Lymphedema Holistic Treatment

Clare Stevinson Kristin L Campbell Christopher M Sellar and Kerry S Courneya

Systematic reviews of trials with cancer survivors have reported few adverse events associated with exercise. However, it should be noted that clinical trials have rigorous screening criteria and exclude participants for whom exercise may pose a potential risk (e.g., those with uncontrolled cardiovascular or pulmonary disease, existing musculoskeletal disorders, or cancer-related conditions such as severe cachexia, anemia, neutropenia, thrombocytopaenia, or metastatic bone disease). Studies that have addressed the role ofexercise in causing or worsening lymphedema in breast cancer survivors who have undergone axillary node dissection, have found no increased risk with upper body physical training.91-93

Primary Enterocyte Abnormalities

Protein-losing enteropathy is a broad term including all the conditions that cause an abnormal loss of plasma proteins from the gut. Three main mechanisms are responsible for protein-losing enteropathy enhanced mucosal permeability to proteins (as in eosinophilic gastroenteritis and Menetrier's disease), mucosal erosions or ulceration (as in erosive gastritis and inflammatory bowel disease), and lymphatic obstruction (congenital or secondary). Enteric loss of protein may be revealed noninvasively by an increased stool concentration of -antitrypsin or, more expensively, by radioactive methods (intravenous administration of 51Cr albumin or chloride).

Role of physiotherapy

Procedures of the physiotherapy in palliative care is also used for pain, lymphoedema, dyspnoea and other symptom assessment and treatment, as well as for the education on safe transfer and mobility management of the patient. Constipation, nausea, sleep disturbance (insomnia), anxiety, fatigue, dyspnoea, pain scores and appetite are all improved by physio-therapeutic intervention. Some of these clinical complications can be also prevented or minimized. Along the time, the lymphoedema management in the terminally diseases has developed more effectively, with evidence supporting the complex physiotherapy treatment and the integration with other professionals 5, 7, 16 .

Measures to Prevent Postmastectomy Pain

Lymphedema refers to swelling in an extremity, and is associated with painful sensations of swelling, heaviness, aching, tenderness, and numbness. These symptoms may be mild and not volunteered to health care professionals. In one review, the incidence of lymphedema in breast cancer patients ranged from 6 to 30 .116 In a cohort of 263 breast cancer survivors who had undergone axillary dissection 20 years previously, 128 patients (49 ) reported a sensation of swelling, and 33 patients (13 ) had severe lymphedema, defined as a difference in arm circumference of greater than 2 cm. While 98 patients (77 ) developed within the first 3 years of diagnosis, onset could occur up to 17 years later.117 The incidence of lymphedema may decrease in the future as axillary dissections become more limited, and radiation techniques advance. In a telephone survey of 148 breast cancer survivors, 15 reported moderate to severe pain, and pain severity and swelling explained 25 of the...

Jos Verbeek and Evelien Spelten

Cancer Patient Return Work

From our review, it became apparent that the earlier emphasis on legal and insurance issues had been augmented by a wider scope of factors impacting the return to work of cancer patients. Ranging from self-esteem, through the effects of chemotherapy to social support and lymphedema as well as fatigue and job context.

Morphological Factors Tumor size

Some breast units have historically undertaken routine lymph node clearance,19 whilst others, especially in the UK, have performed four-lymph-node sampling. The latter groups have argued that node sampling provides sufficient and equivalent prognostic data, with less morbidity in the form of lymphoedema and reduced shoulder mobility.20,21 There is evidence that a similar proportion of patients will be

Intestinal Lymphangiectasia

Intestinal lymphangiectasia is a protein-losing enteropathy with gastrointestinal lymphatic obstruction and excessive leakage of plasma protein into the intestinal lumen, with resultant oedema and hypoproteinemia. Patients have symptoms of diarrhea, steatorrhea, nausea, vomiting, and signs of ascites or pleural effusions. Bacterial infections due to lymphopenia and hypogammaglobulinemia occur. Patients often have malabsorption of

Physiotherapy procedures in the management of the patient with prostate cancer

Physiotherapy also assists with postoperative respiratory recovery, early mobilization, lym-phoedema prevention, education and garments if required, as well as the later management of pelvic floor re-education, continence advice and lymphoedema treatment if necessary. Men undergoing RP under a general anaesthetic will be off work for about 6 weeks. Moerover, they will stay in hospital for 5-7 days and have a urinary catheter for 2 weeks. The sphincter valve has gone and the urine leaks without control, day and night until the patient has learned again to use his muscles of the pelvic floor to regain his continence. Concerning ED, when a man wakes up from a RP he will almost certainly have ED initially. If there is going to be a recovery of erectile function, it may take 18-24 months to occur. Approximately 30 of men will recover erectile function and medication (Viagra or Cialis) will usually boost this recovery. However, physiotherapy procedures could be another suitable option...

Cancer Diagnosis and Depression

Term survivors of breast cancer had a clearly increased risk of depression (between 22 and 30 ) compared to those with benign breast disease (less than 10 ).38 In another, Kornblith and Ligibel37 pointed out that a significant subset of breast cancer survivors continue to experience significant depression and anxiety as long as 4 years posttreatment. They note that depression seems to be mediated in long-term survivors of breast cancer by ongoing medical sequelae, such as lymphedema.

Complications And Prognosis

The main complications from wide local excision are superficial infection, wound dehiscence, and cosmetic defect. Risk of tumor recurrence after excision with appropriate margins is low. Complications of SNB are also local in nature infection, seroma, injury to nerves, and dehiscence. The risk of lymphedema is minimal in the head and neck lymphatic basins.

Clinical Features Due to Regional Spread of Tumor

Dyspnea, dysphagia, and hoarseness occur as a result of compression of trachea, esophagus and recurrent laryngeal nerve respectively by a centrally placed tumor or enlarged mediastinal lymph nodes, or due to lymphatic obstruction. The longer intra thoracic course of the left recurrent laryngeal nerve makes it more susceptible to compression from left-sided tumors compared to right-side lesions. Dysphagia usually occurs with both solids and liquids, and may be complicated by recurrent aspiration due associated recurrent laryngeal nerve palsy. Involvement of the phrenic nerve is associated with hiccups early in the disease this later leads to paralysis and elevation of the hemidiaphragm with resulting dyspnea.

Clinical aspects of metastatic disease

Although lymphatic metastases are commonly found in patients assessed for radical treatment, they do not invariably give rise to clinical problems. When they do, patients usually suffer from the effects of lymphatic obstruction, resulting in swollen legs. It is relatively unusual for para-aortic, or mediastinal lymph node metastases to be of clinical significance, although, presumably, they are frequently involved pathologically (16).

Table 61 Some Experts Recommendations on CAM Therapies

Massage (people who are anxious or have lymphedema or nausea) Moderate exercise (see Chapter 7 for details on this topic) Psychological and mind-body therapies As I indicated earlier, acupuncture, once considered a CAM therapy, is more often now accepted as a mainstream treatment for musculo-skeletal conditions due to its pain-relieving (analgesic) effects and its effects on the immune system. The use of acupuncture in cancer patients may help with chemotherapy-related side effects such as nausea, vomiting, and pain. Acupuncture can also be tried in the post-treatment phase for residual surgical pain or other pain as well as to help heal musculoskeletal injuries. For example, one of my patients is a woman who had a mastectomy and developed significant lymphedema, a condition involving arm swelling that may occur after surgical exploration of the underarm lymph nodes. Because my patient was trying to protect the arm that had lymphedema, she overused her other arm and developed a common...

Table 79 Problems Cancer Survivors May Encounter

Lymphedema Lymphedema is the swelling of a limb (seen most frequently in people with breast cancer who have swelling of an arm after some of their underarm lymph nodes are removed during surgery). The swelling is caused by extra lymph fluid that collects in the limb as a result of disruption in the lymph nodes and the flow through them. In the past, it was believed that exercise, especially strenuous exercises done with the affected limb, might cause or promote this problem. But the research on lymphedema and exercise is inconclusive it may be that exercise actually helps protect people from getting lymphedema. And for those who have it, exercise may improve the symptoms. I have patients with lymphedema who race dragon boats using paddles, and this exercise doesn't seem to make their symptoms worse. Besides, they are more physically fit than if they were not exercising, and I believe the exercise helps them emotionally as well. My advice if you have or are at risk for lymphedema is to...

Early Effects Of The Diagnosis And Initial Treatment On

There is also consensus regarding a third set of findings from this literature on early effects of diagnosis and treatment with regard to the physical realm. These include menstrual changes and menopause, infertility, sleep problems, lymphedema, pain, problems with physical and recreational activities, and weight gain and reduced energy.15,18,30,32-40 Ganz found nearly identical rates of arm problems 2 and 3 years posttreatment related to the initial surgical procedure (numbness, tightness and pulling in the arm, and intermittent mild pain).30 Other early effects are energy reduction, decreases in physical functioning, and symptom distress as found in our early study of Hodgkin's disease.28 Sexual, urinary, and bowel function changes are specific to prostate cancer.29


Sometimes if you are having radiation without a hysterectomy, your doctor will also do a lymph node dissection to help determine how extensively the cancer has spread. A lymph node dissection usually is well tolerated. The risks of a lymph node dissection include injury to the blood vessels or nerves that are near the lymph nodes. Also, some women develop lymphedema, a condition in which the lymph fluid builds up in the legs causing swelling.

The Extremities

Amputation is the most obvious long-term effect of surgery on the extremities, but many other cancer operations also require sampling of regional lymph nodes. Lymphedema is a not uncommon late effect of these procedures. While this may have no noticeable downstream effects, like in colorectal cancer, when it involves dissection of lymph nodes draining the extremities, as in axillary dissection for breast cancer or a groin dissection in melanoma, it risks leaving patients without sufficient lymphatic drainage from a limb. The resultant lymphedema may take several years to become clinically apparent as fluid accumulation in the tissues is initially restricted by counteracting hydrostatic pressure within those tissues. As the tissues stretch and expand, however, the lymphedema accelerates. Functional disability from stiffness, pain, limited range of motion, and predisposition to cellulitis (which can further damage lymphatics and exacerbate lymphedema), coupled with the cosmetic effects,...

Where to Find Help

National Lymphedema Network The NLN is an internationally recognized nonprofit organization that provides education and guidance to lymphedema patients, health care professionals, and the general public. The NLN supports research into the causes and possible alternative treatments for this condition. The Web site offers information about lymphedema treatment centers, health care professionals, training programs, and support groups.

Cancer and CAM

The authors did not issue outright recommendations of any of the CAM treatments, although several were listed in a combined category of accept may consider recommending. Treatments in the combined category included (1) vitamin E for prostate cancer (2) acupuncture for chemotherapy-related nausea and vomiting (3) massage for anxiety, lymphedema, and nausea related to bone marrow transplantation and

Nonmalignant Pain

Chloe is a middle-aged woman who had endometrial cancer more than a decade ago. At the time, she had a number of pelvic lymph nodes removed and subsequently developed problems with lymph drainage that resulted in swelling of her right leg (called lymphedema). This swelling was painless, and for many years Chloe wasn't overly concerned about recurrence of her cancer. However, over time she began to experience increasing back pain. Chloe immediately thought that her cancer had come back and spread to her spine. During her initial office visit, it was clear to me that her back pain was likely due to the awkward position in which she slept, with her leg elevated in order to minimize the swelling. Of course I ordered the appropriate imaging tests just to be sure there was no cancer, and they came back normal. I recommended that Chloe meet with one of our therapists who is certified in the treatment of lymphedema for better management that didn't involve awkward sleep positions. In a few...