Steven Schonholz, MD
Steven Schonholz, MD, medical director at the Breast Care Center at Mercy Medical Center, Springfield, Massachusetts.
When cancer strikes, all thoughts focus on beating the disease—but there’s often a litany of complications related to treatment that many patients don’t hear about until cancer treatment is over. One of the most serious is also quite common—lymphedema, which is especially prevalent for breast cancer survivors. The good news is that it is preventable, now more so than ever.
Lymphedema is the diagnosis for an uncomfortable swelling of the arms or legs, caused by abnormal build-up of fluid that occurs when lymph nodes are removed during surgery or damaged by radiation therapy, as both can disrupt the flow of lymph fluid. If the fluid accumulates, it’s uncomfortable and movement is difficult. The greater number of lymph nodes removed, the greater the risk for lymphedema.
Unfortunately this vulnerability to lymphedema remains a problem for months, even years. If lymphedema develops, it affects mobility and strength and leads to a diminished quality of life. If not treated early, lymphedema can become chronic and disabling, not to mention it carries the risk of severe infection.
A new study, conducted by the National Institutes of Health and the National Naval Medical Center, shows that early detection and prompt treatment with compression garments can effectively treat lymphedema, even before symptoms develop. New technology makes it easier to determine who is at risk, even in the very early stages.
In the study, the researchers measured the pre-surgical upper arm volume of 196 breast cancer patients to establish their baseline, and at three-month intervals after surgery. Twenty two percent (43 women) had an increase in upper limb volume of 3% or more—not necessarily enough to cause symptoms, but an indication that problems were developing. They were treated with a compression sleeve and gauntlet glove, worn daily. After an average of one month, arm volume in all of the women had returned to nearly a pre-surgical state.
According to Steven Schonholz, MD, medical director at the Breast Care Center at Mercy Medical Center in Springfield, Massachusetts, what’s most exciting about these findings is that there are new advanced tools, like the ones used to measure limb volume in the study, making it possible for doctors to diagnose lymphedema long before a patient is aware she has a problem.
With lymphedema, doctors have traditionally waited for trouble to arise—either a notable enough increase in limb volume to be detected with a tape measure or water displacement at regular visits or relying on patients to report symptoms.
There are two kinds of new technology allowing doctors to detect the condition earlier. One kind (typically used in hospitals) is the Perometer, an infrared laser measuring device. Another is a hand-held device, which is what Dr. Schonholz uses for his patients. It is called bioimpedance—low-frequency electric current travels through the arms to measure fluid retention. Since current travels faster through fluid than through muscle, fat and bone, even a slight increase in fluid in the arm (because of poor drainage) results in an abnormal lymphedema score, explains Dr. Schonholz. “Fluid retention can be detected early—as much as 10 months before the patient’s limb would have become swollen.”
Though common with breast cancer, lymphedema can also occur after treatment of other cancers that affect the lymph nodes, including uterine, ovarian, bladder, colon or prostate cancer and melanoma. Lymphedema can develop in one or both legs following treatment for cancers in the pelvis or abdomen—the legs are affected in up to 70% of men who have had lymph nodes removed for prostate cancer. As with breast cancer, risk goes up with the number of nodes removed.
Meanwhile there are self-care measures you can take to help prevent lymphedema after cancer treatment. To reduce your risk:
Insurance typically covers the cost of lymphedema screenings, but unfortunately these measuring technologies aren’t available at every medical center at present, so cancer patients would do well to inquire specifically about them, advises Dr. Schonholz. He believes, however, that these procedures will soon become the standard of care for anyone having lymph node removal that could affect an extremity.
Unfairly, many cancer survivors still have battles to fight after treatment—and lymphedema is one of them. However, taking preventive measures and making sure you are screened regularly can help prevent it from becoming a chronic and uncomfortable impediment to your life.