Did you know that as many as 3-5 million individuals suffer from lymphedema in the United States, and the majority of whom develop this condition as a result of cancer treatment (i.e. surgery and/or radiation therapy to the lymph nodes within the neck, armpit, pelvis and groin)? In the United States, the most common cause of lymphedema is due to breast cancer treatment, but it can resultfrom the treatment of cervical, endometrial, vulvar, head andneck, and prostate cancers, as well as sarcomas and melanoma.
The risks of developing lymphedema depend on multiple factors, including the extent of treatment to the lymph node region (combining both surgery and radiation significantly increases the risk when compared to either treatment, alone), obesity, surgical infections, etc.
Signs and symptoms that the patient may present with includea feeling of heaviness or tightness in the limb, aching or discomfortof the limb, restricted range of motion of the limb, and swellingin a portion of the limb or the entire limb.
A preoperative (or pre-radiation) evaluation and prevention educationshould occur with all patients who will undergo treatment thatputs them at risk for the development of lymphedema. This initialencounter with the patient should include baseline measurements of the affected and unaffected limbs, educatingthe patient concerning arm or leg care guidelines, and notingany risk factors that may put the patient at an increased riskfor the development of lymphedema.
The early detection and treatment of lymphedema is of the utmostimportance. Baseline measurements of will assistin finding any significant changes in the size of the limb,allowing the intervention to occur as early as possible.
Only with early detection can the severity of lymphedema be most effectively minimized. Once lymphedema has progressed to more advanced stages, it becomes increasingly difficult to return the affected tissues to their pre-treatment state. Nevertheless, all stages of lymphedema can and should be treated to prevent worsening symptoms and complications.
There are multiple, non-invasive methods available to assess for the development of lymphedema (i.e. limb diameter, limb volume, ultrasound, bioimpedence spectroscopy.) One of the most exciting, recent developments in assessing for the earliest signs of lymphedema is the use of “bioimpedence spectroscopy.” This technology quickly and accurately measures the amount of fluid in the limbs using a set of adhesive skin electrodes, generating an easy-to-follow number (called an “L-Dex” score.) The benefit of this method is that it can detect lymphedema earlier than previously possible with older assessment techniques (i.e. limb diameter, limb volume, ultrasound.) These FDA-approved devices are available at many physician and physical therapy offices across the U.S. No matter which assessment method is used,
Lymphedema is a chronic condition, but with early identification and treatment the signs and symptoms can often be significantly reduced. I encourage all patients who may receive (or already have received) treatment for cancer to discuss their risks of developing lymphedema with their physicians. A referral to a certified lymphedema therapist is strongly encouraged for anyone who has lymphedema.
Ever tried acupuncture? A new study reports that acupuncture may be able to reduce lymphedema after breast cancer by over 30%!
Read my review article on Lymphedema in the American Cancer Society’s journal CA: A Cancer Journal for Clinicians
