Of Vera Martinella
In Italy there are 40 thousand new diagnoses per year, unfortunately often late: the symptoms are neglected for a long time. Patients undergoing surgery for cancer (with removal of lymph nodes) or treated with radiotherapy are especially at risk
It causes pain and difficulty moving freely, a sense of heaviness, soreness, tension, discomfort. Lymphedema is a chronic, progressive and debilitating disease caused by the accumulation of fluid (lymph) in the tissues of the limbs upper or lower, which therefore appears swollen. In Italy around 350 thousand people suffer from it every year 40 thousand new cases are recorded. Yet, patients encounter great difficulties in identifying the professionals and specialized centers to turn to. Not only that: it is important that all sick people know that Lymphedema is treatable with good resultsabove all if the diagnosis is timely, if specific therapies are carried out and if some simple behavioral rules are adopted.
For this reason, the Italian Society of Reconstructive-Regenerative and Aesthetic Plastic Surgery (SICPRE) organizes on March 6, on the occasion of World Lymphedema Dayan information and awareness event open to the public in Rome (from 4 pm in the Medicinema room of the Gemelli Polyclinic in Rome) and online on Youtube channel of the scientific society.
What is lymphedema
Lymphedema is a abnormal accumulation of fluids due to a circulation defect in the lymphatic vessels which branch throughout the body and transport lymph, a colorless liquid rich in white blood cells, important for immune defenses. Along these vessels are found the lymph nodes, small oval-shaped organs that constitute the first site of activation of the immune response against pathogens. For this reason, the lymph nodes are concentrated in strategic locations such as armpits, groin or neck. When the liquid remains and is not correctly drained, theincrease in volume of a limb.
«Lymphedema can be primary, if caused by congenital anomalies of the lymphatic system, or secondarywhen it appears as a consequence of some diseases or, more often, from the surgical removal of the lymph nodes, as in some cases of breast, cervical, uterine, ovarian, prostate cancer, melanomas and sarcomas” explains Marzia Salgarello, president of the Sicpre event and associate professor of Plastic Surgery at the Catholic University of the Sacred Heart who in 2016 founded a center specialized in the surgical treatment of lymphedema at the Gemelli Polyclinic.
Swelling after lymph node removal
In cancer patients, lymphedema can appear when thelymph nodes have been surgically removed (lymphadenectomy) or subjected to radiotherapy. Or when, in the presence of an advanced form of tumor, lymph nodes and lymphatic vessels are invaded by neoplastic cells or are compressed. It does not always happen, the risk increases if the number of lymph nodes eliminated is high, if radiotherapy is then performed in the same area (as often happens for breast and gynecological tumors), if patients are obese or very overweight and if they suffer from diabetes.
«Early diagnosis is very important because it allows you to avoid the progression of the disease, preserving your quality of life of patients who, in many cases, have already had to fight cancer – he underlines Stefania de Fazio, president Sicpre – . Lymphedema Day was created precisely to spread specific behaviors capable of preventing the disease, to inform about its first manifestations and provide information on the fundamental multidisciplinary approach to combat the disorder.”
Symptoms and prevention
Swelling usually develops one year (usually within the first four) after surgery, but it can occur many years later. The feeling that clothes, rings, watches, shoes lace up more than usual, changes in sensitivity to touch, tingling to your hands or feet, skin changes (tight, red or dry) or the ache they are generally the first manifestations of lymphedema and often precede obvious swelling. The important thing is not to neglect the “alarm bells”: “Lymphedema reduces the functionality of the affected limb (the arm in the case of removal of axillary lymph nodes for breast cancer, the leg for removal of inguinal and pelvic lymph nodes for gynecological and urological tumors) making the patient's daily life and relationships difficult. It can cause pain, recurrent infections and skin changes – recalls Salgarello, president of Beautiful After Breast Cancer (BABC) Italia Onlus –. Patients often underestimate the symptoms and they arrive at the diagnosis of lymphedema when the swelling is stable and persistent, and therefore in an intermediate or advanced clinical stage».
Therapies
As physiatrists and physiotherapists will explain during the Sicpre event on 6 March, treatment today involves measures and activities capable of promoting the drainage of lymph towards the root of the limb, such as weight control, decongestive physiotherapy, bandaging and the use of a tailor-made compression garment, to be changed periodically.
«And then of course there's the surgery – adds Salgarello –. Always on the basis of maximum personalization of the treatment, they can be performed lymphatic-venous anastomoses, that is, connecting the obstructed lymphatic vessels to small venules with a super-microsurgical technique. In this way, the lymph discharges into the venous system and the swelling is reduced.” The operation involves incisions of approximately two centimeters and is therefore minimally invasive for the patient.
Another surgical possibility is self-transplantation of lymph nodes and lymphatic tissue. «In this case – concludes the expert – the operation consists in taking lymphatic tissue or lymph nodes from other areas of the body (such as the groin, neck or armpit) which are then transferred to the limb affected by the lymphedema. With the use of an intraoperative microscope, the vessels of the lymph nodes are connected to small local vessels, improving the lymphatic drainage of the diseased part over time. In all cases, it is about super-specialized surgery, which is performed in a few experienced centers».
#Lymphedema #symptoms #treatments #swelling #arms #legs #worse