By Jeri-Lynn Atwood
Lymphedema is one fairly common side effect of cancer treatment where a rehabilitation program can be particularly beneficial for the patient. It’s a condition that arises when structural damage to the lymphatic system occurs following treatments for breast cancer, although it can be associated with other cancers as well. While there is no cure, early diagnosis and treatment improves both the prognosis and the condition.
The lymphatic system is comprised of a series of tiny vessels and nodes throughout the body which transports fluid collected in the spaces between the cells (the interstitium) which the body produces during normal metabolism. This fluid, called lymph, contains proteins, fats, water, cells, and waste products. This complex network collects one to four liters per day then transports the fluid back into the venous system. When the system is properly functioning, the fluid balance within the body is maintained.
Lymphedema is an abnormal accumulation of protein-rich fluid in the interstitial tissue which results in swelling, most commonly in the arms or legs, and occasionally in other areas of the body. There are two forms of lymphedema, primary and secondary. Primary lymphedema is the result of an insufficient lymph system caused by the malformation or absence of lymph vessels from birth and accounts for only 1% of lymphedema in the United States. It may manifest soon after birth or later in life, often around the time of puberty. Secondary lymphedema is caused by damage to the lymph system due to cancer treatment, surgery, trauma, or infection.
Lymphedema as a result of cancer treatment can occur due to trauma to the lymph nodes and lymphatic vessels from surgery, removal of lymph nodes, and radiation therapy. Lymph fluid becomes trapped in the tissues resulting in swelling of the limb. Not all patients who have treatment for cancer will develop lymphedema since there are significant variations in individual anatomy and the lymph vessels will sometimes form alternate routes around an affected area. The overall risk of developing lymphedema for all cancers is estimated to be 15.5% according to the National Lymphedema Network.
Lymphedema begins slowly and is usually progressive. If left untreated, lymphedema results in hardening of the tissues (fibrosis), chronic infection, distortion of the shape of the affected area, and loss of function. Early diagnosis and treatment can prevent these complications. Early signs of lymphedema include a feeling of heaviness or achiness in the limb, tight fitting jewelry, and swelling which may resolve overnight with elevation in early stages. The swelling usually starts at the hand or foot then progresses further up the arm or leg.
Treatment of lymphedema begins with an accurate diagnosis by a physician followed by medical clearance to begin treatment. The treatment for lymphedema is called Completed Decongestive Therapy (CDT). CDT is considered the “Gold Standard” in the treatment of lymphedema and it has been shown to be safe and effective. Treatment is administered by healthcare professionals who have completed specialized training in CDT. It consists of five components of treatment: skin care, manual lymph drainage, compression bandaging and/or compression garments, remedial exercises, and instruction in self-care.
BMH’s new STAR-certified cancer rehabilitation program includes Complete Decongestive Therapy. Treatment is provided by a physical therapist that has completed over 150 hours of training and has been certified in CDT. If you or anyone you know suffers from lymphedema, consult with a primary health practitioner about a referral.
Jeri-Lynn Atwood, PT, CLT works in the Rehabilitation Services Department at Brattleboro Memorial Hospital. She can be reached at 802-257-8255. The BMH STAR Program team will be hosting an open house on May 22 from 5 to 6 PM on the 1st floor of the Richards Building for anyone interested in learning more about the program and meeting with the staff. Light refreshments will be served.