• 5/1/2008
  • New York, NY
  • Tara Parker-Hope
  • New York Times (nytimes.com)

Cancer patients and their doctors often focus on beating the disease first. But new research shows they also benefit by early monitoring for lymphedema, a devastating side effect of cancer treatment that can show up years later.

Lymphedema is a painful swelling of an arm or leg that can occur months or even years after cancer treatment. Breast cancer patients, who often have lymph nodes removed during diagnosis and treatment, are particularly susceptible. But any cancer patient whose lymphatic system has been damaged by radiation or the removal of lymph nodes is vulnerable. That includes patients treated for prostate and gynecological cancers, head and neck cancers, testicular cancer, bladder cancer, colon cancer and melanoma.

The lymphatic system normally helps transport body fluids, but in someone with a compromised system, fluid can build up in an arm or leg, depending on where the lymph nodes were removed. If lymphedema sets in, a limb can swell far out of proportion to the rest of the body, and if not treated quickly, the condition can be irreversible.
But an important new study conducted by the National Institutes of Health and the National Naval Medical Center shows that cancer patients benefit if their treatment plans include early interventions to monitor risk for lymphedema. During the five-year study, researchers measured the upper limb volume of 196 newly diagnosed breast cancer patients to establish a baseline before they had surgery.

After surgery, doctors developed a lymphedema surveillance method in which they continued to measure upper limb volume. In the study, 43 women, or 22 percent, developed “subclinical” lymphedema, which means it typically would not be detected in a routine exam. The women were quickly prescribed pressure garments, which are tightly worn around the affected limb. All of them showed improvement that put them at or close to the presurgical “normal” state. The study was published in the online edition of the journal Cancer.
The study suggests there’s a benefit to using more sophisticated tools to track lymphedema, such as devices that use electrical signals to assess fluid changes in the body. Most physicians currently rely on tape measures to track changes in limb circumference and size or wait for a patient to report a loss of mobility or swelling in an arm.

Dr. Steven Schonholz,, a breast surgeon and medical director of the Breast Cancer Center at Mercy Medical Center in Springfield, Mass., says that by using better tools to measure limb volume, doctors can now identify lymphedema in its earliest stages, long before a patient is even aware of the problem.

“If patients aren’t treated at the earliest possible indication of lymphedema, it is less likely to be effectively treated,’’ Dr. Schonhlz said. “The condition may require lifelong costly treatment and, more importantly, have an enormous impact on a woman’s self-esteem, function and quality of life.”

Every cancer patient should talk to his or her doctor about lymphedema, and ask about monitoring and early detection, as well as baseline measurements of limb volume before treatment. In addition to being monitored for lymphedema, patients need to know that even minor overuse of an affected limb, such as carrying a heavy bag or typing for hours on a keyboard, can trigger the swelling.