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leg_swelling_and_cervical_cancer

Leg Swelling After Cervical Cancer

Related Terms: edema, leg swelling, lymphedema, cancer, malignancies, Endocervical curettage (ECC), Colposcopic impression, Cystoscopy, Intravenous pyelogram (IVP), MRI, chemotherapy, radiation therapy, immune system, proctoscopy, Sigmoidoscopy, Anoscopy, Pap Imaging

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.

We have seen dramatic improvement in the treating of cervical cancer of the last several years and thankfully that means a much much higher survivorship.

The flip side however is that once women have overcome the cancer, the their leg begins swelling.

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.

Pat

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.

Lymphedema At Risk Groups

Group One

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

Group Two

Another extremely large group that experiences permanent leg swelling are cancer patients, people who are morbidly obese, or those with the condition called lepedema. What causes the swelling to remain permanent is that the lymph system has been so damaged that it can no longer operate normally in removing the body's waste fluid. In cancer patients this is the result of either removal of the lymph nodes for cancer biopsy, radiation damage to the lymph system, or damage from tumor/cancer surgeries.

This is also referred to as secondary lymphedema.

Group Three

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

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

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

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

What is Lymphedema?

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

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

What are the symptoms of Lymphedema?

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

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

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

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

4.) Any arm inflammation, redness or infection.

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

How is Lymphedema Treated?

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

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

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

What are some of the complications of lymphedema?

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

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

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

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

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

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

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

8. Possible amputation of the limb.

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

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

11. Chronic localized inflammations.

Can lymphedema be cured?

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

© 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.

Ovarian Cancer

Per the National Cancer Institute, cervical cancer is Cancer that forms in tissues of the cervix (the organ connecting the uterus and vagina). It is usually a slow-growing cancer that may not have symptoms but can be found with regular Pap tests (a procedure in which cells are scraped from the cervix and looked at under a microscope). Cervical cancer is almost always caused by human papillomavirus (HPV) infection.

Estimated new cases and deaths from cervical (uterine cervix) cancer in the United States in 2011:

New cases: 12,710 Deaths: 4,290

Risk Factors

There are many possible risk factors and other possible contributory for cervical cancer.

(1.) Human Papillomavirus (HPV) This is presently the number one risk factor for cervical cancer.

(2.) Using birth control pills for a long time

(3.) Weakened Immune system

(4.) Smoking (Cigarette smoking is associated with an increased risk of cervical cancer.)

(5.) DES (diethylstilbestrol): Drug used in the 1960s to prevent miscarriage

(6.) Lack of regular Pap tests

(7.) Multiple sexual partners or high risk sexual behavior

(8.) Infections such as chlamydia

Symptoms

From: Cervical Cancer NLM

Most of the time, early cervical cancer has no symptoms. Symptoms that may occur can include:

Symptoms of advanced cervical cancer may include: Back pain; Bone fractures; Fatigue; Heavy bleeding from the vagina; Leaking of urine or feces from the vagina; Leg pain; Loss of appetite; Pelvic pain; Single swollen leg; Weight loss

Symptoms of advanced cervical caner include: Back pain; Bone fractures; Fatigue; Heavy bleeding from the vagina; Leaking of urine or feces from the vagina; Leg pain; Loss of appetite; Pelvic pain; Single swollen leg; Weight loss

Diagnosis

There may be several diagnostic tests done to confirm the diagnosis and to ascertain how much the cancer has spread.

These tests include a biopsy of the cervix or a pap smear. This is often done through colposcopy, a magnified visual inspection of the cervix aided by using a dilute acetic acid (e.g. vinegar) solution to highlight abnormal cells on the surface of the cervix.

Colposcopic impression, the estimate of disease severity based on the visual inspection, forms part of the diagnosis.

Further diagnostic procedures include a loop electrical excision procedure (LEEP) and conization, in which the inner lining of the cervix is removed to be examined pathologically. These are carried out if the biopsy confirms severe cervical intraepithelial neoplasia. You may also need a cystoscopy (endoscopy of the bladder), intravenous pyelogram (IVP) (a special x-ray of the kidneys, bladder, and ureters (the tubes that carry urine from the kidneys to the bladder), a proctoscopy, to look at the lower part of the large intestine (colon) to determine whether the cancer has metastasized.a positron emission tomography (PET) and finally a MRI.

New diagnostic tests include:

Imaged Directed Pap Testing - approved for use by the FDA in 2003 to assist in primary cervical cancer screening for cancerous and pre-cancerous cells. The combination of the ThinPrep® Pap Test and the ThinPrep® Imaging System improves detection of abnormal cells and reduces false negative Pap tests.

Dual Review: Combining the Strengths of Human and Computerized Reviews

The ThinPrep® Imaging System combines computerized and human review of Pap test slides in a new class of imaging technology, called Dual Review™. With Dual Review, individual patient slides are first reviewed by the Imager, which scans every cell and cell cluster identifying areas of interest for further human review.

How the ThinPrep Imaging System Works

The ThinPrep Imaging System is an interactive computer system that assists cytotechnologists and pathologists in the primary screening of ThinPrep Pap Test slides. Pap tests are collected in a ThinPrep® Pap Test vial in the clinician's office and then sent to the laboratory for processing on a ThinPrep processor. Slides are stained with a proprietary stain that eliminates variability for reproducible results. Similar to a Papanicalaou stain, the ThinPrep® stain is specially formulated for the Imager System. From: Pap Imaging - NCCC

Blood tests may include:

A complete blood count (CBC), to check for anemia and other abnormal blood values. A chemistry screen, to find out how the liver and kidney are working.

Treatment

A variety of treatment methods may be used. These include radiation therapy, chemotherapy, and/or surgery to remove the malignancy. However, the type and stage of the cancer will most determine your treatment. You will want to also educate yourself on the possible complications involved with any of the treatment methods.

The surgeries used may include Cone biopsy to remove the cancer; Radical trachelectomy to remove the cervix, part of the vagina, and the pelvic lymph nodes (lymph node dissection) but not the uterus; Simple hysterectomy to remove the uterus and cervix; Modified radical hysterectomy and lymph node dissection to remove the cancer; laser therapy to burn away abnormal tissue.

There may be other treatments used for some of the symptoms accompanying cervical cancer. Acupuncture may be tried to relieve the pain; meditation (yoga) may be used to relieve stress. Light massage or biofeedback. Breathing exercises and/or aromatherapy may also be used to help you relax.

REMEMBER these treat other comorbidities of cervical cancer not the caner itself and complementary therapies for the cancer are NOT a substitute for the standard treatment. Discuss this with your physician.

Common chemotherapy medicines used to treat cervical cancer include: Cisplatin, Fluorouracil (5-FU), Mitomycin, Paclitaxel, Ifosfamide,Carboplatin, Bevacizumab, Docetaxel, Epirubicin.

Prevention

In addition to life style changes, to lessen the risk of cervical cancer, there also is actually a vaccine for the HPV infection. The two vaccines are Gardasil and Cervarix. These are given to women between nine to twnety-six years of age.

The use of condoms provides “some” protection although there is no concrete evidence that they actually protect against HPV. They do however, pprovide protection from other sexually transmitted diseases in addition to genital warts.

Some claim there are vitamins that can help bolster protection and these include Vitamin A; B12, vitamin C, vitamin E, and beta-carotene.

Prognosis

Many factors influence the outcome of cervical cancer. These include: the type of cancer; the stage of the disease; the woman's age and general physical condition.

Pre-cancerous conditions are completely curable when followed up and treated properly. The chance of being alive in 5 years (5-year survival rate) for cancer that has spread to the inside of the cervix walls but not outside the cervix area is 92%.

The 5-year survival rate falls steadily as the cancer spreads into other areas.

Abstracts and Studies

Re-consideration of lymphadenectomy for stage Ib1 cervical cancer. Jan 2010

Kato H, Todo Y, Suzuki Y, Ohba Y, Minobe SI, Okamoto K, Yamashiro K, Sakuragi N.

Source

Divisions of Gynecologic Oncology Pathology, National Hospital Organization, Hokkaido Cancer Center, Department of Obstetrics and Gynaecology, Hokkaido University School of Medicine, Sapporo, Japan.

Abstracts and Studies

Aim: 

Because of less frequent lymph node metastasis and parametrial involvement, patients with stage Ib1 cervical cancer may benefit from a curtailment of surgery. We retrospectively investigated the distribution of lymph node metastasis in stage Ib1 patients. After comparing the data with that of higher stages and sentinel lymph node navigation (SLNN), the appropriate extent of lymphadenectomy (LA) in stage Ib1 disease was newly suggested.

Method:

A total of 303 patients underwent a radical hysterectomy with LA and the region-specific rate of node metastasis was obtained. SLNN was performed for 50 patients using (99m) Tc phytate injection into the cervix and intra-operative detection by a gamma-probe.

Results: 

The rate of node metastasis and the average number of nodes removed, respectively, were: 23/189 (12.2%), 65.2 in stage Ib1; 14/47 (29.8%), 70.1 in stage Ib2; 7/20 (35.0%), 78.2 in stage IIa; and 26/47 (55.3%), 69.1 in stage IIb. Lymph node metastasis in stage Ib1 was prevalent in the obturator (Ob) (9.5%), inter-iliac (Ii) (4.9%), superficial common iliac (Sc) (2.3%), cardinal (Cd) (2.2%) and external iliac (Ei) (1.7%) nodes. In patients with upper stage disease, lymph node metastasis could occur in all lymph nodes. In stage Ib1 patients, the sentinel nodes were assigned only to the Ob, Ii, Sc and Ei nodes, being identical with frequent metastatic sites in stage Ib1 (excluding Cd).

Conclusion: 

The extent of LA can be routinely completed with the removal of Ob, Ii, Ei, Sc and Cd nodes, which may provide a higher quality of life, including the reduction of lymphedema by preventing the removal of the inguinal nodes.

PubMed

Common genetic variants in TERT contribute to risk of cervical cancer in a Chinese population. Jan. 2012

Wang S, Wu J, Hu L, Ding C, Kan Y, Shen Y, Chen X, Shen H, Guo X, Hu Z.

Source

Nanjing Maternity and Child Health Hospital of Nanjing Medical University, Nanjing, China.

Abstract

Single-nucleotide polymorphisms (SNPs) of TERT rs2736098, rs2736100, and CLPTM1L rs402710 at 5p15.33 are significantly associated with risk of a spectrum of cancers. However, cervical cancer has been rarely evaluated. In this study, we genotyped the three SNPs in a case-control study with 1,033 cervical cancer cases and 1,053 cancer-free controls in a Chinese population. Logistic regression analyses showed that the two TERT SNPs both significantly associated with cervical cancer risk in the recessive model (rs2736098, AA vs. AG/GG: adjusted OR = 1.35, 95% CI = 1.06-1.72; rs2736100, CC vs. AC/AA: adjusted OR = 1.38, 95% CI = 1.11-1.73). However, no association was found between CLPTM1L rs402710 and cervical cancer. These results suggest that genetic variants in 5p15.33, especially in TERT, may be markers for susceptibility to cervical cancer.

WileyOnline

Cervical Cancer Links and Resources

Definitions

Abnormal cervical cells: Abnormal cervical cells are cells in the lining of the cervix that have changed in appearance. The more severe the cervical abnormality, the more likely i

Chemotherapy is the use of medicine to destroy cancer cells. Chemotherapy can be: Taken by mouth (orally), in pills, capsules, or a liquid. Mixed into a cream that is rubbed onto the skin (topically). Given as a shot (injection) into a muscle or under the skin. Given through a thin tube (a catheter) directly into the abdominal cavity (intraperitoneal chemotherapy). Given through a catheter directly into an organ, such as the bladder (intravesical chemotherapy).

Cystoscopy is a test that allows your doctor to look at the inside of the bladder and the urethra using a thin, lighted instrument called a cystoscope.

Colposcopy radiological test to look at the cervix for problem areas when a Pap test was abnormal. If an area of abnormal tissue is found during colposcopy, a cervical biopsy or a biopsy from inside the opening of the cervix (endocervical canal) is usually done.

Cone biopsy is an extensive form of a cervical biopsy. It is called a cone biopsy because a cone-shaped wedge of tissue is removed from the cervix and examined under a microscope.

Loop electrosurgical excision procedure (LEEP) uses a thin, low-voltage electrified wire loop to cut out abnormal tissue. Also to cut away abnormal cervical tissue that can be seen during colposcopy. Remove abnormal tissue high in the cervical canal that cannot be seen during colposcopy. In this situation, LEEP may be done instead of a cone biopsy.

Intravenous pyelogram (IVP) is an X-ray test that provides pictures of the kidneys, the bladder, the ureters, and the urethra (urinary tract ). An IVP can show the size, shape, and position of the urinary tract, and it can evaluate the collecting system inside the kidneys.

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leg_swelling_and_cervical_cancer.txt · Last modified: 2012/10/16 14:40 (external edit)