Lymphatic Learning

October is breast cancer awareness month.  As a Certified Lymphedema Therapist, I have decided to blog about lymphedema, a potential complication of certain breast cancer treatments.

By way of introduction, allow me to share some background information. In western societies, breast cancer is the most commonly diagnosed tumor among women.  In fact, 27% of tumors diagnosed among women are breast tumors. Fortunately, minimally invasive surgeries (including sentinel or axillary lymph node dissection) have become extremely popular.  However, as with any surgical procedure, internal scarring and adhesions may develop which may affect upper extremity joint and muscle function.  Furthermore, removal of lymph nodes may result in dysfunction of the lymphatic system, as will be discussed below.

Approximately 10% of water that exits the circulatory system at the cellular level does not return at the venous end of capillaries due to pressure related factors.  This excess water is called the lymphatic load.  It enters the lymphatic system at lymphatic capillaries, and it is returned to the circulatory system at the venous angle (the junction of the left subclavian vein and the internal jugular vein).  The lymphatic system also allows for transport of certain particles (including fats from the digestive system and certain large proteins) that are too large to travel through the circulatory system.

Lymph nodes are small oval shaped organs that contain white blood cells, T cells, and B cells (which are responsible for fighting infection and are a component of the immune system).  Lymph fluid travels through a series of lymph nodes, where filtration of the load occurs.  There are approximately 600 lymph nodes in the average adult human body.

Dysfunction of the lymphatic system can result in lymphedema, swelling of the upper or lower extremities due to an impaired lymphatic system.  Lymphedema can also develop in the trunk, head, neck, or genitals.  It is a chronic disease and treatment involves lifetime management of the condition.

Primary lymphedema involves a congenital malformation of the lymphatic system (ex. the vessels are too large or small) resulting in lymphedema.  Secondary lymphedema is when an initially healthy lymphatic system can develop problems through infection, obstruction, or damage.  Globally, the most common cause of lymphedema is filariasis, a parasitic disease that is caused by thread-like roundworms which occupy the lymphatic system.  The worms enter the lymphatic system through blood feeding mosquitoes and black flies in certain tropical countries.

In the United States, the most common cause of lymphedema is breast cancer-related surgeries that involve removal of affected axillary lymph nodes.  Removal of lymph nodes disrupts the normal return of fluid to the venous angles.  This can result in swelling of the involved upper extremity.  Similarly, lower extremity lymphedema can develop after removal of pelvic and or inguinal lymph nodes (ex. due to prostate or gynecological cancer surgeries).

Lymphedema can develop days, weeks, months, or even years after surgical node removal.  Therefore, individuals who have undergone these types of surgeries should be aware of their predisposition towards developing the disease. Any abnormal swelling or changes should be reported to one’s physician immediately, because the prognosis is better if the disease is detected and treated as soon as possible. The gold standard of care to treat lymphedema is complete decongestive therapy (CDT).  CDT consists of four components:

  1. Manual Lymphatic Drainage (MLD)
  2. Compression
  3. Exercises
  4. Skin Care

MLD was pioneered by Dr. Emil Vodder in the early 1900s, and it is series of manual techniques (including “pump,” “rotaries,” “scoop,” “and pump-push”) which promote mobilization of excess lymph fluid from the distal extremities towards proximal, healthy open lymph channels.  Another way to think about lymphedema due to lymph node removal is that there is congestion on one “road”.  Therefore, the certified lymphedema therapist (CLT) seeks to create new channels on uncongested “roads,” thereby creating detours for the lymph to return to the venous system through alternate routes.  MLD allows the CLT to direct the lymph along healthy, open lymphatic pathways.

Revitalize Physical Therapy recognizes that the breast cancer fight might not fully end after surgery.  As a therapist trained in CDT and MLD, it would be an honor and privilege to help address lymphedema experienced by you or a loved one. Please contact us if there is anything we can do to help.

Positive Prospects for Prevention

October is Breast Cancer Awareness Month

October is Breast Cancer Awareness Month, and what better way to promote awareness than by blogging about exciting new research on the topic!  Much progress has been made by the Breast Cancer and the Environment Research Program (BCERP), led by Dr. Caroline H. Dilworth, which is supported by the National Institute of Environmental Health Sciences (NIEHS) and the National Cancer Institute.  BCERP seeks to explore both environmental and genetic factors associated with breast cancer risk over the course of the female lifespan.  Regarding the aforementioned environmental factors, BCERP analyzes exposure to various elements during specific periods during the lifespan (known as “windows of susceptibility”) such as during puberty or pregnancy.  Certain factors may be highly correlated with breast cancer developing during one period of life whereas it may be relatively benign during another.  Determining these environmental factors and gaining more information about them will be key in breast cancer prevention.

Furthermore, BCERP has recently launched a new initiative along with the National Institute of Health (NIH).  This phase of the research focuses on risk factors (such as breast density), and it expands the scope of participants to include more racially and ethnically diverse groups of women.  Including socio-economically disadvantaged women and women from minority groups is crucial for gaining a broadened perspective.  The research will be conducted at seven different centers across the country, including Brigham and Women’s Hospital, University of Wisconsin-Madison, Michigan State University, and Columbia University, just down the road from Revitalize Physical Therapy!

Many breakthroughs and much progress are yet to be made.  Fortunately, the path is being paved in the proper direction, and research is focusing on key areas which will hopefully lead to a significant amount of prevention.  Until then, it is of course important to perform monthly breast self-examinations (instructions here) and yearly mammograms starting at age forty.

Breast cancer survivors who have undergone surgeries that involve axillary lymph node removal may experience lymphedema, swelling of the upper extremity.  Manual lymphatic drainage, a component of complete decongestive therapy, is an appropriate intervention to reduce swelling.  If you or someone that you know stand to benefit from this treatment, please contact us at Revitalize Physical Therapy.  We look forward to the opportunity to help you!

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