Cancer treatment is a grueling process, and one people are anxious to put behind them. But for some, the surgeries and radiation needed to treat cancer result in the development of lymphedema — a painful and chronic condition that affects a patient’s limbs.
It’s estimated that anywhere from 5 to 40 percent of patients with breast, gynecologic, prostate, and other cancers could develop congenital or secondary lymphedema after treatment. Some of those patients may have been genetically predisposed to developing lymphedema, while others develop the chronic condition as a result of cancer treatment.
In either case, with the proper treatment, pain and swelling can be managed. But the first step for patients is to educate themselves on this relatively unknown disease.
What is lymphedema?
Part of the immune system, the lymphatic system is responsible for circulating lymphatic fluid. This fluid is a continuous cleaning mechanism that is essential for maintaining a healthy body. But lymphatic fluid is also extremely toxic and causes swelling and damage if not drained continuously. Lymphedema occurs when the circulation of this lymphatic fluid is blocked and can’t be drained properly. The fluid then leaks into the surrounding tissue, which become chronically inflamed. Over time, if the disorder isn’t properly managed, the inflammation results in deposits of solids that cause the affected arm or leg to become painfully swollen and hard.
The stages of lymphedema
Generally speaking, there are two stages of lymphedema. Stage I lymphedema is early stage lymphedema and involves a buildup of excess lymphatic fluid only in the affected arm or leg. Most likely this is when a patient will first notice something is wrong. Their arm or leg begins to swell, and no amount of diet or exercise changes the size of their limb. However, the arm or leg can be reduced in size to match the unaffected side in stage I. Generally speaking, the fluids and associated swelling can be brought down with conservative treatments like occupational therapy, physical therapy, compression garments or bandaging, elevating the limb, or other modalities such as microsurgery.
Because lymphatic fluid is extremely toxic and lymphedema causes that fluid to leak into the surrounding tissues, it can cause damage to the surrounding structures, including the lymphatic drainage system itself. Over time, a vicious cycle takes place where the system gets further damaged, causing more build-up and less drainage, which causes even more swelling, inflammation and tissue damage.
This eventually leads to the deposit of fat and protein, which is permanent and can no longer be treated with conservative treatments or microsurgery. At this point, the arm or leg no longer reduces in size to match the unaffected side. Now the patient suffers from stage II lymphedema and requires a combination of surgery and conservative treatments to alleviate symptoms.
How does cancer treatment cause secondary lymphedema?
When breast or other cancer spreads to the lymph nodes, patients need to have their nodes removed as a part of their treatment. However, in some cases, the cancer affected lymph nodes regulate the drainage of lymphatic fluid in an adjacent arm or leg. The circulation of the fluid becomes backed up or blocked in these areas too. Improper drainage occurs, causing lymphedema. Radiation treatment, necessary to kill cancer cells, can also damage surrounding lymph nodes and keep them from performing as they should.
Advances in cancer treatment have reduced the number of lymph nodes that must be removed in many cases. Such recent improvements in breast cancer detection and surgery have decreased the instances of lymphedema. However, even the best surgeons can’t completely avoid techniques and surgeries that could cause lymphedema in many cancer cases. While these surgeries and radiation treatments are necessary to the survival of the patient, they may cause this unfortunate side effect.
Who’s most at risk of developing secondary lymphedema?
A majority of cancer survivors avoid developing lymphedema after surgery. So why are some patients not so lucky? The likelihood of a patient developing lymphedema comes down to a combination of how invasive the surgery was (how many lymph nodes were removed) and the baseline performance of the patient’s lymphatic system.
Depending on where the cancer settles, some patients may need to have more lymph nodes removed than others. Patients with cancerous tumors that are large enough to block the lymphatic system, for instance, are at a higher risk of developing secondary lymphedema. Likewise, if a patient had a relatively weak lymphatic system prior to cancer treatment, it’s more likely that invasive surgery will result in lymphedema than for a patient with a more robust system.
The importance of early detection in secondary lymphedema
Much like cancer, the early detection of lymphedema is crucial. By getting in early and treating lymphedema with conservative therapies, patients can potentially avoid the disorder progressing to stage II, which requires more significant surgery.
It’s highly recommended to book an appointment with a lymphedema therapist as soon as a patient suspects something is wrong. These therapists are highly trained to spot the early signs of lymphedema and they can help educate patients on ways to avoid aggravating the disorder.
While lymphedema therapists are often able to identify swelling caused by lymphedema that even the patient may not recognize, they may also have access to a number of detection and diagnosis modalities and machines. For instance, the SOZO machine uses the dielectric constant to detect lymphedema, and indocyanine green (ICG) and/or lymphoscintigreaphy imaging can also be used for early detection.
At Granzow Lymphedema & Lipedema Center, we conduct multiple types of imaging studies that show us the functional state of the lymphatic system and reveal issues that we might not be able to see otherwise.
How is secondary lymphedema treated?
Stage I lymphedema can often be treated with conservative therapies provided the patient is working with a therapist who is highly trained in lymphedema management. Patients may require a combination of physical therapy, occupational therapy, compression garments, and pumps. All of these treatments are meant to reduce the toxic fluid that’s present in the affected limb to avoid further damage.
Some stage I patients might also benefit from microsurgery. Dr. Granzow is a lymphedema surgery pioneer and has developed a system for surgically treating both stage I and stage II lymphedema. For stage I patients, Dr. Granzow can reconnect the lymphatic channels so they drain properly. In some cases, he will reconstruct the lymphatic system by moving healthy lymph nodes from other parts of the body into the area where they’ve been removed.
For patients with advanced, stage II lymphedema, conservative therapies and microsurgery cannot remove the pathologic solids present. We have seen many patients with stage II lymphedema that were treated elsewhere with microsurgery that inevitably failed. For stage II, conservative treatments are performed first to reduce excess fluid present and reduce inflammation. After that, SAPL surgery is used to aspirate out the large amounts of remaining solids to get the patient down to reapproximate a stage I (fluid only) condition. From there, patients would undergo the same conservative therapies and microsurgeries as other stage I patients to further drain the remaining fluid, improve symptoms and decrease the need for therapy and compression.
Most diseases, such as heart disease, high blood pressure, diabetes, etc are chronic, have no cure, but can be well managed with proper treatment. Lymphedema is no different. While surgery can produce fantastic improvements in patient outcomes, it will not eliminate lymphedema entirely. After surgery, almost all lymphedema patients need to continue with some amount of therapy and wear compression garments to maintain their results, even if only in small amounts. However, surgery should significantly alleviate feelings of discomfort, shrink the affected limb, and reduce the need for therapy and compression garments.
Before and after surgery, compression garments are an important part of lymphedema treatment. A highly skilled therapist should be able to measure patients for the right fit and determine what kind of compression garment to use and how often a patient should wear them based on where they are in their treatment.
How effective is secondary lymphedema treatment?
The effectiveness of secondary lymphedema treatment is based on the patient, the treatment selected, and the skill of the surgeon or therapist in charge of the treatment plan. At Granzow Lymphedema & Lipedema Center, we can consistently expect to take a limb affected with stage I or stage II lymphedema and bring it down to the size of an unaffected limb and also reduce the amount of therapy and compression needed to keep it there lifelong.
If you experience any post-breast-cancer-surgery swelling in an arm or post-gynecologic-cancer-surgery swelling in a leg, call a therapist right away. They can diagnose the issue and begin treatment early to keep you from progressing to stage II. The experts at Granzow Lymphedema & Lipedema Center can also help. Contact the experts to get the relief you deserve today.