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Archive for Tuesday, December 30, 2008

Hospitals testing ways to prevent lymphedema after breast cancer

December 30, 2008

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— Hospitals in about a dozen states are testing whether some simple steps, such as arm-strengthening exercises, could reduce the risk of one of breast cancer’s troubling legacies — the painful and sometimes severe arm swelling called lymphedema.

Lymphedema has long been a neglected side effect of cancer surgery and radiation: Many women say they never were warned, even though spotting this problem early improves outcomes.

And while less invasive surgical techniques mean fewer breast cancer patients today than just a few years ago should face lymphedema, it’s a lingering threat for tens of thousands of survivors because it can strike two decades after their tumor was treated.

“I have ladies tell me the lymphedema is much worse than their cancer because the cancer’s cured,” says Dr. Electra Paskett, an epidemiologist at Ohio State University who is leading the first-of-its-kind research into possible protective steps.

Among them: Wearing elastic sleeves to counter temporary swelling during things like airplane flight or heavy lifting, and doing special exercises with light weights designed to help keep open the lymph channels that allow fluid to drain through the body.

“The theory is building up muscles in your arm acts as a natural pneumatic pump to move the fluid,” explains Paskett, herself a breast cancer survivor who developed lymphedema.

When lymph nodes under a breast cancer patient’s arm are removed or damaged by biopsy, surgery or radiation, lymph fluid can build up and cause anything from mild swelling to a ballooning of the arm.

Lymphedema isn’t just a legacy of breast cancer treatment. The leg can swell if groin nodes are damaged from other cancers, including gynecologic cancer. Melanoma treatment left former presidential candidate John McCain with facial swelling.

But lymphedema among breast cancer survivors may be most common. It’s been estimated to affect between 20 percent and 30 percent of patients who have 10 or more under-the-arm nodes examined, called an “axillary lymph node dissection.”

A surprising study published in November’s Journal of Clinical Oncology suggests few such women may be diagnosed. University of Minnesota researchers analyzed records from the huge Iowa Women’s Health study, to cull more than 1,200 patients who’d had breast cancer between 1986 and 2003. Eight percent had been formally diagnosed with lymphedema yet another 37 percent of the women suffered symptoms.

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