Tweets from ESL (3) – Screening for lymphoedema

[LVASurgeon]

@Oxford OLP

Sep 26

Second day of ‪#ESL‬‬ Genoa 2014. Early start - I think most people are still enjoying an Italian breakfast! Surgeons are here... ‪#lymphedema‬‬

Pierre Bourgeois talking on ‪#Lymphedema‬‬ ‪#prevention‬‬. Screening and early microsurgery is very important

Johansson: MLD not really effective for preventing ‪#Lymphedema‬‬ ‪#Microsurgery‬‬ has been shown to be effective in preventing lymphoedema

The big theme of day 2 of the ESL meeting in Genoa was early detection and prevention of lymphoedema. This is a topic that I find fascinating, and incredibly important.

I see in my patients the difficulties of living with lymphoedema on a daily basis, and how it affects their quality of life. For some, they hate the stigma of wearing compression garments, the questions in the supermarket, the constant reminder of their cancer treatment. For others, they just want to get their favourite pair of boots on. Others have more physical symptoms – heaviness, decreased movement, recurrent infections. If we could prevent this from happening, we would greatly increase the quality of life of thousands of cancer survivors.

Conservative measures (such as compression garments and MLD) are important in the everyday management of established lymphoedema, but can they prevent lymphoedema from happening? Unfortunately, the answer to this question appears to be no. Karin Johannon from Lund, Sweden presented data on early detection of breast cancer related lymphoedema. She said that MLD was not effective in preventing lymphoedema. Compression garments managed to control lymphoedema in the majority of patients detected early, but as I have posted before, many patients don’t like wearing their garments, so we need to find a better solution, and early microsurgery seems to be the way forward.

Pierre Bourgois is from Brussels. He presented on early detection of lymphoedema using Indocyanine Green Lymphography (ICG scan). This is a technique we use in our clinic. A simple injection of green dye in the foot or the wrist, followed by scanning in the clinic room using a special infra-red camera is invaluable for mapping lymphatics and detecting early lymphatic dysfunction. It is also vital for planning surgery. It is painless and does not involve radioactivity like lymphoscintigraphy.

We offer a service where we can screen patients at risk of lymphoedema after their cancer treatment, and then intervene when they show the earliest signs of lymphoedema, even before they know that their limb is swollen. This can prevent the progressive changes that happen in the lymphatics with lymphoedema, and prevent the swelling form happening. This means that patients can avoid compression, MLD, and the complications of lymphoedema, like multiple infections.

If you would like to follow me on Twitter, please search for @OxfordOLP. There is also a lot of information available on our website olp.surgery

[andyduudz]

thank you very much for share your post

[MarianneC]

Very interesting to hear all of this. Early detection would obviously be most beneficial for patients. I suffered from Lymohoedema for at least 10 years before it was diagnosed properly. No one mentioned this possibilty when I got my Cancer treatment.

It's great work you are doing although I do feel for those people who cannot afford private treatment. In due course hopefully this treatment will be available on the NHS.

Regards, Marianne

[nan2high]

Following breast cancer surgery with the removal of one lymph node and 30 radiography sessions which left me badly burned, it took nearly 2 years for a diagnosis of lymphoedema to be given and MLD treatment started. I have no swelling in my arm but my left breast, midriff, belly and leg are all affected. There was a tiny mention of the possibility of Lymph. occurring in the arm on the affected side in a leaflet I was given prior to surgery. In no way did it prepare me for the condition I have now. Every time I saw a doctor or the breast nurse I complained about the state I was in but they just said "this happens sometimes". No treatment, advice or help was offered. My G.P. eventually suggested it could be Lymphoedema and I was referred to a therapist who has tried her best but I just keep getting bigger and more lop-sided. I saw a plastic surgeon last week, he is sending me to have more scans, he doesn't think the swelling in my midriff etc. is lymphoedema. It may be rare or unusual but surely I can't be the only person affected in this way?

[LVASurgeon in reply to nan2high]

Dear nan2high,

This sounds really horrible for you. It is good that you have got to see a Plastic Surgeon, and it sounds like they have got the right idea to investigate the cause and plan treatment.

Good luck.