk patients — can help. We still tell patients to avoid blood draws and blood pressure detection in the arm that underwent lymph node surgery and use compression sleeves during air travel, even though some experts now discount these restrictions.
We owe patients complete information, navigation for decision-making and, of course, more research into this common problem. Initiating public dialogue and education is the first step.