Each year, more than a quarter of a million cases of breast cancer are diagnosed, according to the US Centers for Disease Control and Prevention (CDC). Adding to the stress of being diagnosed, patients who must have surgery as part of their treatment face the possibility of developing lymphedema, a condition experts say is caused by a disorder in the body’s lymphatic system. A local cancer expert recently spoke about the symptoms and risks of lymphedema, as well as its treatment and prevention.
“Women who undergo a lymph node biopsy for breast cancer are at risk of developing lymphedema. In most patients, the risk is very low but this is still a risk,” he says. Hilary Shapiro-Wright, DoAnd the Breast Surgical Oncologist at Baptist Health Christine E. Lin Institute of Women’s Health and Wellness And the Eugene M and Christine E. Lin Cancer Institute.
Dr. Shapiro-Wright notes that lymphedema does not usually occur immediately after surgery but does develop over time. “Lymphedema can occur at any time after surgery,” she says. “Therefore, it is common to evaluate patients starting soon after surgery and for several years thereafter to monitor for subclinical lymphedema.”
Disabling the lymphatic system
The body’s lymphatic system is made up of a network of vessels, ducts, and lymph nodes that “act as filters that pick up the bad stuff and, hopefully, prevent it from spreading to other parts of the body,” says Dr. Shapiro-Wright. She adds that the problem is a disorder of the lymphatic system, which leads to a buildup of fluid that can occur after a patient undergoes a lymph node evaluation with lymph nodes removed at the time of surgery for breast cancer.
Dr. Shapiro-Wright says that many people with early-stage lymphedema have no obvious symptoms. “In its invisible early stage, lymphedema can be subclinical, which means you can have it and not even know it,” she says.
Some patients with early (invisible) lymphedema may not notice anything at all or even just slight changes to their clothing or jewelry fittings differently. Other, more advanced symptoms can include heaviness, tightness, and visible limb enlargement.
In its most advanced form, known as elephantiasis lymphadenitis, the tissue becomes hard, the surface of the skin becomes thick and rough, unlike that of the elephantiasis, and excess skin can form on the limb. “These symptoms are what most people think of when they think of advanced lymphedema, but it’s very rare for someone to have such advanced disease,” says Dr. Shapiro-Wright. “But even at this late stage, treatment can still be beneficial.”
If left untreated, lymphedema can cause other conditions that can be serious, chronic and life-threatening, says Dr. Shapiro-Wright. These include a decrease or loss of limb function. skin breakdown; Chronic infections such as cellulitis, dermatitis. Sepsis, an infection in the bloodstream. And some irreversible complications, too.
Identification and diagnosis of lymphedema
At Lynn Women’s Health & Wellness Institute, specialized equipment uses bioimpedance technology to measure a patient’s intercellular fluid levels in the extremities prior to breast surgery, according to Dr. Shapiro-Wright. The patient is measured again after surgery and if any subclinical changes occur, they can easily be identified and measured.
‘Patient is standing on SOZO® The unit, a bio-impedance spectrometer that’s like a modern version of a standing meter in your doctor’s office, and in a matter of minutes we can measure and monitor your body’s fluid status and tissue composition,” Dr. Shapiro Wright says. SOZO is also used at the Health’s Gloria Drummond Physical Rehabilitation Institute Baptist Health at Boca Raton Regional Hospital.There, physical therapists with advanced degrees in treating lymphedema patients are able to assess and monitor the patient’s response to treatment.
Lymphedema can be treated and even reversed
Dr. Shapiro-Wright says early-stage lymphedema is “very easily treatable and reversible” with treatments such as elevation of the affected limb, physical therapy and lymphatic drainage-specialized manual massage.
More advanced diseases can be treated by wearing compression garments such as sleeves or gloves over the affected limb, or wrapping the limb with different levels of pressure. Another innovative treatment uses specialized coils with pneumatic pumps that Dr. Shapiro Wright says help keep your muscles moving lymph fluid through your system.
Even with late-stage lymphedema, these treatments still have a “remarkable effect” of softening tissue and reducing swelling, according to Dr. Shapiro-Wright. However, in more advanced cases, lymphatic bypass surgery, or lymphatic bypass, may be needed, she says.
Others are at risk of developing lymphedema
According to Dr. Shapiro Wright, breast cancer surgery patients are not the only ones at risk of developing lymphedema. Other risk factors include old age. Being overweight or obese. Rheumatoid arthritis or psoriatic arthritis. and radiotherapy.
Dr. Shapiro Wright notes that “a significant portion of patients who have had breast cancer surgeries recommend radiation exposure as part of their treatment,” adding that patients with more widespread disease who have to undergo regional nodal radiation to the axillary region are at an increased risk of developing edema. lymphatic;
If you have concerns about lymphedema, Dr. Shapiro-Wright advises speaking with your breast surgeon or primary care physician to determine if an evaluation with a physical therapist who specializes in lymphedema is recommended. Or, she says, you can call the Gloria Drummond Institute for Physical Rehabilitation directly at 561-955-4700.
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