Cancer Survivors Share Lifetime Risk for the Disease
PHOENIX, Feb. 12 /PRNewswire/ — Although major advances have been made in the prevention and treatment of cancer, more attention needs to be given to one of the more serious side effects of surgery, radiation and chemotherapy — the painful and often progressive condition called lymphedema, a panel of vascular experts reported today.
“While we hear so much about cardiovascular disease, few physicians are familiar with lymphedema — the other vascular disease,” said Stanley G. Rockson, M.D., Chief of Consultative Cardiology and Director of the Stanford Center for Lymphatic and Venous Disorders, Stanford University School of Medicine.
“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,” added Dr. Rockson, who was the moderator of a symposium on lymphedema awareness held last night at the 21st Annual Meeting of the American Venous Forum, presented at the Arizona Grand Resort. The AVF meeting runs through Saturday, February 14th.
The Other Vascular Disease
Lymphedema is an incurable, often painful debilitating condition that affects an estimated 3-5 million people in the United States and 170 million people worldwide (The World Health Organization). It most commonly occurs as a result of cancer treatment from surgery and radiation therapy. More than 3.3 million breast cancer survivors in the United States are at a lifetime risk for the disease. Although major advances have been made in the prevention and treatment of cancer, minimal attention has been given to lymphedema diagnosis and management. But this is slowly changing due to education and awareness.
Characterized by progressive swelling of one or more limbs due to the accumulation of excessive lymph fluid, lymphedema affects both men and women. Once established, the disease has an inexorable tendency to progress. In the United States, 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 percent of breast cancer survivors will experience the condition, and for many it remains a lingering threat because it can strike many years after their 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.
Physicians and medical staff who practice in fields where lymphedema is infrequently seen may fail to correctly diagnose the condition. Moreover, many insurance companies make the expensive mistake of not recognizing lymphedema as a serious condition that becomes progressively worse without proper treatment. And lymphedema treatment providers and insurers may not be aware of the most advanced therapeutic technologies, leaving the patient with the risk of suboptimal care.
Lymphedema Diagnosis and Treatment
Most people do not know what lymphedema is until they have it. Physical examination may reveal a region of persistent edema, and painful thickened skin with a dimpled “orange-skin” texture, among other signs. Treatment for lymphedema varies depending on the severity of the edema and the degree of chronic scarring of the affected limb. Most people with chronic lymphedema follow a daily regimen of life-long self-care as prescribed by their physician or overseen by a certified lymphedema therapist.
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.
The use of older-generation compression pumps has been associated with discomfort and pain, skin irritation, and a higher risk of skin thickening and inflammation. Additionally, these simpler pumps do not offer the programmability of more advanced pumps to treat the trunk or chest lymphatics, and have been associated with creating new areas of swelling in the chest, back and genitals. As a result, the use of these non-programmable pumps has fallen from favor in medical practice.
Watch for Danger Signs
Experts advise certain steps can be taken to reduce the chances of developing lymphedema, especially if you’ve had cancer treatment that may have damaged your lymphatic system. These include maintaining a healthy diet, exercising regularly and avoiding infections from cuts and insect bites.
If you do get an infection, however slight, consult your doctor immediately for a possible course of antibiotics to reduce the risk of lymphedema developing. If you’ve had a double mastectomy, any needle procedures should be preferentially performed in the leg rather than the arm. Be alert for any subtle or unusual swelling.
Obesity is a risk factor because it puts excess stress on the lymphatic system. Additionally, burns and scarring can damage or destroy lymphatic capillaries.