Testicular cancer and lymphedema

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Testicular cancer and lymphedema

Postby patoco » Sun Jun 11, 2006 9:19 am

Testicular cancer, prostrate cancer and lymphedema

Our Home Page: Lymphedema People

http://www.lymphedemapeople.com

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Single drug dose effective after cancer surgery

July 22, 2005 06:27:29 PM PST

After surgery, a single dose of carboplatin appears to be just as effective in preventing relapse as three weeks of radiation therapy in men with early-stage testicular cancer, according to the findings of a study published in this week's issue of The Lancet. Carboplatin also appears to be associated with less severe adverse effects and lower risk of developing a tumor in the other testicle.

Although radiotherapy has long been the accepted treatment approach, research has suggested that it may increase the risk of later developing other types of cancer and cardiovascular disease. Based on preliminary study findings that found one course of carboplatin is as effective as radiation, Dr. R. T. D. Oliver and colleagues initiated a trial comparing the two strategies.

Oliver, from St. Bart's and the London Hospital in the UK, and colleagues included 1,477 patients with stage I testicular cancer from 70 hospitals in 14 countries treated between 1996 and 2001. The analysis included 885 men randomly assigned to radiotherapy and 560 to carboplatin. The subjects were followed for an average of four years.

The relapse-free rate at three years was 95.9 percent in the radiation group and 94.8 percent in the carboplatin group, a nonsignificant difference. New, second primary testicular germ-cell tumors developed in 10 patients treated with radiation and two treated with carboplatin. One testicular cancer-related death occurred in the radiation group.

There were no significant differences at two years in gonadal function as measured by hormone levels. Although adverse events were more common at 72 hours in the carboplatin group, carboplatin was associated with less lethargy over the next few of months and a more rapid return to work.

"This trial has shown the non-inferiority of carboplatin to radiotherapy in the treatment of stage I seminoma," the authors conclude. They add, "These findings need to be confirmed beyond four years' follow-up."

In a related commentary, Drs. Padraig Warde and Mary Gospodarowicz, from the University of Toronto, caution against adopting carboplatin as standard follow-up treatment after surgery for early-stage testicular cancer because surveillance alone seems to be a safe option.

However, they add, "We do agree with Oliver and colleagues that adjuvant carboplatin is worthy of continued study and might be of benefit in some settings."

SOURCE: The Lancet, July 23, 2005.

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What Is Testicular Cancer?

American Cancer Society

Testicular cancer is cancer that typically develops in one or both testicles in young men. It is a highly treatable and usually curable form of cancer.

The testicles (also called the testes; a single testicle is called a testis) are a part of the male reproductive system. These 2 organs, each normally somewhat smaller than a golf ball in adult males, are contained within a sac of skin called the scrotum, which hangs beneath the base of the penis.

The testicles manufacture the male hormones, most of which is testosterone. They also produce sperm. Sperm cells are carried from the testicle by the vas deferens to the seminal vesicles, where they are mixed with fluid produced by the prostate gland. During ejaculation, sperm cells, seminal vesicle fluid, and prostatic fluid enter the urethra, the tube in the center of the penis through which both urine and semen are passed.

The testicles contain several types of cells, each of which may develop into one or more types of cancer. It is important to distinguish these types of cancers from one another because they differ in their prognosis (the course of disease and the outlook for cure) and in the ways they are treated.

Germ Cell Tumors

Over 90% of cancers of the testicle develop in certain cells known as germ cells. (Germ means seed; these are the cells that produce sperm.) The 2 main types of germ cell tumors (GCTs) that occur in men are seminomas (60%) and nonseminomas (40%). (The suffix -oma means tumor.) Seminomas and nonseminomas are recognized by their appearance under the microscope. They also have different patterns of spread.

These 2 kinds of cancer occur in about equal numbers. Some cancers contain both nonseminoma and seminoma cells. These are classified as nonseminomas because they grow and spread like nonseminomas.

Invasive testicular germ cell cancers can begin as a noninvasive form of the disease called carcinoma in situ or intratubular germ cell neoplasia. Researchers have estimated that it takes about 5 years for carcinoma in situ to progress to the invasive form of germ cell cancer. There is no practical way to detect carcinoma in situ before it develops into cancer, because it causes no symptoms. The only way to diagnose testicular carcinoma in situ is to have a biopsy. Some cases are found incidentally in men who have a testicular biopsy for some other reason, such as infertility. However, testicular carcinoma in situ is so rare that it is not reasonable to consider testicular biopsies as a screening test. Also, carcinoma in situ may not always progress to cancer.

When a testicular cancer becomes invasive, its cells have penetrated the surrounding tissues and may have spread through either the blood circulation or the lymph nodes (small, bean-shaped collections of white blood cells that fight infection) and lymphatic channels (fluid-filled vessels that connect the series of lymph nodes) to other parts of the body.

Seminomas: Seminomas develop from the sperm-producing germ cells of the testicle. The 2 main subtypes of these tumors are classical (or typical) seminomas and spermatocytic seminomas. Doctors can tell them apart by how they look under the microscope. Over 95% of seminomas are classical. These usually occur in men when they are between their late 30s and early 50s. This is an older population than those with nonseminomas.

The average age of men diagnosed with spermatocytic seminoma is about 55, which is 10 to 15 years older than the average age of men with typical seminomas. Spermatocytic tumors are different from classical seminomas. They grow very slowly and usually do not spread to other parts of the body.

Nonseminomas: These germ cell cancers tend to develop earlier in life than seminomas, usually occurring in men between their late teens and early 40s. The main types of nonseminomas are embryonal carcinoma, yolk sac carcinoma, choriocarcinoma, and teratoma. Most tumors are mixed with at least 2 different types, but this does not change treatment. All nonseminoma germ cell cancers are treated the same way, so the exact type of nonseminoma is not that important, except that they do have different patterns of spread.

Embryonal carcinoma: In this type of nonseminoma germ cell cancer, the embryonal cell type is the most plentiful. It is present in about 40% of testicular tumors. Pure embryonal carcinomas occur only 3% to 4% of the time. Seen under a microscope, these tumors can resemble tissues of very early embryos, with a diffuse pattern of disorganized and irregular, small rounded cells without specific organization into organ-like structures. This type of nonseminoma is more likely to grow rapidly and spread outside the testicle.

Yolk sac carcinomas: These are so named because their cells resemble the yolk sac of an early human embryo. Other names for this cancer include endodermal sinus tumors, infantile embryonal carcinoma, or orchidoblastoma. Yolk sac carcinoma is the most common form of testicular cancer in children. When they occur in children, these tumors usually are successfully treated. When yolk sac tumors develop in adults, however, they are more dangerous, especially if they are "pure" (that is, they do not contain other types of nonseminoma cells), although they still respond very well to chemotherapy if they have spread. This type of tumor releases a protein into the bloodstream known as alpha-fetoprotein (AFP). The presence of AFP helps confirm the diagnosis (see below).

Choriocarcinomas: This is a very rare and aggressive type of testicular cancer occurring in adults. Such cancers are likely to spread rapidly to distant organs of the body, including the lungs, bone, and brain. Pure choriocarcinoma does not often occur in the testicles. More often, choriocarcinoma cells are present with other types of nonseminoma cells in a mixed germ cell tumor. This type of tumor is classically associated with the production of another protein, human chorionic gonadotrophin (HCG), as discussed below.

Teratomas: Teratomas are germ cell tumors with areas that, when viewed under the microscope, resemble each of the 3 layers of a developing embryo: the endoderm (innermost layer), mesoderm (middle layer), and ectoderm (outer layer). The 3 main types of these tumors are the mature teratoma, immature teratoma, and teratoma with malignant transformation.

- Mature teratomas are tumors formed by cells similar to cells of adult tissues. They rarely spread to nearby tissues and distant parts of the body. They are usually treated by surgical removal, which is curative. Sometimes deposits of mature teratoma are found after chemotherapy to treat a nonseminomatous mixed germ cell tumor is finished. It is thought that these deposits represent elements of a tumor that are left behind after chemotherapy has killed the other components of the tumors.

- Immature teratomas are less well-developed cancers that may also spread to other organs. Their cells resemble those of an early embryo. Unlike mature teratomas, this type has a greater potential to invade and occasionally to metastasize, and it is this type that is sometimes found to relapse years after treatment.

- Teratoma with malignant transformation is a very rare cancer. These cancers contain some areas that look like mature teratomas and other areas that resemble types of cancers that develop outside of the testicle, in tissues such as muscles, the lungs or intestines, or the brain.

Stromal Tumors

Tumors can also arise in the supportive and hormone-producing tissues, or stroma, of the testicles. Such tumors are known as gonadal stromal tumors. They account for less than 4% of adult testicle tumors and up to 20% of childhood testicular tumors. The 2 main types are Leydig cell tumors and Sertoli cell tumors.

Leydig cell tumors: Leydig cell tumors develop from normal Leydig cells (also called interstitial cells) of the testicle. These are the cells that normally produce androgens (male not allowed hormones, like testosterone). Leydig cell tumors may develop in adults (75% of cases) or children (25% of cases). They often produce androgens but sometimes produce estrogens (female not allowed hormones). Most Leydig cell tumors do not spread beyond the testicle and are cured by surgical removal but a few spread to other parts of the body. Metastatic Leydig cell tumors have a poor prognosis because they do not respond well to chemotherapy or radiation therapy.

Sertoli cell tumors: These tumors develop from normal Sertoli cells, which support and nourish the sperm-producing germ cells. Like the Leydig cell tumors, they are usually benign; however, if they spread, they tend to be resistant to chemotherapy and radiation therapy.

Secondary Testicular Tumors

Secondary testicular tumors are those that start in another organ and then spread to the testicle. Lymphoma is the most common secondary testicular cancer. Among men older than 50, testicular lymphoma is more common than primary testicular tumors. Their prognosis depends on the type and stage of lymphoma. The usual treatment is surgical removal, followed by radiation and/or chemotherapy. In children with acute leukemia, the leukemia cells can sometimes form a tumor in the testicle.

Cancers of the prostate, lung, skin (melanoma), kidney, and other organs can secondarily spread to the testicles. The prognosis for these cancers is usually poor because these cancers generally spread widely to other organs as well. Treatment depends on the specific type of cancer.

Revised: 07/01/2005

http://www.cancer.org/docroot/cri/conte ... cer_41.asp?

AMERICAN CANCER SOCIETY

http://www.cancer.org/docroot/home/index.asp

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Testicular Cancer Resources

Testicular Cancer Resource Center

http://tcrc.acor.org/

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Testicular Cancer - Medline Plus Links Page/Info

http://www.nlm.nih.gov/medlineplus/test ... ancer.html

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Testicular cancer information centre

CancerBacup - UK

http://www.cancerbacup.org.uk/Cancertype/Testes

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Testicular Cancer

Cancer Information Network

http://www.cancerlinksusa.com/testicular/index.asp

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Testicular cancer

By Mayo Clinic staff

http://www.mayoclinic.com/invoke.cfm?id=DS00046

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Leg Swelling After Prostate/Testicular Cancer

With the advent of better and more effective cancer treatments, the survival rate for all cancers has risen dramatically. With this progress, a new and often misunderstood and misdiagnosed complication has arisen.

Many cancer survivors , having overcome cancer, find themselves with sudden and often unexplained swelling, usually of the arms or of the legs.

This swelling occurs because of one of several factors.

First, the swelling begins after lymph nodes have been removed for cancer biopsies.

Second, the swelling may start as a result of radiation damage to either the lymph nodes and/or the lymph system.

Due to either the removal of lymph nodes or damage to the lymph system, your body is no longer able to rid itself of excess fluids. The fluids collect in the limbs effected and swelling beings.

This swelling is called lymphedema. The swelling that occurs is permanent, and while it is not curable it is treatable.

Permanent Leg Swelling

****In the situation of any permanent leg swelling whether the cause is known or unknown, the diagnoses of lymphedema must be considered****

There are several groups of people who experience leg swelling from known causes, but it doesn't go away or unknown causes where the swelling can actually get worse as time goes by.

Group One

This group includes those who have had the injuries, infections, insect bites, trauma to the leg, surgeries or reaction to a medication. When this swelling does not go away, and becomes permanent it is called secondary lymphedema.

Group Two

Another extremely large group that experiences permanent leg swelling are cancer patients, people who are morbidly obese, or those with the condition called lepedema. What causes the swelling to remain permanent is that the lymph system has been so damaged that it can no longer operate normally in removing the body's waste fluid.

In cancer patients this is the result of either removal of the lymph nodes for cancer biopsy, radiation damage to the lymph system, or damage from tumor/cancer surgeries.

This is also referred to as secondary lymphedema.

Group Three

Group three consists of people who have leg swelling from seemingly unknown reasons. There may be no injury, no cancer, no trauma, but for some reason the leg simply is swollen all the time.

The swelling may start at birth, it may begin at puberty, or may begin in the 3rd, 4th or even 5th decade of life or sometimes later.

This type of leg swelling is called primary lymphedema. It can be caused by a genetic defect, malformation or damage to the lymph system while in the womb or at birth or be part of another birth condition that also effects the lymph system.

This is an extremely serious medical condition that must be diagnosed early, and treated quickly so as to avoid painful, debilitating and even life threatening complications. Treatment should NOT include the use of diuretics.

What is Lymphedema?

Lymphedema is defined simply as an accumulation of excessive protein rich fluid in the tissues of the leg. The accumulation of fluid causes the permanent swelling caused by a defective lymph system.

A conservative estimate is that there may be 1-2 million people in the United States with some form of primary lymphedema and two to three million with secondary lymphedema.

What are the symptoms of Lymphedema?

If you are an at risk person for leg lymphedema there are early warning signs you should be aware of. If you experience any or several of these symptoms, you should immediately make your physician aware of them.

1.) Unexplained aching, hurting or pain in the leg.

2.) Experiencing "fleeting lymphedema." This is where the limb may swell, even slightly, then return to normal. This may be a precursor to full blown leg lymphedema.

3.) Localized swelling of any area. Sometimes lymphedema may start as swelling in one area, for example the foot, or between the ankle and knee. This is an indication of early lymphatic malfunction.

4.) Any arm inflammation, redness or infection.

5.) You may experience a feeling of tightness, heaviness or weakness of the leg.

How is Lymphedema Treated?

The preferred treatment today is decongestive therapy. The forms of therapy are complete decongestive therapy (CDT) or manual decongestive therapy (MDT), there are variances, but most involve these two type of treatment.

It is a form of massage therapy where the leg is very gently massaged to actually move the fluid out of the leg and into an area where the lymph system still functions normally.

With these massage treatments, swelling is reduced and then the patient is fitted with a pre-measured custom pressure garment to keep the swelling down and/or is taught to use compression wraps to maintain the leg size.

What are some of the complications of lymphedema?

1. Infections such as cellulitis, lymphangitis, erysipelas. This is due not only to the large accumulation of fluid, but it is well documented that lymphodemous limbs are localized immuno-deficient.

2. Draining wounds that leak lymphorrea which is very caustic to surrounding skin tissue and acts as a port of entry for infections.

3. Increased pain as a result of the compression of nerves usually caused by the development of fibrosis and increased build up of fluids.

4. Loss of Function due to the swelling and limb changes.

5. Depression - Psychological coping as a result of the disfigurement and debilitating effect of lymphedema.

6. Deep venous thrombosis again as a result of the pressure of the swelling and fibrosis against the vascular system. Also, can happen as a result of cellulitis, lymphangitis and infections.

7. Sepsis, Gangrene are possibilities as a result of the infections.

8. Possible amputation of the limb.

9. Pleural effusions may result if the lymphatics in the abdomen or chest are to overwhelmed to clear the lung cavity of fluids.

10. Skin complications such as splitting, plaques, susceptibility to fungus and bacterial infections.

11. Chronic localized inflammations.

Can lymphedema be cured?

No, at the present time there is no cure for lymphedema. But it can be treated and managed and most of the complications can be avoided. Life with lymphedema can still be active and full, with proper treatment, patient education, and patient life style adaptation.

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Your Body After Cancer Treatment

Lymphedema: Arm or Leg Swelling

Lymphedema is a swelling of a part of the body, usually an arm or leg, that is caused by the buildup of lymph fluid. It can be caused by cancer or the treatment of cancer. There are many different types of lymphedema. Some types happen right after surgery, are mild, and don't last long. Other types can occur months or years after cancer treatment and can be quite painful. Lymphedema can also develop after an insect bite, minor injury, or burn.

People who are at risk for lymphedema are those who have had:

Breast cancer--if you had radiation therapy or had your underarm lymph nodes removed. Your risk is even higher if you had radiation in the underarm area after your lymph nodes were removed.
Melanoma of the arms or legs--if you had lymph nodes removed and/or had radiation therapy.

Prostate cancer--if you had surgery or radiation therapy to the whole pelvis.

Cancer of the female or male reproductive organs--if you were treated with surgery to remove lymph nodes or had radiation therapy.
Other cancers that have spread to the lower abdominal area. The pressure from the growing tumor can make it hard for your body to drain fluid.

Full article: http://www.nci.nih.gov/cancertopics/lif ... ment/page5

Cancer Resources and Information:

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Your Body After Cancer Treatment

http://www.nci.nih.gov/cancertopics/lif ... ment/page5

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Cancer Information on the Internet

http://www.hackley.org/medical_services ... _links.htm

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Cancer Resource Center

http://patient.cancerconsultants.com/li ... x?id=32333

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Cancer Lynx

http://www.cancerlynx.com/

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Cancer Information & Support International

http://www.cancer-info.com/

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Men's Health Topics - Medline Plus Information Topic and Links Page

http://www.nlm.nih.gov/medlineplus/menshealth.html

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Lymphedema

WHAT IS IT?

Lymphedema is a buildup of a fluid called lymph and protein in the tissues under the skin. Lymph accumulates when there is an obstruction to normal flow causing swelling, usually in an arm or leg. The lymph system is similar to the blood system in its network of vessels that carry lymph fluid throughout the body.

Trauma to lymphatic tissue by surgery or radiotherapy is the main cause of lymphedema in the context of cancer. It can result from surgery and/or radiation therapy during treatment for cancers of the breast, abdomen, melanoma, connective tissues (sarcomas) and the pelvic area, as well as lymphomas, in both men and women. Lymphedema may also be the result of infection, such as dermatophytosis in the foot.

Cancer tumors also can block the lymph vessels, especially in people with prostate cancer or lymphoma.

IF I HAVE CANCER WILL I DEVELOP LYMPHEDEMA?

Not necessarily. The most frequent cases occur in women with breast cancer; 10% to 25% of breast cancer patients will develop lymphedema. While most cases are mild, approximately 400,000 women cope daily with some degree of disfigurement, discomfort, and sometimes disability because of arm and hand swelling.

Because of improvements in radiation and surgical techniques (such as removing smaller samples of lymph nodes), lymphedema is less common today than it use to be. Lymphedema develops in about one in four breast cancer patients who have a mastectomy with lymph-node dissection. The risk doubles for those who also receive radiation treatments to the underarm area.

Radical prostatectomy, a procedure that removes the prostate gland, seminal vesicles and sometimes the nearby pelvic lymph nodes, can lead to lymphedema .One type of Kaposi’s sarcoma is called the lymphadenopathic form that can spread throughout the body and may aggressively involve lymph nodes, viscera, and occasionally the GI tract – resulting in a kind of lymphedema.

SENTINEL LYMPH NODE BIOPSY

If breast cancer spreads, it first goes to the lymph nodes under the arm. That's why women with breast cancer have these nodes examined. Until recently, surgeons would remove as many lymph nodes as possible, but this greatly increased the risk of lymphedema. More recently, a growing number of physicians have begun focusing on finding the sentinel nodes — the first nodes to receive the drainage from breast tumors and therefore the first to show evidence of cancer’s spread. Experts believe that if a sentinel node is removed and found to be healthy, then the chance of finding cancer in any of the remaining nodes is very small and no other nodes need to be removed. This spares as many as 75% of women who have no evidence of tumor spread to the axillary nodes the risk of complications, especially lymphedema.

WHEN DOES IT DEVELOP?

Lymphedema can appear any time after surgery or radiation treatment including many years later.

When the condition develops very soon after surgery, it is usually mild, and goes away within one to two weeks. It can also develop six to eight weeks after surgery or radiation. Again, this type of lymphedema usually goes away in a few weeks.

Unfortunately, the more common form of lymphedema in cancer survivors develops slowly over time. It may show up many months or even years after treatment ends and swelling can range from mild to severe. In most cases however, lymphedema appears between six and 12 months after treatment. While people who have many lymph nodes removed and radiation therapy have the highest risk of developing lymphedema, some high-risk patients won’t develop the condition.

WHEN TO CALL A PROFESSIONAL

Patients should contact a physician if they had a mastectomy, lower abdominal surgery or radiation treatments in the past, and the affected limb becomes red, painful or hot, or if it develops open sores or areas of broken skin. Doctors should be consulted especially if there is a fever in addition to swelling.

Diagnostic Tests

Usually, no specific testing is necessary to diagnose lymphedema, but tests may be done such as a blood count that can identify signs of infection. Ultrasound may be ordered to look for blood clots, which can cause swelling. Computed tomography (CT) may be used to find a tumor that could be blocking lymph vessels. In addition, there are more specialized tests that can identify lymph flow and lymph vessel abnormalities.

Symptoms

The first signs of lymphedema can be a change in a patient’s arms or legs or other affected area such as the groin. Initially, skin will remain soft, but if the problem continues, the limb may become hot and red and the skin hard and stiff. The lymph fluid that collects in the tissues can be very uncomfortable, but pain is not always present. Early symptoms of lymphedema may include:

A feeling of tightness around the arm on the area that was treated for cancer,

Decreased flexibility in a hand, elbow, wrist, fingers, or leg,

Difficulty fitting into clothing,

Tight fit of a ring, wristwatch, bracelet, or shoe,

Weakness, pain, aching or heaviness in the arm, legs, or feet,

Skin that looks shiny, has fewer folds, and feels stiff or taut,

A dull ache in the affected limb,

A feeling of tightness in the skin of the affected limb,
Difficulty moving a limb or bending at a joint because of swelling and skin tightness,

Pitting (small indentations left on the skin after pressing on the swollen area)

In most cases, only one arm or leg is affected. If the leg is involved, swelling usually begins at the foot, then progresses upward toward the ankle, calf and knee.

Severity

The severity is directly related to the extent of surgery and radiation treatment to the lymph nodes. Severity and general risk of developing lymphedema seems to increase with obesity, weight gain and infection in the affected area.

TREATMENTS

Lymphedema has no cure so treatment focuses on reducing the symptoms. Treatment has varied from virtually no treatment to surgery, but there are various practical methods to deal with the condition, including elevation of the limb (in the first year only), compression garments (no greater than 20-30 mm Hg), certain types of massage and exercises, pneumatic compression devices (controversial), and other types of physical therapy. Experts also recommend keeping the affected limb clean, dry and lubricated.

The National Lymphedema Network (www. Lymphnet.org) encourages massage by an specially certified expert in lymphedema massage.. In many cases, patients can also be trained to massage themselves to improve the flow of lymph fluids.

Medications

There are no medications to treat lymphedema. Diuretics have been found to be ineffective and may actually exacerbate the condition. Other medicines have been tried, but there is no clear evidence of significant effectiveness with any particular drug.

MILD LYMPHEDEMA:

Elevating the arm or leg above the level of the heart(during the first year) and flexing it frequently are basic methods to manage the condition. Since elevation is impractical except for short periods, patients should be fitted with an elastic sleeve, covering the arm or leg.

A significant reduction in edema (swelling) has been reported after wearing elastic sleeves for 6 consecutive hours per day. Using these garments during exercise, physical activity, and especially air travel is recommended, since air travel seems to exacerbate the condition.

If the legs are affected, avoid periods of prolonged standing. If working or standing a lot, a doctor may prescribe special graduated compression stockings to wear throughout the day. A doctor may also suggest a protein-rich, low-salt diet for those who are over-weight or obese.

MODERATE TO SEVERE:

For people with moderate to severe lymphedema in the legs, doctors prescribe pneumatic compression devices to be used at home to help reduce limb swelling. The “pneumatic stockings” are worn every day for an hour or two to reduce the swelling. Once the swelling has been reduced, a person may still need to wear elastic stockings up to the knee every day from the moment of rising until bedtime.

For lymphedema in the arm, pneumatic sleeves--like pneumatic stockings--can be used every day to reduce the swelling; elastic sleeves may also be needed.

Others recommend a special type of massage therapy called manual lymph drainage. Antibiotics also may be prescribed to prevent or treat infection in the affected limb. Since skin infections can be more serious in people with lymphedema, a person may need to have antibiotics administered intravenously in the hospital during an infection.

Complex Decongestive Therapy

More serious cases of lymphedema can be treated with Complex Decongestive Therapy by a physical therapist or other health care professional, who has special training. Complex Decongestive Therapy consists of skin care, massage, special bandaging, exercise, and fitting for a compression sleeve. Seeking and getting treatment early should lead to a shorter course of treatment to get the lymphedema under control. While most insurance companies will pay for this treatment, some do not.

Someone certified in the procedure should perform Manual Lymph Drainage (MLD).

In the case of lymphedema of the arm, the procedure involves a type of massage that moves built up fluid around the blocked vessels and across the chest to the other side of the body where the lymphatic system is still in tact. Usually the healthy area will be “worked” first. After each treatment, the effected area is carefully bandaged with a special layered wrap that looks like an ace bandage but is made of a different fabric. The wrap is important for keeping the effected limb de-congested. An average course is 15 daily treatments of 60 to 90 minutes each. After a MLD course of treatments, the patients will wear a compression garment every day. The patient should be measured for a new compression sleeve every six months or so. Sometimes a yearly MLD treatment course is recommended as a kind of “tune up.”

PREVENTING COMPLICATIONS

Because lymphedema development may occur even after several decades, patients should monitor themselves for signs of lymphedema and report any changes to their physicians.

Prevention is important and can require daily attention to manage the symptoms of swelling in particular. Arm and hand precautions are based on two key ideas: (1) Do not increase lymph production, which is directly proportional to blood flow, and (2) do not increase blockage to lymph system. Therefore, patients should avoid excessive heat, infections, and overly-strenuous arm exercises which would increase blood flow in the arm and thereby increase lymph production.

MANAGING LYMPHEDEMA

Patients should follow these suggestions to manage their lymphedema:

Avoid puncturing or injuring the skin in any way. Use first aid care if there is a break in the skin.

Avoid vaccinations, injections, blood pressure monitoring, blood drawing, and intravenous administration in the arm affected.

Avoid tight-fitting clothing or jewelry.

Avoid heat, such as with sunburns or tanning, baths, and saunas.

Avoid strenuous exertion, but do exercise while wearing compression garments.

Exercise, But Avoid Muscle Strain
It is important to use your affected limb for normal everyday activities, yet overuse can cause lymphedema to occur in some people. Follow these suggestions whenever possible:

Use affected arm or leg as normally as possible until fully healed, about 4 to 6 weeks after surgery or radiation treatment.

Exercise regularly but do not strain the arm or leg. Before any strenuous exercise, such as weightlifting or tennis, talk with a doctor, nurse, or physical therapist about specific goals and limitations to decide what level of activity is right. Ask if a fitted sleeve or stocking should be worn during strenuous activities or while flying.

If an arm or leg starts to ache, lie down and elevate it.

Avoid vigorous, repeated activities, heavy lifting, or pulling.

Watch for early signs of infection: rash, red blotches, swelling, increased heat, tenderness, or fever. Call a doctor right away if there are signs of infection.

Experts also recommend that those with lymphedema avoid any trauma to the area affected.

Trauma includes extreme temperature changes, repetitive movements against resistance (pushing or pulling), heavy lifting, and excessive exercise.

For More Information

American Cancer Society

The American Cancer Society held an international conference on lymphedema in 1998 in New York City. It involved 60 of the world’s leading experts and included a forum of more than 250 breast cancer survivors, leaders of breast cancer advocacy groups, and others. The conference report plus a lymphedema resource guide are available as a book from the ACS at cancer.org. (See below for title.)

National Lymphedema Network

The National Lymphedema Network is a charitable organization with an international scope. Founded in 1988, the Network’s mission is to provide education and guidance to patients and health care professionals. The Network promotes standardizing quality treatment for lymphedema patients. In addition, the organization supports research into the causes and possible alternative treatments for this “often incapacitating, often-neglected condition.”

Sources:

Current Trends in Lymphedema Management, Esther Muscari Lin, RN, MSN, CS, ACNP, AOCN, November 7, 2002.
American Cancer Society, Cancer (Vol. 92, No. 4: 748-752). http://www.cancer.org/

Cancer Principles and Practices of Oncology, Lippincott Williams &
Wilkins, 6th Edition, 2001. http://www.lww.com/productdetailresults ... 60,00.html

Harvard Medical School, Intelihealth.com, http://www.intelihealth.com/IH/ihtIH?t= ... SIHW000|~b, |

Lymphatic Research Foundation, http://www.lymphaticresearch.org/

Lymphedema Online Support Group, http://www.acor.org/.

Lymphology Association of North America, offers professional certification. http://www.clt-lana.org/main.html

Merck Manual, 17th Edition, 1999. http://www.merck.com/pubs/mmanual_home/contents.htm

National Lymphedema Network,

http://www.lymphnet.org/

https://www.cancerpage.com/centers/Side ... hedema.asp

.............................

For extensive information on lymphedema, please visit our home page:

Lymphedema People

http://www.lymphedemapeople.com

(c) Copyright 2005 by Pat O'Connor and Lymphedema People. Use of this information for educational purpose is encouraged and permitted. It must be available free and without charge and not used for financial renumeration or gain. Please include an acknowledgement to the author and a link to Lymphedema People.
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