For those that have had surgery
for cancer, oftentimes lymph nodes are removed as a means of
checking whether the cancer has spread (sentinel lymph node
biopsy) or they are removed when cancer is present in the lymph
nodes or there is a high likelihood that the cancer may spread
node dissection). Some patients develop lymphedema – an
uncomfortable and sometimes painful condition in which lymph fluid collects at
the site of removed lymph nodes causing swelling that
can limit mobility and functionality. Radiation can also
increase the risk of developing lymphedema in some patients.
Lymphedema is usually treated with manual lymphatic drainage
massage, compression sleeves or wrapping, yoga and exercise.
In severe cases the usual treatments only bring temporary relief.
There are two other options for avoiding or treating lymphedema.
innovative procedure called lymphovenous bypass can help to
prevent lymphedema in patients that have a high number of lymph
nodes removed. Dr. Dhruv Singhal, Director of Lymphatic Surgery at
Beth Israel Deaconess Medical Center, compares
the lymphatic system to a network of trains when describing the
bypass which has been developed to “keep the lymphatic train on
track.” During the removal of lymph nodes a fluorescent green dye is injected into the closest
extremity which makes the lymphatic channels, or train, glow. That
glow can then be followed to figure out where the lymphatic
channel, or train, was derailed. The surgeon, using a specialized
microscope, is then able
to re-route the train onto a different track system,
or the veins. This restores the flow of the lymphatic fluid so
that the risk of swelling in the extremity is minimized.
Lymph node transfers are used for patients whose
lymphedema has not responded to physical therapy treatment.
In a lymph node transfer healthy lymph nodes are
taken from another part of the body and placed at the site of the
blockage that’s creating the lymphedema.
Dr. Richard Klein, who completed the
lymph node transfer surgery in Florida in 2013, explains that the area
where the lymph node is being taken from is carefully selected so it doesn’t cause lymphedema
where it is harvested from. A small cluster of
lymph nodes with a small artery and a vein is taken and moved to the location where
they are needed. Then the arteries and the veins are reattached. Over
a period of a couple of months, the lymph nodes will start
creating new lymphatic channels between them and the surrounding
tissues. The idea is for them to connect with the lymphatic
channels that had previously been cut and then new channels form
that can begin draining the limb that’s blocked.
out more about these options and if they are right for you talk to
your oncologist or surgeon. Remember every patient is
different and every body responds differently - you and your
doctors, working together, can find which treatment works best for