“Cancer can be cured!”. A diagnosis that might sound like a sentence 20 years ago is now a responding disease with proof-based treatment. On one hand, modern medicine provides not just novel therapeutic sequences but a whole new approach – now there’s not only chemotherapy but targeted drugs aimed at a special part of the cancer cell; immunotherapy, which “trains” immune cells to fight tumors more effectively; and gene cell therapy that is based on agents, made from patient’s cells.
On the other hand, there are still radical but “harmful” treatments like surgical procedures or radiology. So, most patients can hope they can achieve remission and have no signs of malignant disease. But this also puts a question, impossible to ask just a decade ago: how can we bring these patients back to quality life?
A new surgical specialty, focused on management of the post oncological traumas, is now being developed. It involves bones and joint prostheses, vessel reconstruction after sarcoma, orofacial reconstructive surgery, and mammaplasty after mastectomy.
The one complication that follows an oncological condition and is rarely thought of is lymphedema or lymphedema. It occurs after surgical removal of the tumor and adjacent lymph nodes. The most common are breast cancer, cervical and other gynecological cancers, prostate cancer, and melanoma. In this case, lymph can no longer circulate freely so it collects in body tissues and enlarges extremities.
There are two major causes of lymphedema: particular anatomical or genetic properties which are quite rare, and lymphatic system lesion or lymph node removal. The rate of such complications has significantly risen nowadays due to more radical and effective surgical treatment with longstanding remission. Now based on the USA date, it occurs in every 1000th patient. This creates a paradox: from a rare condition it became a quite common complication. With more patients, there is more need for effective therapy. Nowadays a condition that was considered a payback for cancer treatment has a therapeutic solution.
Why lymphedema occurs?
One way to spread cancer cells is by using the lymphatic system. That’s why when excessive tumor growth is suspected, adjacent lymph nodes are removed because there might be tumor cells. Since lymph nodes play an important role in liquid circulation helping it to be directed properly, its removal causes congestion of liquid in tissues that makes them swell.
Its worst feature is that once lymphedema has occurred it will only decline and won’t regress until treated. Those common phrases mean that an affected limb will progressively increase in size. In some severe cases, it might lead to the inability to raise it and to serve oneself. One of the options offered is an amputation. But even in mild cases lymphedema won’t make a quality of life any better – clothing changes, inability to continue a job or hobby, involving an affected limb, and usual infection management, that persists due to a local immune system failure. Consequently, that might cause even more problems than the absence of a breast.
How to treat?
Lymphedema must be treated anyway. Today there’s a scheme of surgical and non-surgical procedures to help you.
The therapeutic approach involves complex decongestive therapy (CDT), which provides a special lymph drainage massage with a consequent bandaging. This approach is not aimed at the cause of lymphedema – nodes are still removed and the lymphatic system is damaged. But it can help to get rid of excessive liquid in the limb which therefore lessens a limb’s size and improves the local immune system. The most often question asked by our patients is – will the swelling return after CDT? Yes, it will, but if the right compression garment is assorted this process might take a long time.
You can read more about the conservative therapy of lymphostasis here.
The second way to manage lymphedema which is only gaining popularity in Russia is surgery. Today there are several techniques to restore lymph drainage surgically.
At the early stages of lymphedema, when there are functional lymph vessels left, the patient would be offered lymphovenous anastomosis as an initial treatment. It is an effective and not traumatic procedure where lymph vessels are being sutured with veins to drain liquid. In some patients, it provides a total relief, a cure. This is a supermicrosurgical procedure, it has got such a name because a surgeon operates on 0.5 mm structures.
We tell you more about LVA here.
If it is a more severe condition and there are no lymph vessels to use for anastomosis, there’s another procedure that can be performed – lymph node transplantation. The key of the procedure is to move a complex of lymph nodes and vessels from the unaffected part of the body (usually lower abdomen or supraclavicular) to the part where they were removed after oncological surgery. Sounds like fiction, but it is reality – we really can transplant one’s tissues so that they will slowly compensate for a loss of function. This approach is also applicable in patients with hereditary lymphedema.
You can read about lymph node transplantation here.
It is internationally agreed that the earlier the procedure is performed the better. Lymph vessels and veins suturing are even indicated for patients without lymphedema but who are in a group of high risk to have one. We would like to emphasize that regardless it is a quite technically demanding procedure that requires good skills it is safe for patients. It is performed under local anesthesia, needs no narcosis or hospital admission, and the post-op wound is only 2 cm long.
So surgical treatment of lymphedema should not be a question to postpone. Early performed procedures can help to better restore the lymphatic system for better results.