Lymphedema: A primer on the identification and management of a chronic condition in oncologic treatment

Abstract

The primary goals of oncologic therapy are the compassionate care of cancer patients, eradication of disease, and palliation of symptoms. Advances in various targeted therapies such as highly conformal and image-guided radiotherapy techniques, sentinel lymph node dissection, and molecularly targeted agents hold the promise of allowing those goals to be reached with fewer treatment-related complications. Unfortunately, certain side effects remain problematic due to the inability to completely avoid injuring normal tissues. Lymphedema, a chronic condition that occurs as a result of the body's inability to drain lymph fluid from the tissues, is a common treatmentrelated side effect experienced by cancer patients. In this review, many of the important aspects of lymphedema with which clinicians who treat cancer patients should be familiar are outlined, including the anatomy, pathophysiology, diagnosis, and management of this condition. The authors also identify some of the resources available both to cancer patients with lymphedema and to the clinicians who treat them. It is hoped that this review will convey the importance of the early identification and management of this incurable disorder because this is essential to minimizing its complications.

Effects of autotransplanted lymph node fragments on the lymphatic system in the pig model

“…Surgical removal of LN often leads to an impaired lymph flow, because of the damage to the lymphatic network. This causes lymphatic insufficiency and accumulation of fluid in the subcutaneous tissue, if the transport capacity of the lymphatic system is overloaded [2]. Additionally, hemodynamic factors seem to be involved in the maintenance of edema, which is a reversible condition at the beginning [3].…”

Lymphedema Quality of Life Inventory (LyQLI)-Development and investigation of validity and reliability

“…Treatments include; daily wrapping with non-elastic bandages, manual lymphatic drainage, skin-care, physical training, intermittent pneumatic etc. [2][3][4][5].…”

“…Without adequate treatment LE can result in complications such as massive edema, lymphangitis/cellulitis, impaired limb function, psychosocial disability, and even malignant complications [1][2][3][4]. LE is most often a chronic condition which requires lifelong treatment including conservative treatment such as daily wrapping with non-elastic bandages and/or compressive garments, manual lymphatic drainage, intermittent pneumatic [2][3][4][5] and in some cases surgical treatment [6] or lymphatic venous anastomosis [7].…”

Yes, breast cancer related lymphoedema can be managed

“…Lymphoedema occurs when the lymphatic load exceeds the transport capacity of the lymphatic system, resulting in an abnormal accumulation of protein-rich fluid in the interstitium (Norton School of Lymphatic Therapy 2004;Zuther 2005;Lawenda, Mondry & Johnstone 2009). Primary lymphoedema is the result of developmental dysplasia of the lymph vessels or lymph nodes (Földi & Földi 2006) and may be present at birth, or develop later with no obvious cause (Norton School of Lymphatic Therapy 2008).…”

“…Lymphoedema is incurable because of permanent damage to, or absence of, the various lymphatic components (Lawenda et al 2009). People do not die of lymphoedema, but their quality of life is severely impaired.…”