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.
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.
In the situation of any permanent leg swelling whether the cause is known or unknown, the diagnoses of lymphedema must be consideredThere 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.
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.
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 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.
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.
If you are an at risk person for leg lymphedema there are early warning signs you should be aware of. If you experience any or several of these symptoms, you should immediately make your physician aware of them.
1.) Unexplained aching, hurting or pain in the leg.
2.) Experiencing “fleeting lymphedema.” This is where the limb may swell, even slightly, then return to normal. This may be a precursor to full blown leg lymphedema.
3.) Localized swelling of any area. Sometimes lymphedema may start as swelling in one area, for example the foot, or between the ankle and knee. This is an indication of early lymphatic malfunction.
4.) Any arm inflammation, redness or infection.
5.) You may experience a feeling of tightness, heaviness or weakness of the leg.
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.
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.
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.
© 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.
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
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.
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. 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/docroot/CRI/content/CRI_2_4_1X_What_is_prostate_cancer_36.asp?sitearea=
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ScienceDaily (Nov. 27, 2007) — More than a third of men with early prostate cancer who participated in a study analyzing treatment choice received therapies that might not be appropriate, based on pre-existing problems with urinary, bowel or sexual function. The prevalence of these treatment “mismatches” could reflect patient' unwillingness to discuss such problems with their physicians.
“Prostate cancer patients experience the same fears and hard decisions as all cancer patients do, but prostate cancer treatment directly affects very personal things that most people aren't comfortable talking about – urinary, bowel and sexual function,” says James Talcott, MD, SM, of the Center for Outcomes Research at Massachusetts General Hospital (MGH) Cancer Center, who led the study. “In this case, however, having that information matters because the three major treatments available to patients have different patterns of potential side effects. Knowing if patients already have problems in these areas should help guide treatment decisions.”
The standard treatment options for early prostate cancer are external radiation therapy; brachytherapy, in which tiny radioactive particles are implanted into the prostate gland; and prostatectomy, surgical removal of the prostate gland. These approaches have similar levels of effectiveness, but each presents a different risk of side effects – external radiation can lead to bowel dysfunction, brachytherapy may cause urinary problems, and surgery can damage nerves involved in sexual function.
For patients who already have problems in these areas, therapies that could worsen their symptoms are usually not recommended. In addition, approaches designed to preserve normal functions, such as nerve-sparing prostate-removal surgery, would not be appropriate for patients for whom those functions have already been lost.
To investigate the frequency of treatment mismatches, the research team enrolled patients treated for early prostate cancer at four Boston centers over a six-year period. Study participants completed a questionnaire before beginning treatment and subsequent questionnaires at intervals of 3, 12, 24 and 36 months after they entered the study. They also gave the researchers – who were not involved in their clinical care – permission to review their medical records. The questionnaires were designed to assess urinary incontinence and other urinary problems, along with bowel and sexual dysfunction. Participants were also asked to assess their level of distress with any symptoms they experienced.
Of the almost 440 patients who completed the entire study, 389 or 89 percent reported having some level of urinary, bowel or sexual problem before beginning treatment. Those participants were classified into four groups. Group 1 was patients with serious symptoms in a single area, for whom decisions would be expected to be the most straightforward. Group 2 had less serious symptoms that would count against a single treatment option. Group 3 had problems in several areas but still had one potentially appropriate treatment. Group 4 included those patients with significant dysfunction in all three areas, for whom none of the treatment options would be recommended.
The study results showed similar levels of treatment mismatches in all groups – 34 percent in Group 1, 37 percent in Group 2, and 40 percent in Group 3. Among Group 4 patients – those with dysfunction in all three areas – only 5 percent chose watchful waiting, a strategy in which they receive no treatment but are followed closely by their medical team. Since patients take many considerations into account when choosing therapies, the surveys asked about several factors that might affect those decisions, none of which could account for the mismatched choices. As expected, patients reporting pre-existing conditions were more likely to have problems after treatment if they had received a mismatched treatment.
“It could be that treatment choices are determined by factors other than those we asked about, or patients may decide to go ahead with mismatched treatments for their own reasons, knowing the risks,” Talcott says. “But it also could be that the open, frank conversations patients should have with their doctors aren't taking place or that doctors aren't making it clear to patients why they should be forthright about urinary, bowel or sexual problems they are having.” He and his colleagues theorize that patients may be more open about addressing sensitive topics on a questionnaire than they are in conversation and suggest that factoring such a questionnaire into treatment decisions could reduce mismatches, a strategy they hope to study in the future.
Journal article: “Treatment 'Mismatch' In Early Prostate Cancer: Do Treatment Choices Take Patient Quality of Life Into Account?” Ronald C. Chen, Jack A. Clark, Judith Manola, and James A. Talcott, Cancer; Published Online: November 26, 2007 (DOI: 10.1002/cncr.23138); Print Issue Date: January 1, 2008.
First author of the Cancer study is Ronald Chen, MD, of the MGH Cancer Center; the other co-authors are Jack Clark, MD, Boston University School of Public Health, and Judith Manola, MS, Dana-Farber Cancer Institute. The study was supported by a grant from the Agency for Healthcare Research and Quality.
Adapted from materials provided by Massachusetts General Hospital.
by Jeanie Lerche Davis WebMD Feature Reviewed by Brunilda Nazario, MD
Like his favorite car, a guy's body needs regular checkups — one that includes a screening for prostate cancer, otherwise known as a PSA test. The risk of prostate cancer goes up every year after age 50, that's why men need to take steps in preventing it, or making sure it's detected early.
The prostate-specific antigen (PSA) test is the best way to detect prostate cancer in its early stages. It's typically done along with a rectal exam, because most malignant prostate tumors start nearest the rectum. With these two exams, prostate cancer can be detected when it's most treatable.
Though all men should get a PSA test after the age of 50, some may need one sooner, if they have certain prostate cancer risk factors, which include:
Family history: Having a father or brother with prostate cancer more than doubles your risk, according to the American Cancer Society. Men who have multiple family members affected have even higher risk — so screening should start at age 40.
Ethnicity: African-American men have 60% higher rate of prostate cancer, compared to white American men — so they should also begin screening at age 40.
Diet: A high-fat diet seems to contribute to prostate cancer. Switching to a diet high in the antioxidant lycopene may lower your risk — so get plenty of tomatoes, pink grapefruit, and watermelon, which contain high levels of lycopene.
Sedentary lifestyle: Getting regular exercise — and keeping weight under control — seems to reduce risk for prostate cancer, and especially for aggressive cancer. One survey of nearly 70,000 American men found that those who lost at least 11 pounds over a 10-year period were about 40% less likely to develop aggressive prostate cancers, compared to guys who had little weight change.
Age: This is the biggest factor. After age 50, prostate cancer risk rises significantly. About two-thirds of all prostate cancers occur in men age 65 and older. Published September 12, 2007.
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.