One in eight women will be diagnosed with breast cancer at some point in their lives, making it the most common cancer to affect women. Breast cancer patients undergo a wide range of treatments, including biopsies, radiation, chemotherapy, mastectomy and removal of lymph nodes. Of those women undergoing lymph node removal, one in four will face an added challenge on the road to recovery — a chronic condition known as lymphedema. Vascularized lymph node transfer is a new surgical innovation offering hope to patients suffering from lymphedema.
According to Dr. Mark L. Smith, Director of Plastic and Reconstructive Surgery at the Continuum Cancer Centers of New York, lymphedema is a swelling in the arm or leg that, in the United States, is most commonly seen after removal of lymph nodes for cancer. The swelling may develop within weeks of surgery, but more commonly is seen several months to years after initial treatment. Lymphedema causes discomfort and tightness that can affect flexibility and the ability to fit into clothing. Patients with lymphedema are also prone to infections and therefore must be careful when doing activities that may result in even minor trauma to the affected area, such as gardening or playing certain sports.
The link between cancer and lymphedema
Although there are other non-surgical causes for lymphedema, the vast majority of Dr. Smith’s patients are those who have had cancer surgery. “Lymph nodes are typically removed as part of cancer surgery to assess for tumor spread and also to remove lymph nodes that might be involved with cancer,” Dr. Smith says. “Lymphedema can happen after surgery for melanoma or cancers of the head and neck or pelvic region — but most commonly we see it after breast cancer surgery, simply because of the sheer number of women treated.”
What is the lymphatic system?
It’s not just blood, veins and arteries that comprise the body’s vast and complex circulatory system. Lymph is a clear fluid made up of plasma and white blood cells that travels through the lymphatic system, helping rid the body of toxins and waste. “We have lymphatic channels throughout our bodies, and there are rich networks of lymph nodes in the intestinal region as well our extremities, head and neck,” says Dr. Smith. “In addition to filtering out tumor cells, lymph nodes also remove bacteria to prevent infection and play a vital role in helping the immune system protect the body.”
When the hundreds of lymph nodes in the body are working normally, they are filtering lymph as it travels from the body’s tissues through lymphatic vessels up toward the neck. In the neck, the lymphatic vessels merge into large veins that return the lymph fluid to the circulation.
Conservative treatments work to lessen symptoms
The most common treatments for lymphedema include manual lymphatic drainage (a special type of limb massage) to squeeze out excess fluid and compression bandaging to preventing fluid from re-accumulating. Other treatments include getting regular exercise, avoiding overexertion, keeping the skin clean and moisturized, and maintaining a healthy diet.
Surgical lymph node transfer offers hope
Though lymphedema is a chronic condition that has no cure, newer treatments hold much promise. “Many patients aren’t aware that there are new surgical options, like lymph node transfer,” says Dr. Smith. Surgically transferring lymph nodes — removing them from another area of the body and transplanting them to the affected area — can help restore the flow of lymph fluid away from the limb, alleviating swelling. Dr. Smith and his colleague Dr. Joseph Dayan developed a technique called reverse lymphatic mapping that allows the surgeon to determine which lymph nodes are safe to transfer and minimizes the risk of causing lymphedema at the site from where they were taken.
“Early diagnosis and conservative treatment can help control the symptoms of lymphedema. However,” adds Dr. Smith, “for patients whose condition is progressive or who are having infections, lymph node transfer may halt or reverse their lymphedema and help improve their quality of life.”
To learn more about lymphedema care offered at the Friedman Center for Lymphedema Research and Treatment at Mount Sinai Beth Israel, call 1-855-411-LWNY (5969) or visit its website.