In the past few years, surgeons have made strides in preventing lymphedema, a potential side effect of breast cancer surgery in which a blockage in the lymphatic system causes fluid buildup and swelling in the arm.
By preserving the underarm lymph nodes in patients with less-advanced cancer, surgeons have reduced the lymphedema risk for those patients.
But lymphedema still affects an estimated 10 to 40 percent of patients, depending on the extent of the cancer and the type of surgery and radiation required.
What can be done for patients whose underarm lymph nodes can't be preserved because of the spread of cancer? Or the ones who get lymphedema despite lymph node-saving surgery?
Approaches that may help are being tested and tried at major cancer treatment centers, among them the lymphatic microsurgical preventive healing approach (LYMPHA) surgical technique, which connects lymph vessels to a nearby vein, restoring drainage when underarm lymph nodes are removed. There's also axillary reverse mapping, which seeks to identify and preserve lymph nodes related to arm drainage (as opposed to breast drainage), and highly sensitive L-Dex bioimpedance spectroscopy, which is used to diagnose lymphedema at its earliest stages, when it is most responsive to treatment.
"There are a lot of people working on different things," said Dr. Sarah McLaughlin, a breast surgeon at the Mayo Clinic in Jacksonville, Fla.
But as much as researchers would like to see advances in this area, she said, it's important to wait until new approaches are backed up by reliable data.
"It just takes time," she said.
At NewYork-Presbyterian Hospital/Columbia University Medical Center, surgeons are seeking to replicate the results of a promising Italian study, in which researchers at the University of Genoa attempted to prevent blocked drainage after lymph node removal by allowing lymph vessels to drain into a nearby vein. In the Italian study, published in 2011 in the Annals of Surgical Oncology, 4 percent of the women in the LYMPHA group had lymphedema at six months after surgery, compared to 30 percent of the women in the control group.
The NewYork-Presbyterian pilot study started in January.
"We've performed this on about seven patients, and so far, it looks very, very good," said Dr. Sheldon Feldman, chief of breast surgery at NewYork-Presbyterian. The procedure takes less than an hour, and the technique is quite simple, he said: Lymphatic vessels are basically attached into a stump of a branch of a nearby vein.
Axillary reverse mapping, in which an injection of dye is used to identify the lymph nodes that drain the arm, as opposed to the breast, for the purpose of preserving the arm lymph nodes during surgery, is being used at some large cancer centers.
Early detection of lymphedema is the aim of L-Dex bioimpedance spectroscopy technology, which uses a small electronic current to detect volume change.
"The longer lymphedema is there, the tougher it is to treat, so the idea is to have a very sensitive tool which could be used to detect very subtle changes in volume in the arm - before it's apparent to the patient, before it's apparent to the doctor," Feldman said.
"That's what this bioimpedance spectroscopy can do."
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