
	Medical Edge


	About

	Television

	Radio

	Newspaper

		Participating Newspapers

	Magazine

	Contact


	About Mayo Clinic

	Make an Appointment at Mayo Clinic

Medical Edge Newspaper Column from Mayo Clinic

LYMPHEDEMA TREATMENT OPTIONS EXPANDING

DEAR MAYO CLINIC: After two surgeries for breast cancer, I’ve been dealing with significant lymphedema. I have an Extremity Pump for my arm, which I use regularly. Are any other treatments available?
— St. Simons Island, Ga.

ANSWER: Lymphedema is a chronic swelling of a part of the body, usually an arm or leg. It is the result of impaired flow of lymph (a protein-rich fluid) through the vessels that return it from the body’s tissues to the bloodstream.

Although lymphedema can be inherited, such types are rare. Cases in the United States tend to occur after cancer surgery or radiation treatment. The surgical procedure can include removal of lymph nodes — sometimes, quite a few — which may impede lymph flow. Similarly, radiation directly over lymphatic vessels may produce fibrous tissue that hinders flow.

In lymphedema, recurrent infection (cellulitis) is a concern because the nutrient-rich lymph is ripe for bacterial growth. Infection — a danger if left untreated — may also worsen the pooling of lymph, as affected vessels scar and reduce flow even further.

A traditional way of treating lymphedema has been the pneumatic (air) compression pumping procedure, such as the one you have used. A sleeve is wrapped around the affected limb and sequentially inflated and deflated, thereby increasing the flow of lymph out of the limb. The standard of care is now shifting to a set of procedures called complex decongestive therapy, or CDT, which consists of a swelling-reduction phase followed by a maintenance phase.

During the swelling-reduction phase, a trained therapist performs manual lymphatic-draining massage — moving the lymph fluid toward the body — and then applies multilayered low-stretch bandaging. Patients also are taught specific exercises that assist in fluid flow, and they learn how to care for the skin in order to minimize presence of bacteria, cracks in the skin and risk of infection. In the maintenance phase, patients wear a compression garment to stimulate the lymph flow, continue with their exercises and may wrap the affected limb at night.

CDT is not available everywhere, and sometimes other treatments are more appropriate. For a patient with an open wound or active tumor, for instance, massage in the affected area might not be advisable. Simple low-stretch wrapping may be the best option. There continues to be new options with advanced pneumatic compression devices as well.

Exciting possibilities for the future may be treatment with growth factors, stem cells or gene therapy. An international community of researchers, now working in the laboratory, is actively trying to grow new lymphatic vessels that could compensate for deficiency. If this research is successful, lymphedema might be minimized or possibly even reversed.

Meanwhile, the risks of developing lymphedema are being lowered. Now that breast cancer surgery typically involves lumpectomy (local tumor removal — less invasive than removal of the entire breast) and sentinel-node biopsy (if the primary draining lymph node is free of malignant cells, then numerous nodes nearby are not usually removed), disruption of the lymphatic system has been reduced. Also, radiation therapy is now much more selective and precisely targeted, and there is much less risk for damage to adjacent tissue. These practices decrease the likelihood of secondary lymphedema considerably, but unfortunately do not eliminate it.

Cancer doctors and patients are also identifying lymphedema sooner, when treatment options have a better chance of more complete reduction. Many patient-education Web sites, such as the National Lymphedema Network (www.lymphnet.org), are extremely helpful to patients in gaining knowledge and earlier access to care.

— Gail L. Gamble, M.D., Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minn.

Additional Resources:
Lymphedema
Appointment Information
More Information on Lymphedema

- - -

Medical Edge from Mayo Clinic is an educational resource and doesn’t replace regular medical care. To e-mail a question, go to www.mayoclinic.org, or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.