By Laura Hegwer
If you have swelling, pain or stiffness in your limb after cancer surgery, radiation or chemotherapy, you could have lymphedema. Options like therapeutic massage, exercise and microsurgery can help you find relief.
What is lymphedema?
Lymphedema is a type of swelling, or edema, that usually affects the arm or leg, says , a cancer physical medicine and rehabilitation physician and medical director of cancer rehabilitation at RUSH MD Anderson Cancer Center.
鈥淓arly warning signs of lymphedema include a feeling of heaviness, tightness or fullness in the limb, along with mild swelling, so recognizing these signs early and starting treatment quickly can make a real difference,鈥 Obaisi says.
What causes lymphedema?
In rare cases, people may develop primary lymphedema from inherited (genetic) conditions. However, most people develop lymphedema when the flow of lymph fluid in the lymphatic system is disrupted by cancer treatments like surgery, chemotherapy or radiation. This is called secondary lymphedema, and it is especially common in breast cancer patients who鈥檝e had lymph nodes in their armpit removed as part of their cancer care, says , a plastic and reconstructive surgeon who serves as chief of the Division of Plastic and Reconstructive Surgery at 海角原创.
鈥淟ymph node removal can cause some scarring, which disrupts the lymphatic vessels,鈥 Chong explains. 鈥淎nd oftentimes, those patients get radiation as well. So, all that trauma impairs lymph drainage from the arm.鈥 Besides the arms, lymphedema can also appear in the breast, chest wall, trunk and groin.
Lymphedema is not only hard to live with, but it can also raise your risk of infections and cause thick, scar-like tissue to develop in the affected area. That鈥檚 why screening is important.
At RUSH MD Anderson, Obaisi has developed a screening program for cancer rehab patients that uses a noninvasive technology called bioimpedance spectroscopy to detect lymphedema before symptoms appear. Patients have a 30-second baseline scan before lymph node surgery, and then routine scans after their lymph nodes have been removed. 鈥淭his lets us detect subclinical changes early and intervene sooner, when treatment is simplest and most effective,鈥 Obaisi says.
Can lymphedema be cured?
Lymphedema cannot be cured, but treatments can greatly reduce swelling and other symptoms. For most patients, the first step is seeing a certified lymphedema therapist or cancer Physical Medicine and Rehabilitation physician like Obaisi who can determine if a nonsurgical treatment called complete decongestive therapy, or CDT, is right for them. CDT combines a specialized type of massage called manual lymphatic drainage, or MLD, along with compression bandages, skin care and exercise. CDT is delivered by a team that includes physical and occupational therapists who are certified lymphedema therapists.
Many people are surprised to learn that exercise can help treat and possibly even lower the risk of developing lymphedema. 鈥淧atients used to be told to protect the affected arm or leg by not using it and to avoid lifting or strenuous activity,鈥 says Obaisi, who is also a certified lymphedema therapist. 鈥淗owever, research has shown that slowly progressive, well-supervised exercise, including resistance and strength training, is safe and may reduce the risk of developing lymphedema and the frequency of flare-ups.鈥
Lymphedema-focused movement courses can help you get moving in a supportive environment. Maintaining a healthy weight can also lower your lymphedema risk and improve overall recovery and quality of life, Obaisi adds.
Can surgery treat lymphedema?
If your lymphedema isn鈥檛 well controlled with CDT, you may be a candidate for a specialized type of surgery called microsurgery that may provide long-lasting relief from your symptoms, Chong says.
鈥淢icrosurgery is, in general, reconstruction that involves the use of specialized instruments and an operating microscope to repair and/or connect small structures such as blood vessels and nerves,鈥 he says. 鈥淥ften it is used to transfer a patient鈥檚 own tissue from one part of the body to another.鈥 Microsurgeons with advanced training can perform what鈥檚 known as supermicrosurgery, connecting blood and lymphatic vessels between 0.3 and 0.8 millimeters. For lymphedema patients, the vessels involved can be even smaller. 鈥淲e use even more specialized equipment and techniques to suture lymphatic vessels that can be smaller than half a millimeter 鈥 about the thickness of a thumbnail,鈥 Chong says.
Two types of surgery are available: lymphovenous bypass and vascularized lymph node transfer.
Lymphovenous bypass, or LVB, is usually an outpatient procedure for people with early-stage lymphedema. During LVB, a surgeon attaches a lymphatic vessel to the vein, allowing lymph fluid to drain through the new channel. Chong likens it to taking a side road to avoid rush hour congestion.
Vascularized lymph node transfer, or VLNT, is an inpatient procedure for moderate to advanced lymphedema. It involves moving lymph nodes, vessels and soft tissue from the groin or abdomen, most commonly, and reconnecting them to the affected area to help remove the extra fluid. Most people can go home after one night in the hospital. For many patients with severe swelling, Chong combines both the LVB and VLNT approaches.
New robotic technology, available first at Rush, can help surgeons like Chong perform both types of procedures. 鈥淲ith this robot, we can sew lymphatics and small vessels together with a high level of precision and less trauma to the vessels,鈥 he says.
After LVB or VLNT, most people feel that their compression wraps are looser and find that they are wearing their compression less often. The procedure can also reduce their risk of infection and chronic inflammation that leads to tissue scarring, Chong says.
New techniques may also help reduce the risk of lymphedema from cancer surgery. Chong is studying immediate lymphatic reconstruction, or ILR, at the time of axillary (armpit) lymph node removal for breast cancer. 鈥淲hen a patient has an axillary node dissection, we inject the arm with a contrast dye and look for the lymphatic vessels that have been damaged. Then we attach those vessels to a vein in order to reroute lymph flow right away,鈥 he says. Patients who鈥檝e had ILR at the time of lymph node removal are less likely to develop lymphedema, he adds.
Getting help for lymphedema
Lymphedema can occur months or even years after cancer treatment. If you have swelling in your limb, talk to an expert about your treatment options.
