Increased Awareness for the Growing Problem of Lymphedema

A panel of vascular experts is calling for increased attentiveness to one of the more serious side effects of surgery, radiation, and chemotherapy - the painful and often progressive condition called lymphedema, the "other” vascular disease.

Lymphedema is an incurable, often painful debilitating condition that affects an estimated 170 million people worldwide, according to The World Health Organization (WHO; Geneva, Switzerland). It most commonly occurs as a result of cancer treatment from surgery and radiation therapy, and is characterized by progressive swelling of one or more limbs due to the accumulation of excessive lymph fluid. Lymphedema affects both men and women, and once established, the disease has an inexorable tendency to progress. It most commonly occurs in the upper limb after breast cancer surgery and lymph node removal on the body side in which the surgery was performed. Some 15-30% of breast cancer survivors will experience the condition, and for many it remains a lingering threat since it can strike many years after the cancer was treated. Lymphedema may also occur in the lower limbs or groin (genital edema) after surgery for colon, ovarian, or uterine cancer in which removal of lymph nodes is required.

The gold standard of care for lymphedema relies upon a set of techniques called Complex Decongestive Therapy (CDT) designed to reduce swelling and maintain skin health. CDT includes exercise, skin care, compression, and a clinically proven massage technique called manual lymphatic drainage (MLD). Initially, CDT involves frequent (sometimes daily) visits to a certified therapist for as long as six weeks. Once the swelling is reduced, self-management is required for ongoing care at home, along with the use of elastic compression garments, non-elastic directional flow garments, and often, an automated pneumatic compression pump.

"Because cancer survivors are living longer, and because lymphedema occurs more frequently in older cancer survivors, more people are at risk for developing the disease. The incidence of lymphedema is especially higher among Latinos and African-American women who have undergone breast cancer treatment,” said panel member Stanley Rockson, M.D., chief of consultative cardiology and director of the Stanford University (Palo Alto, CA, USA) center for lymphatic and venous disorders.

The panel of experts advises certain steps be taken to reduce the chances of developing lymphedema; these include maintaining a healthy diet, exercising regularly, and avoiding infections from cuts and insect bites. If an infection develops (however slight), a doctor should be consulted immediately for a possible course of antibiotics. For women who have undergone a double mastectomy, any needle procedures should be preferentially performed in the leg rather than the arm. Obesity is considered a risk factor because it puts excess stress on the lymphatic system. Additionally, burns and scarring can damage or destroy lymphatic capillaries. The panel met at the symposium on lymphedema awareness at the annual meeting of the American Venous Forum, held during February 2009 in Phoenix (AZ, USA).

Related Links:
Stanford University
WHO