Post Cancer Lymphedema
Lymphedema
During surgery for cancer, nearby lymph nodes are removed and during radiation therapy lymphatics are destroyed.
During surgery for cancer, nearby lymph nodes are removed and during radiation therapy lymphatics are destroyed. Both of them alone orin combination in a susceptible patient can disrupt the flow of lymph which leads to lymphedema in the extremity.People who do develop lymphedema do so within two to three years after their surgery, but it is important to note that the risk remains over a person's lifetime and increases with trauma or injury to a limb.
Also, some people can develop lymphedema even when lymph nodes are not removed if the lymphatic system in the skin is injured from extensive surgery or from radiation therapy.
The Lymphatic system is a network of lymph vessels, tissues and organs that carry lymph throughout the body. If this lymphatic system is blocked or damaged in the body, lymph is not able to flow through the body in the lymphatic vessels. The resultant excess lymph fluid is collected in soft tissues (Lymphedema). There are two types of lymphoedema. Primary lymphedema due to abnormal development of lymph system and Secondary lymphedemadue to damage to lymphatic system due to cancer, post radiotherapy.
Often during breast cancer surgery, some or all lymph nodes are removed from arm. Added damage to the lymphatics is done bypost operative radiation therapy because of which there is higher risk of lymphedema in breast cancer survivor patients.
Symptoms:
- Swelling of the involved extremity
- Feeling of fullness or heaviness
- Itching and Burning sensation
- Thick skin, deformed part.
- Recurrent infections /oozing of fluid out from skin of the affected part
Diagnosis:
- Physical examination and history gives a clue about the diagnosis
- Lymphoscintigraphy= radioactive dye is injectedin the lymphatics and then scanned by a probe to know and delineate the flow of lymph through the lymphatic vessels to diagnose the obstruction of lymphatics.
Avoid injury to the affected limb
- Keep your skin clean. Wash with a mild soap every day.
- Be careful with your nails. Don't pick at the skin around your nails or cut your cuticles.
- Use lotion to keep your skin from getting dry and cracked.
- Use an electric razor instead of a razor blade to shave.
- Always use sunscreen when you go outside.
- If an arm is affected, wear gloves when gardening, cooking, or doing other things that could hurt your skin.
- If a leg is affected, wear hard-soled shoes when outside.
- If you do get a small cut, scrape, or bite on your arm, hand, leg, or foot, clean it well with soap and water and apply an antibiotic cream. Contact your doctor as soon as possible if it does not heal quickly or if you have signs of an infection.
Avoid lymphedema from getting worse over time
Do not wear clothing that restricts flow to and from the limb, and avoid activities that could interfere with lymph flowWear compression garments (special sleeves or stockings) to limit swelling.Keep your weight under control – Excessive weight gain or being overweight can worsen lymphedema and may limit the effectiveness of compression garments.Visit a lymphedema therapist – Some physical therapists are trained in a special kind of massage that can help with lymphatic drainage.Try to do some aerobic exercise and lift some weights – These activities have been shown to reduce the severity of lymphedema, improve overall fitness, and help with weight control. Even gentle forms of physical activity, such as walking, have health benefits.If one of your arms or legs is affected, avoid medical procedures that puncture the skin, if at all possible, in that arm. In addition, avoid continuous blood pressure monitoring on the affected arm. Blood pressure can be taken in the opposite arm or, if both arms are affected, in one of your legs.Contact your doctor if the affected arm or leg develops a rash; becomes red, blistered, painful, or warm to the touch; or if you get a fever (temperature greater than 100.4ºF or 38ºC). These symptoms could signal a possible infection that could cause the beginning or worsening of lymphedema.
Treatment of Post Cancer Lymphedema
- Exercise
- Compression garment or a lymphedema sleeve or stocking
- Compression therapy devices
- Limb elevation
- Massage therapy
- Preventing infection
- Surgical treatment
Microsurgical Approaches:
There are 2 surgical procedures that can treat lymphedema in post cancer patients.
- Free vascularized lymph node transfer: Superficial lymph nodes are harvested from with an artery and vein and microsurgically anastomosed to a recipient artery and vein after tissue release at the wrist region.
- Advantage of recruitment of healthy vascularize tissue
- Challenging and technically demanding procedure
- Post op period with initial rigorous monitoring and maintenance of position by the patient
- Subjective improvement reported by 100% patients with 78% were able to discontinue compression therapy.
- Lymphovenous bypass:In this procedure, the blocked lymphatics are connected to the veins.
- Supermicrosurgical technique to anastomose distal subdermal lymphatic vessels and adjacent venules < 0.8mm.
- Minimally invasive, minimal pain, discharged within 24 hours
- Challenging and technically demanding procedure
Debukling Procedures:
If the extremity is severely deformed or is in advanced stage of lymphoedema, then debulking procedures will help in reducing the severity of the disease. EXCISIONAL procedures or LIPOSUCTION of the arm can be done.
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If you have flat or small breast and you want to improve your breast and hip contour ratio then you are a good candidate for it. The answer will be best provided after the first consultation with Dr Amit Agarwal.
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This surgery does not affect the ducts or the areas of the breast involved in milk production. Thus, it does not affect the breast feeding.
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