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LYMPHEDEMA AND PROSTATE CANCER

Leg Swelling After Prostate 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?

IIf 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.

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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Prostate Cancer: Preventing Lymphedema

Sherri Hanfland, PT, CLT

In the last 5 years, significant strides have been made by the medical community to recognize the side effects that people experience when diagnosed with cancer. Fatigue and pain are two of the most common complaints reported by individuals undergoing cancer treatment. Another side effect that can occur as a result of cancer is a condition known as lymphedema. Lymphedema is a high protein swelling that may develop when cancer cells invade lymph nodes or cancer treatment is focused in these areas. This type of swelling can occur in one or both legs, the abdomen or genital region after prostate cancer. It can develop immediately after diagnosis or many months after the course of treatment is finished.

It is uncertain why some people develop lymphedema, but there are a few factors that can affect your individual risk. Skin care, exercise and compression are three components that you can control to reduce your chances of developing this condition. Making minor changes to your lifestyle can lesson your likelihood of developing lymphedema.

The lymph nodes are a filter system for foreign substances that enter into our bodies. If the lymph nodes have been removed by surgery or treated with radiation therapy, that filtering mechanism has been altered. Keeping your skin clean and well hydrated helps create a good defense barrier to prevent lymphedema. Daily use of a hypoallergenic moisturizer on your legs will keep your skin soft and prevent cracked, dry skin. Dry skin can allow small amounts of bacteria to enter the body, which over time can overwhelm your lymphatic system.

Exercise is another essential component to assist a patient with recovery from prostate cancer. Keeping muscles flexible helps reduce swelling, joint pain and stiffness that some patients experience after treatment. A walking program is an excellent aerobic way to improve your overall health and reduce pain, fatigue and swelling. The effects of exercise are well researched and have consistently shown to reduce symptoms associated with cancer. Be cautious not to exercise in the extreme heat of the day as some patients report developing swelling after being outside for many hours. You should also limit your time in hot tubs to reduce exposure to heat. Drink plenty of water to keep your body cool during your exercise routine. Make sure to discuss any new exercise programs with your doctor to ensure a safe progression into an active lifestyle.

Flying in an airplane, long rides in the car or excessive sitting can aggravate the circulation in your legs. This can lead to the development of lymphedema. Wearing compression stockings during these activities can promote good circulation and lessen your risk of swelling. It is important that your stockings are properly fit, because garments that are too tight can be harmful to your circulation. If you have had extensive radiation and/or surgical treatment for cancer, you may want to discuss the possibility of compression stockings with your doctor. Over the counter or even customized stockings can be ordered from vendors affiliated with most insurance companies.

Lymphedema is a complicated swelling to treat, because medications are usually not helpful with this condition. Occupational or physical therapy is the standard treatment that is shown to effectively manage this condition. Treatment involves a light massage known as manual lymphatic drainage, compression techniques, skin care, and exercises specifically designed to reduce the swelling. Lymphedema is a recognized complication due to breast cancer treatment. Physicians are now more aware that this condition can also occur with patients who have had prostate cancer. It is important for those who have had prostate cancer to watch carefully and report any swelling to their physician. Better results are often achieved when treatment is started early.

If you have any questions regarding lymphedema, you can call 404-501-5140 for more information. 

DEKALB MEDICAL CENTER

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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:

Full article: http://www.nci.nih.gov/cancertopics/life-after-treatment/page5

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What Is Prostate Cancer?

About the Prostate

The prostate, found only in men, is a walnut-sized gland located in front of the rectum and underneath the urinary bladder. It contains gland cells that produce some of the seminal fluid, which protects and nourishes sperm cells in semen. Just behind the prostate gland are the seminal vesicles that produce most of the fluid for semen. The prostate surrounds the first part of the urethra, the tube that carries urine from the bladder and semen out of the body through the penis.

Male hormones stimulate the prostate gland to develop in the fetus. Male hormones are also called androgens. The most common androgen is testosterone. The prostate continues to grow as a man reaches adulthood and is maintained after it reaches normal size as long as male hormones are produced. If male hormone levels go down, the prostate gland will not fully develop or will shrink.

Prostate Cancer

Although several cell types are found in the prostate, over 99% of prostate cancers develop from the glandular cells. Glandular cells make the seminal fluid that is secreted by the prostate. The medical term for a cancer that starts in glandular cells is adenocarcinoma. Because other types of prostate cancer are so rare, if you have prostate cancer, it is almost certain to be an adenocarcinoma. The rest of this document refers only to prostate adenocarcinoma.

Most prostate cancers grow slowly. Autopsy studies show that many older men who died of other diseases also had a prostate cancer that never affected them and that neither they nor their doctor were aware of. Some prostate cancers, however, can grow and spread quickly. Even with the latest methods, it is still hard to tell which cancers may become life-threatening and which likely do not need treatment.

Some doctors believe that prostate cancer begins with a condition called prostatic intraepithelial neoplasia (PIN). PIN begins to appear in men in their 20s. Almost 50% of men have PIN by the time they reach 50. In this condition there are changes in the microscopic appearance (size, shape, etc.) of prostate gland cells. These changes are classified as either low-grade, meaning they appear almost normal, or high-grade, meaning they look abnormal.

If you have had high-grade PIN diagnosed on a prostate biopsy, there is a 30% to 50% chance that cancer is also present within your prostate. For this reason, men diagnosed with high-grade PIN are watched carefully and have repeat prostate biopsies.

Revised: 01/01/2005

http://www.cancer.org/Cancer/ProstateCancer/OverviewGuide/prostate-cancer-overview-what-is-prostate-cancer

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Detailed Guide: Prostate Cancer
Get complete information about each of the topics below. Click a document title to read the document.

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Get Printer-Friendly Document: Prostate Cancer Detailed Guide
What Is It?
What Is Cancer?
What Is Prostate Cancer?
What Are the Key Statistics About Prostate Cancer?

Causes, Risk Factors and Prevention
What Are The Risk Factors for Prostate Cancer?
Do We Know What Causes Prostate Cancer?
Can Prostate Cancer Be Prevented?

Early Detection, Diagnosis, Staging
Can Prostate Cancer Be Found Early?
How Is Prostate Cancer Diagnosed?
How Is Prostate Cancer Staged?

Treating Prostate Cancer
How Is Prostate Cancer Treated?
Surgery
Radiation Therapy
Cryosurgery
Hormone (Androgen Deprivation) Therapy
Chemotherapy
Expectant Management (Watchful Waiting)
Treatment of Pain and Other Symptoms
Clinical Trials
Complementary and Alternative Methods
Considering Prostate Cancer Treatment Options
Treatment Options by Stage

Talking With Your Doctor
What Should You Ask Your Doctor About Prostate Cancer?
What Happens After Treatment?

More Information
What's New in Prostate Cancer Research and Treatment?
Additional Resources
References
Expert Answers

http://www.cancer.org/cancer/prostatecancer/detailedguide/

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Selected Research Abstracts Prostate Cancer

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Informing Men about Prostate Cancer Screening: A Randomized Controlled Trial of Patient Education Materials

J Gen Intern Med. 2008 Apr

Ilic D, Egberts K, McKenzie JE, Risbridger G, Green S.

Monash Institute of Health Services Research, Monash University, Clayton, Australia, dragan.ilic@med.monash.edu.au

BACKGROUND: Patient education materials can assist patient decision making on prostate cancer screening. 

OBJECTIVE: To explore the effectiveness of presenting health information on prostate cancer screening using video, internet, and written interventions on patient decision making, attitudes, knowledge, and screening interest. DESIGN: Randomized controlled trial. 

PARTICIPANTS: A total of 161 men aged over 45, who had never been screened for prostate cancer, were randomized to receive information on prostate cancer screening. 

MEASUREMENTS: Participants were assessed at baseline and 1-week postintervention for decisional conflict, screening interest, knowledge, anxiety, and decision-making preference. 

RESULTS: A total of 156 men were followed-up at 1-week postintervention. There was no statistical, or clinical, difference in mean change in decisional conflict scores between the 3 intervention groups (video vs internet -0.06 [95% CI -0.24 to 0.12]; video vs pamphlet 0.04 [95%CI -0.15 to 0.22]; internet vs pamphlet 0.10 [95%CI -0.09 to 0.28]). There was also no statistically significant difference in mean knowledge, anxiety, decision-making preference, and screening interest between the 3 intervention groups. 

CONCLUSION: Results from this study indicate that there are no clinically significant differences in decisional conflict when men are presented health information on prostate cancer screening via video, written materials, or the internet. Given the equivalence of the 3 methods, other factors need to be considered in deciding which method to use. Health professionals should provide patient health education materials via a method that is most convenient to the patient and their preferred learning style

PubMed

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Concordance of survival in family members with prostate cancer.

 J Clin Oncol. 2008 Apr

Hemminki K, Ji J, Försti A, Sundquist J, Lenner P.

Corresponding author: Kari Hemminki, German Cancer Research Center, Im Neuenheimer Feld 580, D-69120 Heidelberg, Germany; e-mail: k.hemminki@dkfz.de

PURPOSE Several earlier studies have assessed survival in prostate cancer based on familial risk of this disease. As a novel concept, we posit that factors governing survival in prostate cancer are likely to be different from those governing risk of prostate cancer. To prove this, we searched for familial clustering of survival (ie, concordance of survival among family members).

 PATIENTS AND METHODS We used the nationwide Swedish Family-Cancer Database to estimate hazard rates (HRs) for cause-specific and overall survival in invasive prostate cancer. HRs show the probability of death in the study group compared with the reference group. The study covered 610 sons of affected fathers with median follow-up times for survival ranging from 34 to 76 months. Results When the survival in sons was analyzed according to the fathers' length of survival, there was a concordance of prognosis; the HR was 0.62 for sons whose fathers had survived longer than 59 months, compared with sons whose fathers had survived fewer than 24 months (P for trend, .02). On a continuous scale, the sons' survival increased almost linearly with the fathers' survival time. When the analysis was reversed and HRs were derived for fathers, the concordance of good and poor survival remained. 

CONCLUSION The results are consistent in showing that both good and poor survival in prostate cancer aggregate in families. Genetic factors are likely to contribute to the results, which provide the first challenging population-level evidence on heritability in prognosis of prostate cancer.

PubMed

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Erectile Dysfunction After External Beam Radiotherapy for Prostate Cancer.

Eur Urol. 2008 Mar 24

Pinkawa M, Gagel B, Piroth MD, Fischedick K, Asadpour B, Kehl M, Klotz J, Eble MJ.

Department of Radiation Oncology, RWTH Aachen University, Pauwelsstrasse 30, 52057 Aachen, Germany.

BACKGROUND: There is a lack of prospective studies focusing on the sexual quality of life of prostate cancer patients after conformal radiotherapy (RT). 

OBJECTIVE: To evaluate the incidence, progression, and predictive factors for erectile dysfunction (ED). 

DESIGN, SETTING AND PARTICIPANTS: Patients who responded to the sexual domain of the Expanded Prostate Cancer Index Composite (EPIC) questionnaire before and more than 1 yr after RT and never received an antiandrogen treatment were included (n=123). INTERVENTION: RT dose was 70.2-72Gy. Eleven patients used a phosphodiesterase-5 (PDE-5) inhibitor. 

MEASUREMENTS: Patients responded to the EPIC questionnaire before (time A), at the last day (B), a median time of 2 mo after (C), and 16 mo after (D) RT. In a multivariate analysis, risk factors (patient age, prostate volume, planning target volume, use of PDE-5 inhibitor, comorbidities) were tested for their independent effects on ED before and after RT.

RESULTS AND LIMITATIONS: Sexual function and bother scores had already decreased by the end of RT (median function and bother scores at times A/B/C/D: 41/30/32/24 and 75/50/50/50). Initial function scores correlated well with late function scores (r=0.7; p<0.001). The ability to have an erection was reported by 81%/72%/74%/60% (preserved erectile ability in 70% at time D), erections firm enough for sexual intercourse by 44%/33%/35%/27% (preserved erections sufficient for intercourse in 53% at time D) of patients. A higher patient age and diabetes were predictive of both a pre-existing ED and a post-RT acquired ED. Nightly erections before treatment proved prognostically favourable (at least weekly vs. < weekly-hazard ratio of 5.9 for preserved erections sufficient for intercourse; p=0.01). Higher rates of ED can be expected with longer follow-up. 

CONCLUSIONS: The incidence of ED progressively increases after RT. Patient age and diabetes are risk factors for both pre-treatment and RT-associated ED. Nightly erections before RT proved prognostically favourable.

PubMed

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Colorectal complications of external beam radiation versus brachytherapy for prostate cancer.

Am J Surg. 2008 Mar 28

Lesperance RN, Kjorstadt RJ, Halligan JB, Steele SR.

Department of Surgery, Madigan Army Medical Center, Fort Lewis, WA, USA.

BACKGROUND: Although radiation therapy plays a central role in the management of prostate cancer, complications remain a troubling byproduct. We sought to determine the prevalence and significance of colorectal complications after external beam radiation (EBRT) versus brachytherapy (BT) for prostate cancer. 

METHODS: We performed a retrospective review of all patients undergoing EBRT or BT for prostate cancer from January 1999 to October 2005. Toxicities were graded using the Radiation Therapy Oncology Group scoring system or the modified Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer grading criteria. 

RESULTS: A total of 183 patients underwent EBRT and 50 patients underwent BT with a mean follow-up period of 39 months. BT was associated with significantly less acute (6% vs 43.5%) and late toxicities (2% vs 21.8%; both P < .001). Among patients receiving EBRT, acute grade 3 toxicity was experienced by 1 (.5%) patient, and grade 2 toxicity was experienced by 79 (43%) patients. Increased stool frequency was the most common manifestation (62%), followed by rectal pain and urgency (30%) and rectal bleeding (21%). Late toxicity included 34 (18.6%) patients with grade 2 toxicity (bleeding, 68%; frequent stools, 26%; pain and urgency, 18%), and 5 patients (2.7%) with grade 3 toxicity (bleeding requiring multiple cauterizations, 3; small-bowel obstruction requiring surgery, 1; anal stenosis requiring repeat dilations, 1). BT was relatively well tolerated, with only 3 patients (6%) experiencing grade 2 acute toxicity symptoms of pain and urgency. One BT patient suffered late grade 2 toxicity of bleeding requiring intervention. One patient developed rectal cancer 20 years after EBRT. 

CONCLUSIONS: Despite its relative safety, radiation therapy for prostate cancer has a significant incidence of colorectal complications. Overall, BT has a significantly lower incidence of acute and late toxicities than EBRT.

PubMed

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Dose-volume comparison of proton therapy and intensity-modulated radiotherapy for prostate cancer.

Int J Radiat Oncol Biol Phys. 2008 Mar

Vargas C, Fryer A, Mahajan C, Indelicato D, Horne D, Chellini A, McKenzie C, Lawlor P, Henderson R, Li Z, Lin L, Olivier K, Keole S.

Department of Radiation Oncology, University of Florida Proton Therapy Institute, Jacksonville, FL 32206, USA. c2002@ufl.edu

PURPOSE: The contrast in dose distribution between proton radiotherapy (RT) and intensity-modulated RT (IMRT) is unclear, particularly in regard to critical structures such as the rectum and bladder. 

METHODS AND MATERIALS: Between August and November 2006, the first 10 consecutive patients treated in our Phase II low-risk prostate proton protocol (University of Florida Proton Therapy Institute protocol 0001) were reviewed. The double-scatter proton beam plans used in treatment were analyzed for various dosimetric endpoints. For all plans, each beam dose distribution, angle, smearing, and aperture margin were optimized. IMRT plans were created for all patients and simultaneously analyzed. The IMRT plans were optimized through multiple volume objectives, beam weighting, and individual leaf movement. The patients were treated to 78 Gray-equivalents (GE) in 2-GE fractions with a biologically equivalent dose of 1.1. 

RESULTS: All rectal and rectal wall volumes treated to 10-80 GE (percentage of volume receiving 10-80 GE [V(10)-V(80)]) were significantly lower with proton therapy (p < 0.05). The rectal V(50) was reduced from 31.3% +/- 4.1% with IMRT to 14.6% +/- 3.0% with proton therapy for a relative improvement of 53.4% and an absolute benefit of 16.7% (p < 0.001). The mean rectal dose decreased 59% with proton therapy (p < 0.001). For the bladder and bladder wall, proton therapy produced significantly smaller volumes treated to doses of 10-35 GE (p < 0.05) with a nonsignificant advantage demonstrated for the volume receiving < or =60 GE. The bladder V(30) was reduced with proton therapy for a relative improvement of 35.3% and an absolute benefit of 15.1% (p = 0.02). The mean bladder dose decreased 35% with proton therapy (p = 0.002). 

CONCLUSION: Compared with IMRT, proton therapy reduced the dose to the dose-limiting normal structures while maintaining excellent planning target volume coverage.

Elsevier

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Pub Med Research Link Page

http://www.ncbi.nlm.nih.gov/sites/entrez

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Prostate Cancer - Medline Plus Information Links Page

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

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Prostate Diseases - Medline Plus Information and Links Page

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

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Prostate Cancer Foundation

http://www.prostatecancerfoundation.org/site/pp.asp?c=itIWK2OSG&b=46403

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Prostate Cancer - Web MD

http://www.medicinenet.com/prostate_cancer/article.htm

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National Prostate Cancer Coalition

http://www.fightprostatecancer.org/site/PageServer

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Cancer Resources and Information:

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Your Body After Cancer Treatment

http://www.nci.nih.gov/cancertopics/life-after-treatment/page5

-  -  -  -  -  -

Project to End Prostate Cancer

http://zerocancer.org/

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Cancer Resource Center

http://patient.cancerconsultants.com/links.aspx?id=32333

-  -  -  -  -  -

Cancer Lynx

http://www.cancerlynx.com/

-  -  -  -  -  -

Cancer Information  & Support International

http://www.cancersupportinternational.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: 

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:

https://www.cancerpage.com/centers/Sideeffects/lymphedema.asp

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Superficial Inguinal Lymph Nodes

1. Supramedial superficial inguinal
2. Superolateral superficial inguinal
3. Inferior superficial inguinal
4. Deep inguinal lymph nodes

 
 

As you can see from the above illustration and the link below, removal of lymph nodes for biopsy can affect the inguinal and iliac lymph nodes.

link no longer online

Inguinal and Iliac Nodes - Lymph System of the Lower Abdomen and Hip

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LYMPH NODES OF THE LOWER EXTREMITY

Pelvic lymph tissue

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Lower leg edema

http://www.nlm.nih.gov/medlineplus/ency/imagepages/8857.htm

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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

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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

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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

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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

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Lymphedema Glossary

http://www.lymphedemapeople.com/wiki/doku.php?id=glossary:listing

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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

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Home page: Lymphedema People

http://www.lymphedemapeople.com

Updated Jan. 13, 2012