Lymph-node replacement may ease painful legacy of cancer
WASHINGTON — Breast-cancer treatment left Susan Wolfe-Tank with an arm too painfully swollen to lift anything heavy or even fit into her usual clothing — a debilitating condition that gets little attention and has no cure.
Desperate, the Wisconsin woman travelled hundreds of kilometres to seek a delicate operation — replacing under-arm lymph nodes lost in cancer surgery — as a small but growing number of hospitals offer microsurgical attempts at relief from lymphedema that help some patients.
“Right in this area, feel that — that is your lymph node,” Dr. David Song of MedStar Georgetown University Hospital in Washington told Wolfe-Tank during a recent checkup.
Song, Georgetown’s plastic surgery chief, had removed healthy lymph nodes from Wolfe-Tank’s back and side and implanted them in the affected arm. As the new nodes took root, her arm was shrinking. A delighted Song’s only caution: “Take care of them,” by wearing a compression sleeve.
“I will still have to be careful,” said Wolfe-Tank, 51, of Hurley, Wisconsin. But, “I will be able to cross-country ski again, just live a normal life.”
Lymphedema is a chronic swelling, often in an arm or leg, that in severe cases can be disfiguring, impair mobility, cause disabling pain, harden the skin and lead to infection.
Lymph nodes work like biological pumps in a network that’s part of the immune system. They drain watery fluid called lymph that, travelling through tiny channels, brings nutrients to cells and takes away bacteria and waste material. Lose or damage enough lymph nodes or channels in a particular area and that fluid builds up.
Millions of North Americans are estimated to have some degree of lymphedema, and while it can be hereditary or result from injury, many cases are a lasting side-effect of treatment for cancers.
Yet too often, women aren’t warned about symptoms or checked for early signs, when lymphedema is more easily treated, said Dr. Sheldon Feldman of New York’s Montefiore Einstein Center for Cancer Care. He co-wrote physician guidelines issued this fall by the American Society of Breast Surgeons on prevention and treatment of breast cancer-related lymphedema.
Typical patients have “had that swelling for a while,” Feldman said. “Now, the treatment is an uphill battle.”
The main treatment consists of wearing compression bandages and massage to bring down swelling. A lymphedema specialist initially prescribed a large pump that massaged Wolfe-Tank’s arm for an hour a night, temporarily relieving some of the pain.
“But if I used my arm, I was back to square one,” Wolfe-Tank said.
Lymph-node transfer isn’t the only option. A technique called lymphovenous bypass reroutes lymphcarrying channels, going around damaged or missing nodes to drain into veins instead.
Some surgeons use a variation of that technique during the initial cancer surgery, in hopes of preventing lymphedema in the first place.
Feldman noted that over the past decade, the microsurgeries have been studied only in small research trials, and results vary with surgeon experience. One debate is whether to offer lymph-node transfer early, before patients build up damage.
Feldman’s bottom line: Patients considering microsurgery should be evaluated in a comprehensive lymphedema program to determine their best options.