Lymphedema
is swelling,LYMPHEDEMA AND MALE BREAST CANCER
Arm Swelling after Male Breast Cancer
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Home page: Lymphedema People
http://www.lymphedemapeople.com
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Arm and Leg Swelling After Male Breast 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 Arm or 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 and arm 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 and arm swelling are cancer patients, people who are morbidly obese, or those with the condition called lipedema. 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 arm 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 arm
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 arm lymphedema.
3.) Localized swelling of any area. Sometimes lymphedema may start as swelling in one area, for example the hand, or between the elbow and hand. 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 arm.
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.
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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Male Breast Cancer
Male breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast.
Many men do not realize that have breast tissue and that they can develop breast cancer. Until puberty, young boys and girls have a small amount of breast tissue consisting of a few ducts (tubular passages) located under the nipple and areola (area around the nipple). At puberty, a girl's ovaries produce female hormones, causing breast ducts to grow, lobules (milk glands) to form at the ends of ducts, and the amount of stroma (fatty and connective tissue surrounding ducts and lobules) to increase. On the other hand, male hormones produced by the testicles prevent further growth of breast tissue.
Like all cells
of the body, a man's breast duct cells can undergo cancerous
changes. Because women have many more breast cells than men do and
perhaps
because their breast cells are constantly exposed to the
growth-promoting
effects of female hormones, breast cancer is much more common in women.
Many types of breast disorders can affect both men and women. Most breast disorders are benign (not cancerous). Benign breast tumors do not spread outside of the breast and are not life threatening. Other tumors are malignant (cancerous) and may become life threatening. Benign tumors, such as papillomas and fibroadenomas, are common in women but are extremely rare in men.
Benign Breast Conditions
Gynecomastia is the most common male breast disorder. It is not a tumor but rather just an increase in the amount of a man's breast tissue. Usually, men have too little breast tissue to be felt or noticed. A man with gynecomastia has a button-like or disk-like growth under his nipple and areola, which can be felt and sometimes seen. Gynecomastia, common among teenage boys, is due to changes in hormone balance during adolescence. The same condition is not unusual in older men and is also due to changes in their hormone balance.
Rarely, gynecomastia can occur because tumors or diseases of certain endocrine (hormone-producing) glands cause a man's body to produce more estrogen (the main female hormone). Although men's glands normally produce some estrogen, it is not enough to cause breast growth. Diseases of the liver, which is an important organ in male and female hormone metabolism, can change a man's hormone balance and lead to gynecomastia.
Many commonly prescribed medications can sometimes cause gynecomastia, too. These include some drugs used to treat ulcers and heartburn, high blood pressure, and heart failure. Men with gynecomastia should ask their doctors about whether any medications they are taking might be causing this condition.
Klinefelter's syndrome, a rare genetic condition, can lead to gynecomastia and increase a man's risk of developing breast cancer. This condition is discussed further in the section on risk factors for male breast cancer.
General Information about Male Breast Cancer
Types of Breast Cancer
Understanding some of the key words used to describe various types of breast cancer is important. An alphabetical list of terms, including the most common types of breast cancer, is provided below:
Adenocarcinoma: This is a general type of cancer that starts in glandular tissues anywhere in the body. There are several subtypes of adenocarcinoma, which account for nearly all breast cancers.
Ductal carcinoma in situ (DCIS): DCIS is an uncommon type of breast adenocarcinoma in men. Cancer cells fill the ducts but do not invade through the walls of the ducts into the fatty tissue of the breast or spread outside the breast. It is almost always curable.
Infiltrating (or invasive) ductal carcinoma (IDC): Starting in a duct of the breast, this type of adenocarcinoma breaks through the wall of the duct and invades the fatty tissue of the breast. At this point, it can metastasize (or spread) to other parts of the body. IDC (alone or mixed with other types of invasive or in situ breast cancer) accounts for 80% to 90% of male breast cancers.
Infiltrating (or invasive) lobular carcinoma (ILC): ILC is a rare type of adenocarcinoma in men that arises from the ends of a man's breast ducts.
In situ: This term describes an early stage of cancer in which a tumor is confined to the immediate area where it began. Specifically in breast cancer, in situ means that the cancer remains confined to ducts (ductal carcinoma in situ [DCIS]) or lobules (lobular carcinoma in situ [LCIS]), and it has neither invaded surrounding fatty tissue in the breast nor spread to other organs in the body. DCIS occurs relatively often in both men and women. In contrast, LCIS is common in women but very rare among men.
Metastases: These are satellite tumors of a breast cancer that has spread from the site where it began (referred to as the primary cancer) to a lymph node or a distant organ, such as the lung, liver, or brain.
Microcalcifications: These are small calcium deposits, often found in clusters by a mammogram. These deposits, sometimes called calcifications, are neither cancer nor tumors. They are signs of changes within the breast, and certain patterns of calcifications can be associated with cancer or benign breast disease.
Node-positive and node-negative breast cancer: Node-positive means that the cancer has spread (metastasized) to the underarm (axillary) lymph nodes on the same side. Node-negative means that the biopsied lymph nodes are free of cancer, and this result indicates that the cancer is less likely to recur.
Paget's disease of the nipple: This type of breast cancer starts in the breast ducts and spreads to the skin of the nipple. It may also spread to the areola (the dark circle around the nipple). The skin of the nipple usually appears crusted, scaly, and red, with areas of itching, oozing, burning, or bleeding. Using the fingertips, a lump may be detected within the breast. If no lump can be felt, the prognosis (outlook for survival) is generally good. Paget's disease may be associated with in situ carcinoma or with infiltrating breast carcinoma. It accounts for about 1% of female breast cancers and a higher percentage of male breast cancers. Because the male breast is much smaller than the female breast, all male breast cancers start relatively close to the nipple, so spread to the nipple is more likely.
The following types of breast cancer are found in men:
Lobular carcinoma in situ (abnormal cells found in one of the lobes or sections of the breast), which sometimes occurs in women, has not been seen in men.
Risk factors for breast cancer in men may include the following:
A doctor should be seen if changes in the breasts are noticed. Typically, men with breast cancer have lumps that can be felt. A biopsy can be done to check for cancer. The following are different types of biopsies:
After the tissue or fluid has been removed, a pathologist views it under a microscope to check for cancer cells.
Survival for men with breast cancer is similar to that for women with breast cancer when their stage at diagnosis is the same. Breast cancer in men, however, is often diagnosed at a later stage. Cancer found at a later stage may be less likely to be cured.
The prognosis (chance of recovery) and treatment options depend on the following:
After breast cancer has been diagnosed, tests are done to find out if cancer cells have spread within the breast or to other parts of the body. This process is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. Breast cancer in men is staged the same as it is in women. The spread of cancer from the breast to lymph nodes and other parts of the body appears to be similar in men and women.
Stage 0 and stage I male breast cancer: For most men in this group, surgical removal of the cancer is the only treatment needed. This is usually done by mastectomy and removal of lymph nodes under the arm.
Lumpectomy or other breast-conserving procedures are rarely an option since the whole breast can be removed under local anesthesia. If breast-conserving procedures are done, they should be followed by radiation therapy.
Chemotherapy and/or adjuvant (additional) therapy with tamoxifen may be recommended for some men with stage I breast cancer, depending on its size and results of lab tests. Adjuvant therapy is used for tumors larger than 1 cm (about one-half inch) or with high growth rates.
Stage II male breast cancer: The options for surgery and radiation therapy are the same as with stage I cancers. But if the nodes contain cancer cells, adjuvant therapy is usually recommended. Hormonal therapy is suggested for all node-positive, estrogen receptor-positive tumors. Chemotherapy is also usually recommended. Choices about chemotherapy may be influenced by a man's age and general state of health. It is less likely to be chosen for older men, particularly those in poor health.
Radiation may also be recommended if several nodes are involved. Radiation therapy not only reduces the chance that the cancer will come back in the area of the breast, but it may actually increase the chance for cure. When node-negative cancers involve the chest muscle or the skin, radiation therapy after surgery may reduce the risk of local recurrence.
Stage III male breast cancer: This stage will be treated with surgery, followed by adjuvant tamoxifen therapy (if the tumor is estrogen or progesterone receptor positive) and chemotherapy. In addition, most doctors would recommend radiation therapy to the chest wall.
Stage IV male breast cancer: Systemic therapy is the primary treatment, using chemotherapy, hormonal therapy, or both. Immunotherapy with trastuzumab (Herceptin) alone or in combination with chemotherapy is an option for men whose cancer cells have high levels of the HER2/neu protein. Trastuzumab is generally not the initial treatment for these men, however, and is usually started after standard hormonal and/or chemotherapy is no longer effective.
Radiation and/or surgery may also be used to treat certain symptoms. Treatment to relieve symptoms depends on where the cancer has spread. For example, pain resulting from bone metastases may be treated with external beam radiation therapy and/or bisphosphonates such as pamidronate (Aredia). Bisphosphonates are drugs that can help prevent bone damage caused by metastatic breast cancer. (For more information about treatment of bone metastases, see our document "Bone Metastasis.")
Recurrent male breast cancer: If a patient has a local (breast or chest wall) recurrence and no evidence of distant metastases, cure is still possible. Surgical removal of the recurrence, followed by radiation therapy, is recommended whenever possible. If the area has already been treated with radiation, it may not be possible to give much or any additional radiation without severely damaging the normal tissues. Distant recurrences are treated the same way as metastases found at the time of diagnosis.
Recurrent breast cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the breast, in the chest wall, or in other parts of the body.
Different types of treatment are available for men with breast cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the “standard” treatment, the new treatment may become the standard treatment
Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.
Surgery for men with breast cancer is usually a modified radical mastectomy (removal of the breast, some of the lymph nodes under the arm, the lining over the chest muscles, and sometimes part of the chest wall muscles). Some of the lymph nodes under the arm may also be removed and examined under a microscope.
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly in the spinal column, a body cavity such as the abdomen, or an organ, the drugs mainly affect cancer cells in those areas. The way the chemotherapy is given depends on the type and stage of the cancer being treated.
Hormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. Hormones are substances produced by glands in the body and circulated in the bloodstream. The presence of some hormones can cause certain cancers to grow. If tests show that the cancer cells have places where hormones can attach (receptors), drugs, surgery, or radiation therapy are used to reduce the production of hormones or block them from working.
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
Breast cancer in men is treated the same as breast cancer in women.
Most men diagnosed with breast cancer will receive a modified radical mastectomy (removal of the breast, some of the lymph nodes under the arm, the lining over the chest muscles, and sometimes part of the chest wall muscles).
Therapy given after an operation when cancer cells can no longer be seen is called adjuvant therapy. Even if the doctor removes all the cancer that can be seen at the time of the operation, the patient may be given radiation therapy, chemotherapy, and/or hormone therapy after surgery to try to kill any cancer cells that may be left.
These treatments appear to increase survival in men as they do in women. The patient’s response to hormone therapy depends on the presence of hormone receptors (proteins) in the tumor. Most breast cancers in men have these receptors. Hormone therapy is usually recommended for male breast cancer patients, but it can have many side effects, including hot flashes and impotence (the inability to have an erection adequate for sexual intercourse).
For men with distant metastases (cancer that has spread to other parts of the body), hormone therapy, chemotherapy, or a combination of both has shown some success. Hormone therapy may include the following:
Hormone therapies may be used in sequence (one after the other). Standard chemotherapy regimens may be used if hormone therapy does not work. Men usually respond to therapy in the same way as women who have breast cancer.
For men with locally recurrent disease (cancer that has come back in a limited area after treatment), treatment is usually either:
Silence Can Be Deadly - Men and Breast Cancer
Sexual stereotypes have been a problem for ages. Nowhere is this more evident than in breast cancer statistics. Women are reminded by their doctors, nurses, sisters, mothers, aunts and cousins to make monthly breast exams part of their lives.
Mammograms are recommend as part of a regular physical for women over 40. Support groups exist for women of every age, race, religion and sexual orientation. Men are ignored or rebuffed, unless they are included as caregivers.
This introduction from one web site: "...empowers women who are newly diagnosed with breast cancer by providing them with a variety of resources to help them..."
Another features: "70% of all women who develop breast cancer have no risk factors."
Local fundraising events have fought to keep men from participating since they are not part of the sisterhood.
The truth is that men get breast cancer. They may not expect to and they may not get diagnosed, but they become members of this club much more often than anyone looking at the literature would believe. Close to one percent of all breast cancer patients are male. That means for every hundred diagnosed cases, one will be a man. When men are diagnosed they tend to have later stage, less treatable breast cancer. Men are dying from this disease because the focus has been on women only.
There has been some research on breast cancer in men. Several risk factors have been identified. Many of the risk factors for men are the same as for women. There is an increased risk for men of Jewish or African American heritage or who have a family history that includes genetic mutations associated with breast cancer.
Jobs that involve exposure to high temperatures and other environmental hazards such as exposure to electromagnetic fields or ionizing radiation have been linked to breast cancer in men.
Medical conditions that cause increases in estrogen levels or decreases in testosterone can cause changes in male breast tissue resulting in cancer. Mumps after childhood and Klinefelter's syndrome are other medical conditions that increase the risk of male breast cancer.
Symptoms are similar to breast cancer in women. A lump near the areola may be a sign of infiltrating ductal carcinoma. Nearly 90% of male breast cancer belongs in this category. However, men can also contract inflammatory breast cancer which presents as a rash or orange peel like texture of the skin.
Nipple discharge, an inverted nipple or swelling of the breast should be followed up by the same diagnostic tests that women with these symptoms receive. A mammogram, sonogram and biopsy if necessary should be obtained as soon as possible.
It is time to end the silence surrounding male breast cancer. Breast cancer is a treatable disease and the earlier it is diagnosed, the more likely it is that treatments will be effective - no matter what gender you belong to.
Margaret Chiffriller
http://www.malecare.org/male-breast-cancer_13.htm
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MALE BREAST CANCER
The male breast is similar in characteristics to the preadolescent girl's breast. Although breast cancer in males is very rare, it still can happen. All types of breast cancer seen in women can develop in men. In Canada, there will be 140 estimated new cases for 2003 of male breast cancer, and 40 deaths. In the USA, there will be 1,300 estimated new cases, and 400 deaths.
Early detection can be achieved by learning and practicing Breast Self Examination (BSE) on the same day every month.
RISK FACTORS
SYMPTOMS
DIAGNOSIS
A diagnosis of male breast cancer is confirmed by a physical exam of the breast, mammography, thermography and the definitive biopsy.
TREATMENT
Local
The diagnosis of breast cancer in males and the follow-up treatment can present certain problems. The psychosocial impact of a male getting a recognized female disease can impact his masculinity. As with a breast cancer diagnosis in females, he may experience feeling alone and helpless. Because of the surgery, it is recommended that patients do arm exercises to prevent frozen shoulder. Lastly, care must be taken of the arm on the surgical side to prevent Lymphedema, a serious and sometimes life-threatening swelling of the arm.
SIDE EFFECTS
Every man's experience is unique and different. Some of the side effects are:
RESOURCES
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Male Breast Cancer
http://www.pinkribbon.com/maleBChtm.htm
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Male Breast Cancer
http://www.askmen.com/sports/health/18_mens_health.html
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Male Breast Cancer
eMedicine
Last Updated: August 12, 2004
| Author: Marilyn A Roubidoux, MD, Associate Professor, Department of Breast Imaging, University of Michigan Medical Center |
| Editor(s): John M Lewin, MD, Consulting Radiologist, Diversified Radiology of Colorado; Bernard D Coombs, MBChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand; Edward Azavedo, MD, Director of Clinical Breast Imaging Services, Associate Professor, Department of Radiology, Karolinska Hospital, Sweden; Robert M Krasny, MD, Visiting Assistant Professor of Radiology, University of California at Los Angeles Medical Center; Consulting Staff, Healthcare Management Partners; and Eugene C Lin, MD, Consulting Staff, Department of Radiology, Virginia Mason Medical Center |
http://www.emedicine.com/radio/topic115.htm
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Detailed Guide: Male Breast Cancer
What Is Breast Cancer in Men?
American Cancer Society
http://www.cancer.org/docroot/CRI/content/CRI_2_4_1X_What_is_male_breast_cancer_28.asp?sitearea=CRI
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Breast cancer in men
http://www.cancerbacup.org.uk/Cancertype/Breast/Typesofbreastcancer/Breastcancerinmen
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Cancer Resources and Information:
- - - - - -
Your Body After Cancer Treatment
http://www.nci.nih.gov/cancertopics/life-after-treatment/page5
- - - - - -
Cancer Resource Center
http://patient.cancerconsultants.com/links.aspx?id=32333
- - - - - -
Cancer Lynx
- - - - - -
Cancer Information & Support International
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Male Breast Cancer
http://www.nlm.nih.gov/medlineplus/malebreastcancer.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:
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:
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:
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:
*Link no longer available
.................................
Lymphedema
is swelling,
http://www.biohorizonmedical.com/aboutlymph/aboutlymph.html
============================
Breast Cancer Organizations, Support Advocacy
The Breast Care Site
http://www.thebreastcaresite.com/tbcs
...............................................................
Circle
of Hope Lymphedema Foundation
http://www.lymphedemacircleofhope.org/
...............................................................
Susan G. Komen Breast Cancer Foundation
http://cms.komen.org/komen/index.htm
...............................................................
Pink
Ribbon Breast Cancer Resource Guide
http://www.pink-ribbon.org/
Breast
Cancer Association of Nova Scotia
http://bca.ns.ca
............................................................
Lymphedema
- Y Me National Breast Cancer Organization
http://www.y-me.org/diagnosed/lymphedema.php
...............................................................
theCancer.info Breast Cancer Links Page
http://www.cancerlinksusa.com/breast/index.asp
================================
Articles concerning breast cancer and lymphedema
Lymphedema
After Breast Cancer Treatment
October 2003
http://www.lifetimetv.com/reallife/bc/experts/amy_lymphedema.html
....................................................................
Lymphedema:
A Breast Cancer Patient's Guide to Prevention and Healing
by Jeannie Burt, Gwen White, Judith R. Casley-Smith
http://www.amazon.com/exec/obidos/tg/detail/-/0897932641?
br / v=glance
............................................................
Lymphovenous
Canada: Cancer and Lymphedema
http://www.lymphovenous-canada.ca/cancer.htm
.............................................................
Breast
Cancer Related
LYMPHEDEMA
http://www.infobreastcancer.ca/lymph1.htm
............................................................
Lymphedema
Awareness: Before, During And After Breast Cancer Surgery
Saskia R.J. Thiadens, R.N. 1998
http://www.lymphnet.org/lymphedemaFAQs/riskReduction/cancerSurgery.htm
............................................................
Excellent
article: Pain in the Lymphedematous arm following treatment of breast
cancer -
evaluation and treatment
http://www.lymphovenous-canada.ca/paincan.htm
............................................................
Article:
Controversies in Sentinel Lymph Node biopsy for Cancer
http://www.stanford.edu/group/sjeffreylab/PDF%20Files/JeffreyCancerBiother.pdf
............................................................
Article:
Introduction and Treatments for Lymphedema
Sabrina S. Selim, BA, Francine Manuel, RTP, Cheryl Ewing, MD, Ernest H.
Rosenbaum, MD
http://www.cancersupportivecare.com/lymph.html
............................................................
Breast cancer metastasis: a microRNA story
http://breast-cancer-research.com/content/10/2/203/abstract
............................................................
Breast Cancer Gene Ringleader Found
http://www.webmd.com/breast-cancer/news/20080311/breast-cancer-gene-ringleader-found
............................................................
Gene Signatures ID Bad Breast Cancers
http://www.webmd.com/breast-cancer/news/20080401/gene-signatures-id-bad-breast-cancers
............................................................
All about Breast Cancer Genes
http://www.lbl.gov/Education/ELSI/Frames/cancer-genes-f.html
............................................................
Breast Cancer (BRCA) Gene Test
http://www.webmd.com/breast-cancer/breast-cancer-brca-gene-test
............................................................
Familial breast cancer: characteristics and outcome of BRCA 1-2 positive and negative cases.
http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=15996267
================================================
Lymphedema
People Cancer Information Pages
Cervical, ovarian Cancer
http://www.lymphedemapeople.com/phpBB2/viewtopic.php?t=152
Kidney and Renal Cancer
http://www.lymphedemapeople.com/phpBB2/viewtopic.php?t=150
Hodgkins Disease or
Hodgkins Lymphoma
http://www.lymphedemapeople.com/phpBB2/viewtopic.php?t=149
Gynecological Cancer
http://www.lymphedemapeople.com/phpBB2/viewtopic.php?t=977
Leg Lymphedema After
Gynecological Cancer
http://www.lymphedemapeople.com/phpBB2/viewtopic.php?t=979
Kaposi’s Sarcoma
http://www.lymphedemapeople.com/phpBB2/viewtopic.php?t=641
Skin Cancer
http://www.lymphedemapeople.com/phpBB2/viewtopic.php?t=278
Testicular Cancer
http://www.lymphedemapeople.com/phpBB2/viewtopic.php?t=153
Primary Lymphedema and
Cancer
http://www.lymphedemapeople.com/phpBB2/viewtopic.php?t=277
Cutaneous T-cell Lymphoma
http://www.lymphedemapeople.com/phpBB2/viewtopic.php?t=147
Cutaneous B-cell Lymphoma
http://www.lymphedemapeople.com/phpBB2/viewtopic.php?t=146
My Life with Lymphedema
and Lymphoma
http://www.lymphedemapeople.com/wiki/doku.php?id=my_life_with_lymphedema_and_lymphoma
Lymphedema Affects
Quality of Life
http://www.lymphedemapeople.com/phpBB2/viewtopic.php?t=980
Angiosarcoma and Long
Term Lymphedema
http://www.lymphedemapeople.com/phpBB2/viewtopic.php?t=564
Colon Cancer
http://www.lymphedemapeople.com/thesite/lymphedema_and_colon_cancer.htm
Prostate Cancer
http://www.lymphedemapeople.com/thesite/lymphedema_and_prostate_cancer.htm
Melanoma
http://www.lymphedemapeople.com/thesite/lymphedema_and_melanoma.htm
Male Breast Cancer
http://www.lymphedemapeople.com/thesite/lymphedema_and_male_breast_cancer.htm
Leg Swelling
http://www.lymphedemapeople.com/thesite/leg_swelling.htm
Arm Swelling
http://www.lymphedemapeople.com/thesite/arm_swelling.htm
Swelling
http://www.lymphedemapeople.com/thesite/swelling.htm
Breast Cancer
http://www.lymphedemapeople.com/thesite/lymphedema_and_breast_cancer.htm
Lymphedema After Cancer -
How Serious Is It?
http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_after_cancer_-_how_serious_is_it
Secondary Lymphedema in
the Cancer Patient
http://www.lymphedemapeople.com/wiki/doku.php?id=secondary_lymphedema_in_the_cancer_patient
Complications of Breast
Cancer Radiotherapy
http://www.lymphedemapeople.com/wiki/doku.php?id=complications_of_breast_cancer_radiotherapy
Complete decongestive
therapy lymphedema in
breast cancer
http://www.lymphedemapeople.com/phpBB2/viewtopic.php?t=792
Patient self-massage for
breast cancer-related
lymphedema
http://www.lymphedemapeople.com/phpBB2/viewtopic.php?t=332
Predictive Factors of
Response to Intensive
Decongestive Physiotherapy in Upper Limb Lymphedema After Breast Cancer
Treatment: a Cohort Study
http://www.lymphedemapeople.com/phpBB2/viewtopic.php?t=283
Lymphedema Therapy and
the Quality of Life for
Breast Cancer Patients
http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_therapy_and_the_quality_of_life_for_breast_cancer_patients
Cancer Associated with
Lymphedema
http://www.lymphedemapeople.com/wiki/doku.php?id=cancer_associated_with_lymphedema
Pseudolymphomatous
Cutaneous Angiosarcoma: A
Rare Variant of Cutaneous Angiosarcoma Readily Mistaken for Cutaneous
Lymphoma.
http://www.lymphedemapeople.com/phpBB2/viewtopic.php?t=1178
Lymphomatoid Papulosis
http://www.lymphedemapeople.com/phpBB2/viewtopic.php?t=265
Papillomatosis cutis
carcinoides
Related Terms: Verrucous Carcinoma, Squamous Cell Carcinoma,
Epithelioma
cuniculatum, Carcinoma cuniculatum
http://www.lymphedemapeople.com/phpBB2/viewtopic.php?t=108
Cutaneous lymphomas assoc
with
lymphoproliferative disorders
http://www.lymphedemapeople.com/phpBB2/viewtopic.php?t=992
Aqua Lymphatic Therapy
for Postsurgical Breast
Cancer Lymphedema
http://www.lymphedemapeople.com/wiki/doku.php?id=aqua_therapy_for_postsurgical_breast_cancer_arm_lymphedema
Sporadic Cutaneous
Angiosarcomas
http://www.lymphedemapeople.com/phpBB2/viewtopic.php?t=1265
Axillary node biopsy
http://www.lymphedemapeople.com/wiki/doku.php?id=axillary_node_biopsy
Sentinel Node Biopsy
http://www.lymphedemapeople.com/wiki/doku.php?id=sentinel_node_biopsy
Small Needle Biopsy -
Fine Needle Aspiration
http://www.lymphedemapeople.com/wiki/doku.php?id=small_needle_biopsy
Extraperitoneal
para-aortic lymph node
dissection (EPLND)
also includes (1) Retroperitoneal Lymph Node Dissection and (2)
Laparoscopic
Retroperitoneal Lymph Node Dissection
http://www.lymphedemapeople.com/wiki/doku.php?id=extraperitoneal_para-aortic_lymph_node_dissection_eplnd
Lymphoscintigraphy
http://www.lymphedemapeople.com/wiki/doku.php?id=lymphoscintigraphy
Magnetic Resonance Imaging
http://www.lymphedemapeople.com/wiki/doku.php?id=magnetic_resonance_imaging
Cancer Glossary
http://www.lymphedemapeople.com/phpBB2/viewforum.php?f=36
Skin Glossary
http://www.lymphedemapeople.com/phpBB2/viewforum.php?f=42
================================================
Lymphedema People Online Support Groups
MEN WITH LYMPHEDEMA
If you are a man with
lymphedema; a man with a loved one
with lymphedema who you are trying to help and understand come join us
and
discover what it is to be the master instead of the sufferer of
lymphedema.
http://health.groups.yahoo.com/group/menwithlymphedema/
Subscribe: menwithlymphedema-subscribe@yahoogroups.com
Pat O'Connor
================================================
Join us as we work for lymphedema patients everywehere:
Advocates for Lymphedema
Dedicated to be an advocacy group for lymphedema patients. Working towards education, legal reform, changing insurance practices, promoting research, reaching for a cure.
http://health.groups.yahoo.com/group/AdvocatesforLymphedema/
| Subscribe: | AdvocatesforLymphedema-subscribe@yahoogroups.com |
Pat O'Connor
Lymphedema People / Advocates for Lymphedema
================================================
For information about Lymphedema
http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema\
For Information about Lymphedema Complications
http://www.lymphedemapeople.com/wiki/doku.php?id=complications_of_lymphedema
For Lymphedema Personal Stories
http://www.lymphedemapeople.com/phpBB2/viewforum.php?f=3
For information about How to Treat a Lymphedema Wound
http://www.lymphedemapeople.com/wiki/doku.php?id=how_to_treat_a_lymphedema_wound
For information about Lymphedema Treatment
http://www.lymphedemapeople.com/wiki/doku.php?id=treatment
For information about Exercises for Lymphedema
http://www.lymphedemapeople.com/wiki/doku.php?id=exercises_for_lymphedema
For information on Infections Associated with Lymphedema
http://www.lymphedemapeople.com/wiki/doku.php?id=infections_associated_with_lymphedema
For information on Lymphedema in Children
http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_in_children
===================================================
Lymphedema Glossary
http://www.lymphedemapeople.com/wiki/doku.php?id=glossary:listing
===================================================
All
About Lymphangiectasia Yahoo Support Group
Support group for parents, patients, children who suffer from all forms
of
lymphangiectasia. This condition is caused by dilation of the
lymphatics. It can
affect the intestinal tract, lungs and other critical body areas.
http://health.groups.yahoo.com/group/allaboutlymphangiectasia/
Subscribe: allaboutlymphangiectasia-subscribe@yahoogroups.com
Page Updated April 3, 2008