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Lymphedema: Surgical Treatment Options at Midwestern

From the Show: Managing Cancer
Summary: Lymphedema is a condition in which fluid (lymph) is retained in the tissue and causes swelling (edema), often in the arms or legs.
Air Date: 7/6/15
Duration: 10
Host: Melanie Cole, MS
Guest Bio: Daniel Liu, MD
liu-daniel-mrmc-ttInitially trained as a concert violinist, Dr. Daniel Liu attended Hendrix College in Conway, Arkansas as a music scholar. He then turned his focus to medicine. He says, “I wanted to make a more direct impact in people’s lives.”

Dr. Liu completed a bachelor’s degree in chemistry in 2002 and earned a medical degree at Washington University in St. Louis in 2006. Dr. Liu then completed an internship and residency in plastic surgery at the University of Washington in Seattle, where he also served as Chief Resident in the Division of Plastic Surgery.

Dr. Liu has worked as a plastic surgeon at several large hospitals in Illinois. He joined CTCA in August 2014.
Lymphedema: Surgical Treatment Options at Midwestern
Lymphedema is a condition in which fluid (lymph) is retained in the tissue and causes swelling (edema), often in the arms or legs.

The swelling occurs when a blockage in the lymphatic system prevents the fluid from draining adequately.

Lymphedema is often classified as primary or secondary.

Primary lymphedema can develop when lymphatic vessels are missing or impaired, and is a hereditary condition.

Secondary lymphedema can occur when lymph nodes or vessels are removed or damaged, which may develop as an unwanted side-effect of surgery (e.g., node dissection) or radiation treatment.

Daniel Liu, MD, a plastic and reconstructive surgeon at Cancer Treatment Centers of America® (CTCA) in northern Illinois, discusses Lymphedema management for breast cancer and surgical treatment options available at Midwestern.
Transcription:

Melanie Cole (Host)Cancer Treatment Centers of America at Midwestern Regional Medical Center, , has expanded their comprehensive lymphedema treatment program to offer two innovative surgical options for patients suffering from lymphedema. My guest today is Dr. Daniel Liu. He's a plastic and reconstructive surgeon at Cancer Treatment Centers of America in Northern Illinois. Welcome to the show, Dr. Liu. Tell us a little bit first about what is lymphedema.

Dr. Daniel Liu (Guest)Good morning, Melanie. Thanks for having me on the show. First of all, I just want to say that lymphedema is an unrecognized and unpopular thing to talk about because it's not at the top of every patient's mind when they are undergoing cancer treatment. However, it is a very common phenomenon that can happen after treatment of many types of cancers. The most common type of lymphedema that we see here in the United States is after the treatment of breast cancer. Now, when a woman is diagnosed with breast cancer she often has to undergo a series of treatments both including surgery, sometimes radiation and oftentimes chemotherapy. When the lymph nodes are removed as a treatment of the armpit area or the axilla, both with surgical removal as well as radiation therapy to these areas, one of the side effects can be swelling in the affected arm and that is what we see after breast cancers, what's called post-mastectomy lymphedema.

MelanieSo, what is the general cause? You mentioned when lymph nodes are removed, then what actually happens, Dr. Liu?

Dr. LiuWell, first let me say that lymphedema can be caused by many things and actually across the world the most common cause is a parasitic infection that affects the lymph nodes or lymphatics. The normal function of lymph nodes is to filter extra fluid throughout the body and drain extra fluid from the extremities towards the central trunk of the body. When this is not functioning properly then fluid can back up within the extremities, or actually any part of the body. That leads to symptoms of swelling, redness, heaviness and occasionally, infection.

MelanieSo, what happens if it's left untreated? Then, tell us is there something we can do to prevent lymphedema?

Dr. LiuWhen left untreated, lymphedema is, as far as we know, a progressive disease meaning that it slowly and gradually gets worse over time. Unfortunately, there’s no cure for lymphedema. However, there are standards of care that involve physical therapy and some neurosurgical treatment. After treatment of breast cancer by removing the axillary lymph nodes, we oftentimes do maneuvers to try to prevent lymphedema. One of these things is to prescribe a compression garment for the arm called a lymphedema sleeve. That's something that we prescribe for all of our patients who have had axillary lymph nodes dissections as a prophylactic measure.

MelanieSo then, speak about treatment a little bit. If someone comes to you what do you do for them?

Dr. LiuFirst and foremost, we have to make sure that patients are appropriately evaluated and treated by a physical therapist who is qualified to deal with lymphedema and these are called clinical lymphedema therapists who have specialized training. Currently, the treatment of lymphedema centers around multimodalities, from physical therapy, including a combination of compression therapy, garment use, lymphatic pump use, as well as manual lymphatic drainage which is a type of massage. Patients can benefit from a combination of these therapies and there's no proof that one is superior to another. However, the use of these multimodalities can result in good treatment and stabilization of a patient's lymphedema symptoms.

MelanieTell us a little bit about the innovative microsurgery for lymphedema patients at Cancer Treatment Centers.

Dr. LiuOver the past couple of decades, plastic surgeons throughout the world have developed newer techniques to try to attack these problems from a surgical standpoints and with better understanding of both lymphatic anatomy as well as the pathophysiology behind lymphedema. We are trying to do functional surgeries that address the missing lymphatics and/or the missing lymph nodes removed during treatment of cancer. There's two separate procedures that we currently offer. One is called a vascularized lymph node transfer and the other is called a lymphovenous bypass or, more specifically, a lymphaticovenular bypass. These surgeries target different areas of the arm or the axilla with the goal of slowing down the progression of lymphedema.

MelanieIs this a permanent solution? Is it something that comes back—lymphedema--or does this help it to go away?

Dr. LiuUnfortunately, there is currently no cure for lymphedema, either from physical therapy or from these surgeries. However, we believe that by addressing lymphedema in earlier stages with some of these surgical therapies, we can slow the progression of the disease and sometimes cause some reversible changes.

MelanieTell us a little bit about physical therapy to help lymphedema. What's involved in that?

Dr. LiuWell, physical therapy usually involves visiting a CLT, or a clinical lymphedema therapist, for, initially, up to three times a week. These physical therapists will fit our patients with specialized garments based on customized measurements as well as provide some objective measures of lymphedema, both in terms of actual measurements of the lymphs, as well as newer technologies that focus on the fluid content in the extremity. By using these objective measures, we can track a patient's progress and their response to physical therapy. Like I've mentioned before, there's a series of modalities that our physical therapists use in combination with these patients. A lot of this can be done at home by our patients with the use of appropriate garments as well as lymphatic pump devices that patients can purchase. It's important to know that physical therapy needs to be there to guide our patients to make sure they get the appropriate support as well as to follow their progress over time.

MelanieIn just the last few minutes, Dr. Lui, what should people suffering from lymphedema be thinking about when seeking care?

Dr. LiuI think that a lot of people don't realize after their cancer diagnosis what the treatments entail and what the subsequent consequences may involve. Unfortunately, lymphedema is a relatively common phenomenon that happens after a successful treatment of cancer and it can be very debilitating in terms of quality of life. So, one of the important things is to recognize it early; to get into physical therapy early and to slow down the progression of lymphedema over time. With the combination of physical therapy and possibly surgery, patients can often realize a better quality of life by improving their symptoms from lymphedema.

MelanieThank you so much. You are listening to Managing Cancer with Cancer Treatment Centers of America. For more information you can go to cancercenter.com. That's cancercenter.com. This is Melanie Cole. Thanks for listening.

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