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home : columns : ask the doctors November 14, 2019

8/7/2019 7:26:00 AM
Lymphedema common after cancer treatments

Dear Doctor: My best friend had a successful breast cancer surgery last spring. But the surgeon took out some lymph nodes, and now she's getting lymphedema in her left arm. Is it true that there's no cure?

Dear Reader: Lymphedema is the name for swelling that occurs when there is a blockage to the lymphatic system. Often, as in your friend's case, it arises when lymph nodes are removed or damaged during cancer surgery or treatment.

The condition can also be caused by infection, inflammation, injury or certain illnesses. Lymphedema is most common in the arms or legs, but it can occur anywhere in the body in which the lymphatic system is blocked. While there is no cure, recent developments in diagnostic tools offer hope for managing the condition.

The lymphatic system is a remarkable network of tissues, organs, ducts and nodes that collect and disperse lymph, or lymphatic fluid, throughout the body. If you've ever scraped yourself and noticed the clear fluid that seeps from the wound, that's lymph. It's made up of fats, proteins, white blood cells and cellular waste, and it is an integral part of the immune system.

The lymphatic vessels that transport lymph throughout the body have valves that keep the fluid moving in one direction. But unlike our circulatory system, which utilizes the heart to move blood through the body, the lymphatic system has no central pump.

Instead, it relies largely on the movement of skeletal muscles to keep lymph moving. Lymph vessels carry the lymphatic fluid throughout the body and eventually to the lymph nodes -- hundreds of small, round structures that collect the fluid and filter out the waste and bacteria it carries. When enough lymph nodes are damaged or removed, that part of the lymph system is blocked. The result is that fluid collects and causes the swelling known as lymphedema.

The condition can be painful; it can result in tissue damage and infection, and often limits a person's range of motion in the affected limb.

At this time, treatment focuses on managing swelling and pain. This includes the use of compression garments, physical therapy and lymphatic massage, a technique performed by trained specialists to manually disperse the accumulated lymphatic fluid. Strides are also being made in microsurgery, including lymph node transfer and the repair of lymph vessels.

More recently, a diagnostic technique called bioimpedance spectroscopy, which uses an electric current to measure the buildup of extracellular fluid, is seen as a potential advance in the early detection of lymphedema. This is important because the sooner that patients begin lymphedema therapies, the better the condition can be controlled. Last year, small studies into the use of certain anti-inflammatories to manage swelling also showed promise.

Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health. Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.





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