Advances in cancer treatment mean more people are living longer after a cancer diagnosis. But some survivors develop lymphedema—long-term swelling in the arms, hands, legs or feet that can cause pain, limit movement and raise the risk of serious infections. The condition can also affect body image and mental health.
Microsurgeons at The Ohio State University Comprehensive Cancer Center—Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC—James) are refining specialized lymphatic microsurgery techniques to treat—and in some cases help prevent—lymphedema. Their goal is to expand access so more patients who may benefit can be evaluated and treated.
What is the lymphatic system and why is it important?
Some cancer treatments can damage the lymphatic system. Studies suggest as many as 30% of people treated for certain cancers may develop lymphedema, including painful swelling in an arm or leg that can limit movement and affect quality of life.
The lymphatic system connects with the blood and immune systems. It is a network of tiny tubes, called lymph vessels, that run through the body. These vessels help drain extra fluid and help the body clear germs and other harmful substances.
“Think of the lymph system as the body’s sewer system. If there is a blockage in your home’s sewer pipes, the back-up can cause damage and trouble. The same thing is true when lymph vessels are damaged as a side effect of cancer,” said Min-Jeong Cho, MD, a plastic and reconstructive surgeon and director of the Lymphatic Education & Research Network (LE&RN) Center of Excellence at the OSUCCC—James.
“If there is a build-up of lymph fluid, patients experience painful, chronic swelling that can take a major toll on physical and mental health.”
Cancer surgery may include removing lymph nodes (small, bean-shaped glands) to see if cancer has spread. The more lymph nodes that are removed, the higher the risk of lymphedema.
The impact of lymphedema
An estimated 3 to 5 million Americans develop long-term lymphedema after cancer treatment. For years, treatment was mainly medical massage, physical therapy and compression garments. Many patients were left with one arm or leg much larger than the other, making it hard to find clothes or shoes that fit.
OSUCCC—James is among a handful of U.S. centers with deep experience in highly specialized microsurgery to treat and help prevent lymphedema. The team recently hosted the 11th World Symposium for Lymphedema Surgery, a global education forum focused on advancing lymphatic research and lymphedema treatment strategies.
Until about 10 years ago, many cancer survivors had to live with lymphedema as a long-term side effect of care.
New microsurgeries—including lymphatic bypass and lymph node transfer—give patients more options. Cho and colleagues also use ultra-high-frequency ultrasound to visualize very small lymph vessels, which may help determine who is most likely to benefit from surgery.
“These advances through research and surgical techniques are truly changing the lives of patients, and they are going home with an incision the size of a papercut,” said Cho. “We want more people to know there is hope and help in dealing with their lymphedema.”
Key medical concepts
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