The annoying swelling of the limbs (and not only) occurs in a quarter of cancer patients who have undergone the removal of the lymph nodes or radiotherapy. But there are strategies to help manage it effectively
It can happen especially after surgery for a tumor or following a radiotherapy: the arm or leg swell, causing a sense of heaviness, soreness, tension, discomfort. lymphedema, a disease that occurs in about a quarter of patients who have undergone the removal of lymph nodes, due to the accumulation of lymph in the tissues that causes swelling of the limbs. If the causes are irreversible, which is why the disorder may recur or worsen, it is important that all patients know that lymphedema treatable with good results, it can regress or be considerably attenuated and controlled. Especially if the diagnosis is timely, if specific therapies are carried out and if some simple behavioral rules are adopted.
Who risks more
The lymphatic system consists of a dense network of thin vessels, much thinner than veins, which drain the lymph towards the lymph nodes, small organs that are a defense barrier to any structures recognized as foreign to our body (including bacteria, viruses and cancer cells) – explains Monica Pinto, physiatrist director of rehabilitation medicine of the National Cancer Institute Pascale of Naples -. In cancer patients, lymphedema can appear when the lymph nodes have been surgically removed (lymphadenectomy) or underwent radiation therapy. Or when, in the presence of an advanced form of cancer, lymph nodes and lymphatic vessels are invaded by neoplastic cells or are compressed. In all these cases the lymph cannot flow out normally and, consequently, it stagnates in the subcutaneous tissue causing swelling of the affected region. It does not always happen, the risk increases if the number of eliminated lymph nodes is high, if radiotherapy is then performed in the same area (as is often the case for mammary and gynecological tumors), if patients are obese or very overweight and if they have diabetes.
The difference between primary and secondary
Lymphedema can be “secondary” when it depends on damage resulting from other pathologies, such as in cancer patients or some infectious pathologies (for example filariasis, more widespread in Africa and South America) – explains the expert -. More rarely, however, “primitive”, if provoked by a congenital malformation of the lymphatic system mostly caused by genetic alterations, sometimes hereditary. Identifying cases of familiarity is important precisely because it is now possible to carry out genetic investigations which help to discover in time who is most in danger and to intervene accordingly with prevention and early diagnosis. In total, according to the latest statistics, about 200 thousand Italians live with secondary lymphedema and another 150 thousand with a primary form. In any case, it is important to recognize it and contact your doctor immediately to start treatments that can give good results as soon as possible. A dress that hugs under one arm, a ring that no longer fits or pants that go tight are all symptoms that should not be overlooked. The skin generally retains normal color and temperature, at times it can be slightly paler and colder. If, on the contrary, it turns red and warms up, perhaps with pain to the touch, a sign of inflammation and you should consult your doctor.
How to get to the diagnosis and do prevention
The swelling can increase and quickly become chronic and non-reversible, with sometimes severe complications – warns Monica Pinto, who is also coordinator of the Oncological Rehabilitation Section of the Italian Society of Physical Medicine and Rehabilitation -, for this reason it is important to start treatment immediately. The diagnosis is usually simple if you go to specialized centers with doctors who are experienced in rehabilitation: during the visit with a physiatrist, the limbs or the affected area are measured with special instruments (laserscan, photo, perometry), but also the centimeter measurement of the circumferences of the limb in fixed anatomical points is also reliable. On the basis of the individual case, it is then decided which in-depth examinations to carry out and how to proceed, establishing the most appropriate procedure among the many strategies available today. In cancer patients who have undergone lymphadenectomy and radiotherapy, who have a higher risk of developing lymphedema, it is also possible to do prevention. Taking care of the skin a lot, first of all, in such a way as to avoid injury because any wound or burn represents a potential gateway for infections, which increase the production of lymph for its defense activity in the body and if the drainage mechanism does not work as it should, it can lead to the appearance or worsening of the lymphedema. And with specific exercises which are an important part of recovery after surgery, along with weight control.
Cure, an individual project
For the treatment there are specific rehabilitation programs which basically consist of complex decongestive therapy which combines three techniques: manual lymphatic drainage, multilayer bandage and therapeutic exercise with bandage. Afterwards, an elastic-compressive brace in the shape of a glove from the hand to the armpit or a sock from the foot to the thigh or clothing tailored to the other regions of the body, allow to maintain the result obtained – concludes the specialist, who also contributed to a special patient booklet available free of charge on the website of the Italian Cancer Patients Association (Aimac) -. You can then add complementary treatments, such as intermittent pressotherapy or lymphotaping, which do not replace complex decongestive therapy, but can improve the result. Techniques of lymphatic microsurgery, but rehabilitation is still essential in many patients. The starting point for a successful treatment is that there is a individual rehabilitation project (as required by the legislation contained in the national guidelines of 2016), formulated by the physiatrist and that the patient is taken care of by several specialists, according to the necessary skills from the physiotherapist to the psychologist, from the nutritionist to the nurse, to treat the pathology and improve lifestyles.
Physiotherapy, techniques for lymphatic drainage
Need an experienced physiotherapist for manual lymphatic drainagefundamental massage for the treatment of lymphedema: thus, in fact, through specific maneuvers characterized by slow and delicate rhythmic movements that must not evoke pain, reactivates residual functioning lymph nodes and promotes the reabsorption of excess lymph, pushing it towards the reactivated lymph nodes and increasing its flow. There are several techniques, all effective as long as they are entrusted to specialized hands. Each session has a variable duration (30-60 minutes), depending on the area to be treated and the characteristics of the lymphedema. The sessions can be daily or three times a week, usually divided into cycles of at least 10, repeatable during the year depending on the severity and the results obtained. In the interval between one cycle and another, it is useful to carry out some maintenance sessions (once or twice a week) or by self-massagea simplified version of manual lymphatic drainage that the patient can do at home after learning the technique from an experienced therapist.
September 7, 2022 (change September 7, 2022 | 13:11)
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