Hope for first drug against lymphedema

Many cancer patients, especially those who've undergone breast cancer treatment, experience painful, swollen limbs, a condition called lymphedema. Now researchers say they've found an underlying mechanism that could eventually lead to the first drug therapy for the debilitating condition. The findings come from research in mice and human cells. However, there's already a clinical trial underway to see whether these lab discoveries will translate into a new lymphedema treatment. It's estimated that 10 million Americans have lymphedema, said Dr. Stanley Rockson, one of the senior researchers on the study.

"Even though many people might not recognize the term, it's a very common condition," said Rockson, a professor at Stanford University School of Medicine in Stanford, Calif. People with lymphedema have excess fluid buildup in parts of the body, usually the arms or legs. Most often, the condition arises after certain cancer treatments damage the lymphatic system, preventing lymph fluids from draining properly. Right now, there is no cure or drug therapy for lymphedema, Rockson said. Instead, it's typically managed with measures such as massage, compression garments and pneumatic compression devices. Lymphedema is not just a cosmetic issue: It can be uncomfortable, hinder range of motion, and make people vulnerable to infections, according to the American Cancer Society. "It can severely limit physical and social functioning," Rockson said. In the new study, he and his colleagues aimed to get a clearer understanding of the molecular mechanisms that drive lymphedema. So they turned to a drug called ketoprofen.

The drug, a painkiller, has actually been studied as a lymphedema treatment. The problem, according to Rockson, is that ketoprofen can have side effects for the heart, gastrointestinal tract and kidneys. Safer alternatives are needed, he said. To zero in on ketoprofen's good side — its action against lymphedema — the researchers used lab mice induced to have a lymphedema-like condition. The scientists found that the drug prevented tissue injury and fluid buildup by blocking a protein called leukotriene B4 (LTB4). It turned out that the same protein was elevated in cell samples from lymphedema patients. And not only ketoprofen battled lymphedema in mice. Another drug called bestatin worked just as well. Bestatin is not approved in the United States, but it has been used for years in Japan as a cancer treatment. The advantage of the drug, according to Rockson, is that it has more "selective" action against LTB4 — and fewer side effects — than ketoprofen. Based on the lab findings, a clinical trial testing bestatin against lymphedema is already underway, Rockson said. Eiger BioPharmaceuticals, based in Palo Alto, Calif., is funding that trial (and acquiring the drug from its Japanese manufacturer). Rockson and a colleague on the study are consultants to the company. "I think patients should feel very encouraged that work is being done," said Dr. Theresa Gillis, chief of the rehabilitation service at Memorial Sloan Kettering Cancer Center in New York City.

Still, the role of bestatin — if any — won't be clear until the clinical trial results are in, according to Gillis, who wasn't involved in the research. The "mouse model" of lymphedema, she noted, doesn't exactly replicate what happens in cancer patients who undergo radiation therapy or surgical removal of the lymph nodes. And, treatments that work well in animals don't always pan out in people. Gillis agreed that new lymphedema treatments are badly needed. "Millions of dollars are spent each year in the U.S. on treatment of lymphedema," she said. "And those millions are often costs carried by the patients themselves." Beyond costs, Gillis added, the current therapies are burdensome. "Patients with severe lymphedema wear specialty compression garments daily, and may need to use compression bandaging every night — or a second specialty night garment," she said. "Even with optimal efforts by the patient, edema can become progressively worse over time."

The new findings offer a clearer understanding of the underlying process in lymphedema, according to Gillis. Hopefully, the new understanding will "lead us toward eventually preventing the condition altogether," she said. The bestatin trial results are a few years away. But Rockson said he thinks patients can take heart in the fact that the work is happening. "Historically," he said, "lymphedema patients have been largely ignored, and that's led to a certain sense of hopelessness. But now I think we can say answers are on the horizon."

Can My Breast Cancer Come Back?

As you come to the completion of your breast cancer treatments, it seems unfair to think you might have to deal with it again in the future. For many patients, treating breast cancer can be a painful, unpleasant experience, and once your doctor says you're clear of it, it seems like you should be able to carry on without ever having to worry about getting cancer again. But unfortunately, cancer can recur, and some breast cancer survivors struggle with anxiety for the rest of their lives over whether their cancer will come back. Upon completing surgery, radiation or chemotherapy, many patients assume that they're done with treatment and can move on. Some may even assume that simply finishing chemo means they're cured.

But Dr. Melissa Pilewskie, a surgical breast oncologist at Memorial Sloan Kettering Cancer Center in New York, says, "we tend to think of completing treatment as finishing surgery, chemotherapy and radiation. But a lot of women still have treatment going on for years." In the first year after the initial treatments have concluded, "many women will be on some kind of pill," often an anti-estrogen pill or other drug therapy to help prevent cancer cells from regenerating. Dr. Maggie DiNome , associate professor of surgery at the UCLA Santa Monica Breast Center at the David Geffen School of Medicine at UCLA, says that some women with hormone-positive breast cancer will be on drug therapy for upwards of five years.

And only after they complete that treatment can they be considered "cured." Still, even after being cancer-free for any length of time, it's possible your cancer could come back, although DiNome says the risk isn't as high as many women fear. For most women with breast cancer – those who developed the disease without a genetic mutation to aid it – the risk for recurrence is about 6 percent over 15 years, she says. And it's critical to put the fear of recurrence in an appropriate context for patients, she says. "You don't want patients to live a lifetime of anxiety that it's going to recur." At the same time, finally reaching the point where they can be considered cancer-free can create a strange feeling for some women. "When they're in active treatment and they're doing everything you ask them to do, they're comfortable being watched and tested. But then they reach their five-year mark off treatment and you're just monitoring them. That's a tricky scenario for some women – they almost feel like all of the sudden the net's been pulled out from under them," DiNome says. Pilewskie agrees.

"During treatment, most patients feel empowered, that they're doing something to deal with the disease. But once that stops, there can be a fear of what happens next. It's a waiting game of wondering whether something is going to happen. It can be hard emotionally to get back to a healthy lifestyle from that standpoint, and I'll often refer patients struggling with this for counseling and support groups." Recurrence can happen after a period of remission. Pilewskie refers to remission as "no evidence of disease," and this is when treatment will shift from actively battling the cancer to monitoring your body going forward.

 According to the American Cancer Society,"if cancer is found after treatment, and after a period of time when the cancer couldn't be detected, it's called a cancer recurrence." The ACS classifies the different types of recurrence you may experience as local recurrence, regional recurrence or distant recurrence. With a local recurrence, the cancer comes back in the original place it started. In regional recurrence, it returns to the lymph nodes near where it started. And in distant recurrence, the cancer comes back in another part of the body. The ACS reports that "the less time between when the cancer was thought to be gone and the time it came back, the more serious the situation. There's no standard length of time to decide if it's recurrence or progression. But most doctors consider recurrence to be cancer that comes back after you've had no signs of it for at least a year."

Progression, on the other hand, refers to cancer that never fully disappeared and continues to grow and change in the body. For example, if you're diagnosed with Stage 2 cancer and the disease progresses, you could be reclassified as having Stage 3 or 4 cancer. Also, if the cancer metastasizes, or invades a new organ, that would be considered a progression. In some cases, patients can be thought to have been in remission and then the cancer progresses, indicating that the first treatment protocol did not kill all of the cancer and additional treatment is needed. If it's determined that your cancer was in remission and at some point thereafter, cancer is again detected in your body, your doctor will run diagnostic tests to determine whether it's a recurrence or a new cancer altogether (called a second primary cancer); if it's the same type as you originally battled, chances are it's a recurrence. If it's a different type or has a different progression, then it's probably a second cancer.

The ACS reports that developing a second cancer "is much rarer than cancer recurrence, but it does happen. Having cancer once does not mean you cannot get another type of cancer in the future." Pilewskie says that having had breast cancer "does slightly increase the risk for a subsequent case." She also says that there are some second cancers that can be associated with breast cancer, but it's not necessarily the breast cancer itself that's caused this second illness; often there's an underlying genetic reason a person battles cancer more than once. The BRCA1 and BRCA2 genes are perhaps the most widely known genetic mutations associated with breast cancer, though there are other genetic factors that can predispose a person to cancer or elevate your risk for developing a second type of cancer. "Depending on the family history and genetics, breast and ovarian cancer are the two most commonly associated cancers, but in people with these genetic mutations, we also see an increase in pancreatic cancer. For men with these genes, breast cancer, prostate cancer, and some carcinomas may be associated." And what's more, simply surviving cancer – and living longer – can be its own risk factor for recurrence or developing a second cancer. According to Breastcancer.org, "the aging process is the biggest risk factor for breast cancer. That's because the longer we live, there are more opportunities for genetic damage (mutations) in the body. And as we age, our bodies are less capable of repairing genetic damage."

 Although as a whole, any kind of cancer can come back, Pilewskie says your chances of it returning can vary depending on the type of cancer you've had. "The more aggressive cancers may recur faster." With more aggressive forms of breast cancer, if it doesn't recur within the first two years, most likely you can be considered "cured." With slower-growing cancers, the cancer can return much later. Although many breast cancer survivors worry about their cancer coming back "sometimes I think that women overestimate their risk," Pilewskie says. She encourages anyone who's completed breast cancer treatment to have "a good conversation with their doctor about their actual risk of recurrence." Although there's no surefire way to prevent your cancer from coming back, there are a few lifestyle choices you can make to help reduce the chances. These are virtually the same things you're advised to do to help reduce your risk of developing breast cancer in the first place: eating right, controlling stress, getting enough sleep, managing your weight, participating in routine screening and exercising. It's this last item – exercise – that Pilewskie says she thinks holds the most promise for the future of cancer recurrence prevention.

"I just got back from a surgical oncology meeting and exercise is a hot topic. It's going to really come out in the research over the next few years what the specific links are" between breast cancer and exercise. She says she's hopeful that research will pinpoint a specific dose of exercise that's beneficial that doctors can prescribe their patients to reduce recurrence. "There's a lot of data looking at the impact of exercise on women to improve survival and lower recurrence rates. I think it's a complicated relationship in the effect of exercise and dietary factors," but she says breast cancer patients and survivors should strive to get back to a normal exercise routine as soon as possible. And be sure to keep all your follow-up appointments.

Former Aussie model's leg ballooned, 'doubled in size' after pregnancy

A former Perth model, who was pregnant when her leg doubled in size, has been diagnosed with an incurable condition, Lymphedema, but is determined to "find a cure".

Sarah Buller lives in Nice, France with her husband Bruce and her two children Jagger and daughter Charlie, WA Today reports. The 31-year-old mother's left leg grew when she fell pregnant with Charlie in April 2013. Her limb weighed in at about 12 kilograms, while her right leg remained unaffected. Ms Buller believes Lymphedema is a "mistreated and misunderstood pathology” and created a blog and YouTube page to raise awareness of the condition and "instigate more research, better treatments and ultimately a cure”.

The mother-of-two noticed inflammation in her left groin area while pregnant with her first child and thought it was due to “normal pregnancy swelling," Ms Buller wrote on her blog. However, within a few weeks her whole leg had "blown up” and she went to see doctors and had blood tests, assessments and ultrasound scans done. Doctors didn’t know what caused the swelling and said it would go away after she gave birth. "Unfortunately, it did not go away after giving birth and I was diagnosed with Primary Lymphedema a few months later," she wrote.

Ms Buller said she began to feel “depressed and isolated”, which is the biggest impact the chronic condition has on her. The stubborn mother barely knew anything about Lymphedema and when she fell pregnant with her son in 2015 it worsened and caused her to take action. Ms Buller has spent countless hours researching ways to take the swelling down and in May this year, Ms Buller underwent a Vascularised Lymph Node Transfer operation.

She told the newspaper she sold the family car and spent $22,369 worth of savings on the surgery performed by Dr Corinne Becker in Paris. According to Ms Buller, the surgery consisted of "microsurgeons reconnecting the artery and vein to new blood vessels in the axilla to provide vital support to the lymph nodes while they develop their own blood supply". Ms Buller documented the first few weeks after surgery and showed her condition improving post surgery. On top of having surgery, the mother also spends hours every day changing compression garments, exercising and elevating her leg.

Ms Buller also has daily manual lymphatic draining massages at a physiotherapist and must take supplements to get rid of excess fluid. The brave mother told the newspaper she wants Lymphedema sufferers to know they can wear anything and still look beautiful and urges others to not "hide yourself away".

Most Aggressive Form of Prostate Cancer on the Rise

For decades, experts have said the diagnostic used to screen patients for prostate cancer is too unreliable to use routinely because it produces high rates of false positives and often results in additional unnecessary and invasive tests, as well as overtreatment. However, a new study suggests efforts to limit the use of the prostate-specific antigen (PSA) test may be partially responsible for a rise in incidences of the most aggressive form of the disease.

The study, published Tuesday in Prostate Cancer and Prostatic Diseases, suggests doctors may want to reconsider their approach to screening and monitoring the disease, since rates of metastatic prostate cancer have increased 72 percent in the past decade. The researchers also found rates of the this form the disease surged 92 percent in men 55 to 69 years old compared with men in other groups.

“These recent trends highlight the continued need for nationwide refinement in prostate cancer screening and treatment to prevent the morbidity and mortality associated with metastatic prostate cancer,” the researchers write in the study.


For the study, the researchers looked at data from the National Cancer Database (a registry jointly sponsored by the American College of Surgeons and the American Cancer Society). The data accounted for more than 700,000 men who had received a diagnosis of prostate cancer between 2004 and 2013. The researchers say addressing this trend should be a health care priority, since treating late-stage prostate cancer is far costlier than PSA testing and additional screenings measures, such as biopsy, that are used to confirm a prostate cancer diagnosis. Some experts suggest this form of prostate cancer is also becoming more aggressive, which is contributing to the rising number of cases. Others say it could be a combination of both factors.

PSA testing provides a measure of proteins produced by cells of the prostate gland. An elevated level of these proteins is typically found in men with prostate cancer. However, the test can be misleading because the protein level often rises as men age. In 2008 and 2012, the U.S. Preventive Services Task Force—an expert panel composed of independent physicians and supported by the U.S. Department of Health and Human Services—updated its PSA testing guidelines to promote a more judicious use of the test. Doctors have been quick to pick up on these recommendations.


The task force drew up these guidelines after reviewing current research that suggests only about one in every 1,000 men who opt for PSA testing averts death because of this screening. They also found that only one in about every 3,000 men tested dies from prostate cancer complications and many more are harmed due to subsequent tests performed as a result of PSA testing.

Biopsy—used to confirm and stage a prostate cancer diagnosis—poses short- and long-term risk for urinary and sexual dysfunction and can cause infection. Most men diagnosed with cases of prostate cancer don’t require immediate treatment. Instead, physicians are likely to recommend “watchful waiting,” meaning the cancer is monitored and only treated if it progresses significantly.

Early-stage prostate cancer has a survival rate of about 100 percent, but a late-stage metastatic form of the disease has only a five-year survival rate of about 28 percent, according to the American Cancer Society. After skin cancer, prostate cancer is the most commonly diagnosed cancer among men in the U.S.

10 Tips for While Going Through Cancer

10 Tips for While Going Through Cancer

1. Adopt a fighting spirit.
2. It's okay to discourage false cheerfulness and to share how you're feeling.
3. Seek support from your family and friends.
4. As a member of your health care team, learn about your disease and ask questions.
5. Be an active participant in your treatment and recovery efforts.
6. Make positive changes in your lifestyle that will improve your outcomes, such as quitting smoking, incorporating exercise and getting good nutrition.
7. Find something to laugh about each day. Good humor is healthy for the body and soul.
8. For safety's sake, when not feeling your best, ask for transportation assistance to your medical appointments.
9. Participation in a support group can help you learn from others.
10. Pay attention to how you are feeling and get plenty of rest, good nutrition, and take time for personal care.