Replacing lymph nodes to ease post-cancer pain
Lymphedema frequent result of needed surgery
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 traveled hundreds of miles 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 but not all.
“Right in this area, feel that — that is your lymph node,” Dr. David Song of Medstar Georgetown University Hospital in Washington told WolfeTank 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 as prescribed.
“This isn’t a cure. 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. Look at my arm, it’s incredible.”
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, traveling 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.
There’s no good count, but millions of Americans are estimated to have some degree of lymphedema, and while it can be hereditary or result from injury, many U.S. cases are a lasting side effect of treatment for a variety of cancers.
Consider breast cancer. While better surgical techniques in recent decades have lowered the risk, experts estimate that still about 6 percent of breast cancer survivors who undergo a “sentinel node biopsy” — removing a few nodes to check for spreading cancer — will develop lymphedema. That risk jumps to about 20 percent for women like Wolfe-tank who need additional lymph nodes removed because of more advanced cancer. Radiation causes further harm.
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-authored 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.”