New Treatment for Lymphedema 


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 there (lymph 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. 

An 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 first vascularized 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.

To find 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 you.