By Dr. Constance M Chen
More than 2.5 million women in the United States have had breast cancer. Many of them were treated with a combination of surgery, radiation, and sometimes chemotherapy that has removed or damaged lymph nodes and left them vulnerable to upper extremity lymphedema, a condition that can be disfiguring, painful and profoundly impair quality of life for breast cancer survivors.
Lymphedema is characterized by swelling of the arm on the same side as the affected breast. The lymph nodes that can be compromised during cancer treatment are in the axilla, or armpit. When lymphatic fluid cannot drain properly, it backs up and causes the arm to swell. Lymphedema is a chronic condition that requires ongoing care to minimize its effects. With the introduction of autologous lymph node transfer, an innovative surgical technique, lymphedema sufferers have new hope for improving their quality of life.
The lymphatic system collects bacteria and waste products that drains into lymphatic fluid that is ultimately flushed out of the body. When breast cancer surgery and radiation therapy damage lymph nodes or lymphatic vessels, lymphatic fluid cannot drain, and it builds up and causes the arm to swell. Anyone who has had breast surgery, lymph node surgery and/or radiation therapy is at risk for upper extremity lymphedema.
Various studies estimate that 15-54% of survivors will develop upper extremity lymphedema within three years of breast cancer treatment and the remaining women have an ongoing risk of about 1% a year for at least 20 years. The practical consequences for these women can be significant. When detected early and treated aggressively, lymphedema can be responsive to treatment. As the disease progresses and lymphatic fluid builds up in the tissues, however, the condition can become painful and disfiguring, restricting activities of daily living and causing and emotional distress.
The standard of care for upper extremity lymphedema is complete decongestive therapy (CDT). The goal of CDT is to reduce swelling by draining fluid from the arm and to prevent the progression of the disease. It typically includes massage, compression garments, and range-of-motion exercises, and it requires lifelong meticulous hygiene and protection of the arm.
In the last ten years, microsurgical techniques have made it possible to perform a procedure that can further treat the condition. Autologous lymph node transfer harvests healthy lymph nodes from an unaffected site, usually the groin, to replace the damaged or missing lymph nodes in the armpit. The nodes are transferred with intact blood vessels that are microsurgically reconnected at the receiving site and can then absorb and collect the lymphatic fluid that had been blocked. The transferred lymph nodes may also stimulate the growth of new lymphatic vessels to create new pathways for lymphatic drainage. After surgery, patients undergo manual lymphatic drainage for several months, with the goal of reducing the need for intense physiotherapy.
Lymphedema is a progressive problem that gets worse over time. For millions of women, it is a lasting and distressing reminder of breast cancer that disrupts their lives. Autologous lymph node transfer offers the hope of reducing or even eliminating symptoms so that breast cancer patients can live a long and healthy life.