Breast cancer specialists at NewYork-Presbyterian Hospital/Columbia University Medical Center are offering patients new ways to detect early signs of lymphedema, a common side effect of breast cancer surgery that causes painful, debilitating and disfiguring swelling in the arms following removal of lymph nodes.
As many as 30 percent of women who have breast cancer surgery with lymph node removal will develop lymphedema. Radiation treatment increases this risk to as high as 50 percent. While it is possible to arrest the condition through physical therapy and bandaging, there is no cure.
"Just as we've used early detection to improve breast cancer survival, we are using early detection to reduce women's risk for developing lymphedema,"says
Dr. Sheldon Feldman, the Vivian L. Milstein Associate Professor of Clinical Surgery at Columbia University College of Physicians and Surgeons and chief of breast surgery at NewYork-Presbyterian Hospital/Columbia University Medical Center.
Dr. Feldman and his colleagues at NewYork-Presbyterian/Columbia are employing a technique called bioimpedence spectroscopy to help them identify the earliest onset of lymphedema. An FDA-approved device called L-DEX (ImpediMed Inc.) uses a mild electrical current to measure minute changes in extracellular fluid, allowing for a diagnosis of lymphedema by the physician well before any swelling is noticeable. "By catching it early, we can reverse the process and prevent unnecessary pain, embarrassment, debilitation and risk of infection,"says Dr. Feldman.
Alongside its clinical use, the bioimpedence technique is also being used in research to better understand which patients are most at risk for lymphedema and whether the condition always progressively worsens, or if it can naturally correct itself over time. Other studies will investigate the common belief that lymphedema is negatively affected by air travel and weight training.
Another method of reducing risk for lymphedema is a technique called "reverse arm mapping.""The lymph nodes that drain the arm are sometimes removed during breast cancer surgery because they're situated within the armpit (axilla) in the same area as the lymph nodes that relate to the breast. With reverse arm mapping, we inject dye into the patient's arm to differentiate the two kinds of lymph nodes. This allows the surgeon to avoid removing any nodes related to arm drainage while still accurately identifying the sentinel nodes, which are important for breast cancer evaluation and treatment,"says Dr. Feldman. "This should reduce the risk of developing lymphedema."
Arm mapping is part of a larger trend toward reducing or eliminating the need to remove a woman's lymph nodes -- thereby reducing the incidence of lymphedema. Beginning in the 1990s, sentinel node biopsy used dye injected into the breast to target the sentinel lymph node, the gatekeeper to the axilla and the one most at risk for cancer spread. Today, the latest research indicates that fewer patients need any lymph nodes removed than previously thought. Even if the sentinel node is shown to be positive, patients with early-stage breast cancer who are treated with lumpectomy, chemotherapy and radiation may not need to have any further lymph nodes removed.
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