Lymph Glands or Lymph Nodes

Steady Health



Anatomy for Nurses

Lymphatic Drainage

Lymphatic Drainage




Optimum Health Clinic



Lymphatic Drainage Legs




Lymphatic Drainage Arms




Lymphatic Drainage Head




Junior Dentist

Lymphatic Drainage Head and neck


Darmouth EDU


Lymphatic Drainage neck


Mosby's Dental Dictionary/Answers


Lymphatic Drainage Map

Lymph Node Clusters

Real Complications of Lymphedema

Real People Real Complications of Lymphedema

Perhaps after Barbara’s article,  it is time to post some illustrations of what really does happen to those of us with lymphedema.

Think this doesn’t apply to you?

Remember if you have ever had any of these experiences you are at risk and a possible victim of lymphedema: 

1.) Lymph node removal for biopsies

2.) Serious infections that include lymphangitis, cellulitis or erysipelas.

3.) Deep invasive wounds that might tear, cut or damage the lymphatics.   

4.) Radiation treatments, especially ones that are focused in areas that might contain “clusters” of lymph nodes

5.) Morbid obesity can cause secondary lymphedema by “crushing” the lymphatics

6.) Serious burns, even intense sunburn 

7.) Infection of the microscopic parasite filarial larvae, though this is more common in tropical countries

8.) For primary lymphedema any person who has a family history of unknown swelling of a limb

9.) Spider or insect bites

10.) Surgeries that cut or damage the lymph system.

COMPLICATIONS

 1.  Infections such as cellulitis, lymphangitis, erysipelas. This is due not only to the large accumulation of fluid, but it is well documented that lymphodemous limbs are localized immunodeficient.                       

2.  Draining wounds that leak lymphorrea which is very caustic to surrounding skin tissue and acts as a port of entry for infections.

          

3.  Increased pain as a result of the compression of nerves usually caused by the development of fibrosis and increased build up of fluids.

4.  Loss of Function due to the swelling and limb changes.

         

          

5.  Depression - Psychological coping as a result of the disfigurement and debilitating effect of lymphedema.

6.  Deep venous thrombosis again as a result of the pressure of the swelling and fibrosis against the vascular system. Also, can happen as a result of cellulitis, lymphangitis and infections.

7.  Sepsis, Gangrene are possibilities as a result of the infections.

      

8.  Possible amputation of the limb.

 

9.  Pleural effusions may result if the lymphatics in the abdomen or chest are to overwhelmed to clear the lung cavity of fluids. I just had surgery for this as my lungs continue now to fill up every three weeks. Hopefully, the surgery can prevent it.        

      

10. Skin complications such as splitting, plaques,susceptibility to fungus and bacterial infections.

                                              

Elephantiasis nostras verrucosa     Lymphomatoid Papulosis        Hyperkeratosis, Papillomatosis

11. Chronic localized inflammations.

                    

12. Angiosarcoma, a cancer of the soft tissues

     

Cancers – New research is indicating that those of us with lonh standing lymphedema run a 1 in 10 risk factor for these cancers

13. Lymphangiosarcoma which is a rapidly progressive, non curable cancer of long term lymphedema  patients.  Almost always fatal within six months of diagnosis

14. Lymphoma, new research indicates a possibility of this with hereditary lymphedema.  I have been diagnosed with two forms of lymphoma.     

                                                                                                               Skin lymphoma

15. Kaposi’s Sarcoma, another cancer that can and does arise from lymphedema.

16. Septic arthritis  - type of arthritis triggered/caused by systemic infections, cancers and more

                        
Septic arthritis in knee                Septic arthritis in hand

Lymph Node Status and Breast Cancer-related Lymphedema

Lymph Node Status and Breast Cancer-related Lymphedema.

Purushotham AD, Britton TM, Klevesath MB, Chou P, Agbaje OF, Duffy SW.
From *King’s College London and Guy’s and St. Thomas’ NHS Foundation Trust; †Department of Surgery, Ipswich Hospital NHS Trust; and ‡Centre for Epidemiology, Mathematics and Statistics, Cancer Research, London, United Kingdom.

OBJECTIVE: This study examines the association between nodal positivity and risk of developing breast cancer-related lymphedema (BCRL) in patients who underwent axillary lymph node dissection (ALND).

SUMMARY BACKGROUND DATA: The pathophysiology of BCRL is poorly understood. It has been assumed that one of the factors predisposing to the development of BCRL is nodal positivity, although retrospective series have produced contradictory findings. As these studies have included treatment regimens known to cause BCRL, such as axillary radiotherapy, any relationship between nodal positivity and the development of BCRL remains speculative.

METHODS: A total of 212 patients who had undergone ALND for invasive breast cancer had arm volume measurements preoperatively, and at intervals postoperatively. No patient received axillary radiotherapy. Arm volumes were obtained by measuring serial arm circumferences every 4 cm up the arm and then calculated by using the formula for the volume of a truncated cone. Robust regression techniques were used to analyze the effects of node positivity, age, preoperative body mass index, and wound infection on arm volume excess.

RESULTS: In all, 64 of 212 (30%) patients were node positive. Contrary to previous assumptions, positive node status was significantly inversely associated with arm volume after adjusting for tumor size, time since operation, and allowing for correlated observations within subjects. Furthermore, the number of positive nodes also correlated inversely with arm volume.

CONCLUSION: These results are counterintuitive to the conventional understanding of the pathophysiology of BCRL. A possible explanation is that patients who develop disease in axillary lymph nodes and subsequently undergo ALND have more time and ability to develop lymphatic collaterals, which may provide adequate lymphatic drainage following surgery, thereby reducing the risk of developing BCRL.

Article

Lower Limb Lymphedema Common in Survivors of Gynecological Cancer

Lower Limb Lymphedema Common in Survivors of Gynecological Cancer

NEW YORK JUN 27, 2007 (Reuters Health) - A significant proportion of gynecological cancer survivors develop lower limb lymphedema, according to results of a study published in the June 15th issue of Cancer.

"Lower limb lymphedema is one of the most disabling side effects of surgical and radiotherapy treatment for gynecological cancer," note Dr. Vanessa Beesley, of the Queensland Institute of Medical Research, Australia, and colleagues. "For many gynecological cancer patients, lymph node dissection is an integral part of cancer treatment and surgical staging, and this procedure has been associated with lymphedema development."

The researchers conducted a population-based cross-sectional mail survey of gynecological cancer survivors in 2004. The questionnaire, which was completed by 802 women, included items on demographics, supportive care needs, and lymphedema-related needs.
Overall, 10% of subjects reported a diagnosis of lymphedema. Another 15% reported undiagnosed symptomatic lower leg swelling. The prevalence of diagnosed lymphedema was higher among survivors of vulvar cancer (36%) than all other gynecological cancer subgroups.
Multivariate analysis revealed that for cervical cancer survivors, the odds of developing lower limb swelling were 3.5 times higher if they had radiotherapy and 3.3 times higher if they had lymph nodes removed. The odds of developing lymphedema were higher for survivors of uterine and ovarian cancer who had lymph node dissection or who were overweight or obese.

"Whereas 31% reported being informed about lymphedema before their cancer treatment, 34% of women did not recall being informed about this condition until they were diagnosed," Dr. Beesley and colleagues report. "Others (30%) were informed after their cancer treatment but before symptoms arose, or they could not remember when they were informed (5%)."

The researchers note that supportive care needs in the information and symptom management domains were higher in gynecological cancer survivors with lymphedema than in those with no swelling.

"Women at risk for lymphedema would benefit from instructions about early signs and symptoms and provision of referral information," the team concludes.

SOURCE:

Cancer 2007;109:2607-2614.

Cancer Page

New Procedure May Help Prevent Arm Swelling in Breast Cancer Patients

Surgeon Develops Procedure to Prevent Arm Swelling in Breast Cancer Patients

16 March 2007

Keywords: LYMPHEDEMA LYMPH NODES ARM SWELLING AXILLARY REVERSE MAPPING (ARM) BREAST CANCER BIOPSY

Description A surgeon at the University of Arkansas for Medical Sciences (UAMS) has developed a new procedure to prevent one of the most common side effects associated with breast cancer treatment - lymphedema or swelling of the arms due to faulty drainage of the lymph nodes.

Newswise - A surgeon at the University of Arkansas for Medical Sciences (UAMS) has developed a new procedure to prevent one of the most common side effects associated with breast cancer treatment - lymphedema or swelling of the arms due to faulty drainage of the lymph nodes.

V. Suzanne Klimberg, M.D., director of the UAMS breast cancer program, led a study funded by the Tenenbaum Breast Cancer Research Foundation of breast cancer patients at risk for developing lymphedema. Her findings were published in the February issue of the Annals of Surgical Oncology, and she will present the study March 17 at the Society of Surgical Oncology 60th Annual Cancer Symposium in Washington, D.C.

"The removal and analysis of the lymph nodes under the arm remains the most important factor in determining the severity of disease in breast cancer patients," Klimberg said. "In the past, surgery to remove the lymph nodes and most of the fat and tissue in the armpit often resulted in complications, including lymphedema." Five percent to 50 percent of women undergoing surgical treatment for breast cancer have developed lymphedema, mainly dependent upon the extent of surgery.

At the ACRC, surgeons determined that the draining of the first lymph node, known as the sentinel lymph node, is capable of predicting if the cancer has spread to the remaining armpit lymph nodes, known as axillary lymph nodes. This is a less invasive surgery and reduces the likelihood of complications.

However, the lymph node system is at risk of disruption during either a sentinel lymph node biopsy or an axillary lymph node dissection, which often leads to swelling in the arm.

To prevent the arm swelling, Klimberg has developed the Axillary Reverse Mapping (ARM) procedure. The new technique evaluates the ways in which fluid drains through the lymph node system in the arm through the injection of blue dye. The dye is used to map the drainage of the arm.

"Mapping the drainage of the arm decreases the chances of unintended disruption of the lymph node system during surgery and reduces the risk of developing swelling in the arm," Klimberg said. "We are the first to study lymph node drainage in the arm and are now using the ARM procedure as standard procedure at UAMS."

Klimberg will soon begin conducting training seminars on the procedure throughout the country. The seminars will be sponsored by the global medical device company Ethicon, a branch of Johnson & Johnson.

Klimberg is chief of the Division of Breast Surgical Oncology at UAMS and a professor in the Departments of Surgery and Pathology. She also is director of the Breast Cancer Program at the UAMS' Arkansas Cancer Research Center as well as director of Breast Fellowship in Diseases of the Breast at UAMS.

Additional UAMS staff members involved in the published study are Kent Westbrook, M.D.; distinguished professor; Ronda Henry-Tillman, M.D., associate professor of surgery; Margaret Thompson, fellow; Soheila Korourian, M.D., associate professor of pathology; Keiva Bland, fellow; K. Jackman, surgery resident; and Laura Adkins, data manager.

UAMS is the state's only comprehensive academic health center, with five colleges, a graduate school, a medical center, six centers of excellence and a statewide network of regional centers. UAMS has about 2,430 students and 715 medical residents. It is one of the state's largest public employers with about 9,400 employees, including nearly 1,000 physicians who provide medical care to patients at UAMS, Arkansas Children's Hospital, the VA Medical Center and UAMS' Area Health Education Centers throughout the state. UAMS and its affiliates have an economic impact in Arkansas of $5 billion a year. For more information, visit University of Arkansas Medical School