Cancer Surgery Leads to Disfigured Limb

Certain diseases are more popular than others, which may sound like a strange statement, but to those in health care, this is a well-recognized phenomenon. I speak of popularity in terms of media attention, research efforts into cures, charitable organizations aiming to support this research, and support groups providing emotional succor to those afflicted. Heart disease must be considered one of the top attention-getters, as is diabetes. Skin cancer probably does not get enough. Those in wound care know that it’s a huge problem getting far less than it should. But this is not going to be an article about wound care, surprisingly.

How about the problem so often resulting from cancer surgery, that has nothing directly to do with the cancer itself, which causes the development of a swollen, disfigured limb? Lymphedema. Do not feel embarrassed if this pronouncement is met with a blank look: lymphedema is a common condition but it gets little attention. Clearly it is not one of the “sexy” diseases with teams of individuals from all over the country, fund-raising for research. This is a big business, with marathons largely composed of these fund-raising teams. I ran a marathon in Maui, and most of the participants were there as part of some team, with a group running for Leukemia, another for lung cancer. Due to my profession, it should be understandable I was there with the team running for diabetes research.

There is no lymphedema team, and thus this discussion. This is definitely not one of those conditions garnering attention in the media. But perhaps it may be wise to provide some background into what this problem is, how it develops, and its association with cancer. As a prelude, I will provide, as a foundation, some information about the body’s lymph system. Talk about an exciting topic, the lymphatic system is not one that people talk about in casual conversation. Yet it is critical to the functioning of the human body. It’s considered part of the circulatory system, but has important functions in the immune system as well. Lymph fluid, carried by the tiny tubules of the lymphatic system, drain into lymph nodes. It is here that cells, important in the immune system, are produced.

This is critical to our discussion since, when cancer develops in the body, it often spreads via the lymphatic channels, which, as mentioned, drain into lymph nodes. When surgical intervention is utilized as part of the treatment for cancer, it is often necessary to remove lymph nodes to fully eradicate the disease. This has the unfortunate effect of altering, irrevocably, the drainage system that is the lymphatic circulation. Surgery for breast cancer is the most common cause of this type of damage, which is obviously more frequent in women. Studies reveal that about thirty percent of cancer surgery involving the lymph nodes leads to this debilitating condition.

Excessive, chronic swelling in an extremity summarizes the condition called lymphedema, and it is due to this interruption in normal lymphatic flow in a single extremity. World-wide, lymphedema is certainly a common problem, but elsewhere, the cause is different. Rather than it resulting from surgery, in most parts of the globe, it is from a condition called filariasis, which is a parasitic infection. Regardless, lymphedema leads initially to a feeling of heaviness, tightness or warmth, in the affected extremity. These symptoms may be present before there is obvious swelling, but, with time, clothes become tight, and joints in the limb become stiff. The swelling of the involved extremity becomes more pronounced, and skin changes develop, which can include thickening, discoloration. With time, patches with a cobblestone appearance occur, and these can become crusty, or leak a yellowish fluid. With progression of the condition, the skin hardens, and this is generally irreversible.

Unfortunately, there is no cure for lymphedema, and all the treatments are aimed at controlling the problem. Hygiene is of great importance since soft tissue infections can develop easily in those affected. Physical therapy is a mainstay of treatment, and consists of massage and exercise. A specific type of massage is almost always utilized, in which the lymph fluid build-up is, in essence, pushed out of the limb.

Compressive garments are used, and elevation is also prescribed. Pneumatic pumps are devices that use air pressure in large, full length sock that is inflated regularly, to help move the fluid out of the limb. These machines have been around for many years, for this and other swelling problems, but they have evolved and improved significantly. The latest incarnation is much more efficient and effective than prior generations of compressive pumps.

Surgery most often consists of some type of removal of affected, diseased tissue. Unfortunately, the results are typically disappointing, although new techniques are being developed. A variety of procedures have been attempted, but the abundance of different approaches indicates none of them is clearly superior. Pharmacologic methods have been used, and can be helpful, but many of the drugs used have the potential for harmful, serious side effects.

When lymphedema becomes established, the degree of dysfunction and disability is great. This is due to various factors, especially a decrease in joint mobility, which leads to an inability to move the affected limb, as well as the sheer weight of the limb. Significant pain is also common. Performance of day-to-day tasks becomes an insurmountable challenge. Despite of all the problems caused by lymphedema, this disease continues to affect millions of people worldwide. The identification of the most efficacious forms of treatment of this disease is necessary, but this requires research. Other than those afflicted and their family, who is driving the studies and research to develop better methods? Where is the marathon team for lymphedema!?