-
Orvosi Hetilap Jun 2022Breast cancer-related lymphedema may impact life quality and cause co-morbidity of several types. Though breast cancer-related lymphedema does not directly follow the...
Breast cancer-related lymphedema may impact life quality and cause co-morbidity of several types. Though breast cancer-related lymphedema does not directly follow the initial intervention, it may develop even years after it; timely diagnosis and treatment are essential. The combined therapies such as radiation, chemo- and endocrine therapy, and other events (e.g., injury, infection, inflammation, or systemic disease) may further impair the lymphatic function. A prospective surveillance program for the early detection of subclinical edema in high-risk patient groups may improve quality of life. Currently, complex decongestive physiotherapy is the first-line treatment of breast cancer-related lymphedema. It should start soon after the diagnosis. After the early-stage treatment, the lifelong care and followup of the patients are necessary. The article presents pathophysiology, treatment, and future trends of therapies in breast cancer-related lymphedema.
Topics: Breast Neoplasms; Female; Humans; Lymphedema; Physical Therapy Modalities; Prospective Studies; Quality of Life
PubMed: 35895575
DOI: 10.1556/650.2022.32468 -
Current Oncology (Toronto, Ont.) Apr 2023Lymphedema is a chronic progressive disorder that significantly compromises patients' quality of life. In Western countries, it often results from cancer treatment, as... (Review)
Review
Lymphedema is a chronic progressive disorder that significantly compromises patients' quality of life. In Western countries, it often results from cancer treatment, as in the case of post-radical prostatectomy lymphedema, where it can affect up to 20% of patients, with a significant disease burden. Traditionally, diagnosis, assessment of severity, and management of disease have relied on clinical assessment. In this landscape, physical and conservative treatments, including bandages and lymphatic drainage have shown limited results. Recent advances in imaging technology are revolutionizing the approach to this disorder: magnetic resonance imaging has shown satisfactory results in differential diagnosis, quantitative classification of severity, and most appropriate treatment planning. Further innovations in microsurgical techniques, based on the use of indocyanine green to map lymphatic vessels during surgery, have improved the efficacy of secondary LE treatment and led to the development of new surgical approaches. Physiologic surgical interventions, including lymphovenous anastomosis (LVA) and vascularized lymph node transplant (VLNT), are going to face widespread diffusion. A combined approach to microsurgical treatment provides the best results: LVA is effective in promoting lymphatic drainage, bridging VLNT delayed lymphangiogenic and immunological effects in the lymphatic impairment site. Simultaneous VLNT and LVA are safe and effective for patients with both early and advanced stages of post-prostatectomy LE. A new perspective is now represented by the combination of microsurgical treatments with the positioning of nano fibrillar collagen scaffolds (BioBridgeTM) to favor restoring the lymphatic function, allowing for improved and sustained volume reduction. In this narrative review, we proposed an overview of new strategies for diagnosing and treating post-prostatectomy lymphedema to get the most appropriate and successful patient treatment with an overview of the main artificial intelligence applications in the prevention, diagnosis, and management of lymphedema.
Topics: Male; Humans; Quality of Life; Artificial Intelligence; Lymphedema; Lymphatic Vessels; Prostatectomy
PubMed: 37232799
DOI: 10.3390/curroncol30050341 -
Cardiovascular Research Jul 2021Vascular endothelial growth factor receptors (VEGFRs) are part of the evolutionarily conserved VEGF signalling pathways that regulate the development and maintenance of... (Review)
Review
Vascular endothelial growth factor receptors (VEGFRs) are part of the evolutionarily conserved VEGF signalling pathways that regulate the development and maintenance of the body's cardiovascular and lymphovascular systems. VEGFR3, encoded by the FLT4 gene, has an indispensable and well-characterized function in development and establishment of the lymphatic system. Autosomal dominant VEGFR3 mutations, that prevent the receptor functioning as a homodimer, cause one of the major forms of hereditary primary lymphoedema; Milroy disease. Recently, we and others have shown that FLT4 variants, distinct to those observed in Milroy disease cases, predispose individuals to Tetralogy of Fallot, the most common cyanotic congenital heart disease, demonstrating a novel function for VEGFR3 in early cardiac development. Here, we examine the familiar and emerging roles of VEGFR3 in the development of both lymphovascular and cardiovascular systems, respectively, compare how distinct genetic variants in FLT4 lead to two disparate human conditions, and highlight the research still required to fully understand this multifaceted receptor.
Topics: Animals; Cardiovascular System; Disease Models, Animal; Gene Expression Regulation, Developmental; Heart Defects, Congenital; Humans; Lymphatic System; Lymphedema; Mice, Transgenic; Morphogenesis; Mutation; Signal Transduction; Vascular Endothelial Growth Factor Receptor-3
PubMed: 33067626
DOI: 10.1093/cvr/cvaa291 -
British Journal of Community Nursing Jun 2022
Topics: Community Health Nursing; Humans; Lymphedema
PubMed: 35671212
DOI: 10.12968/bjcn.2022.27.6.268 -
Head & Neck Oct 2022Head and neck lymphedema (HNL) is an increasingly recognized complication of head and neck cancer and its treatment. However, no consensus exists on the "gold-standard"... (Review)
Review
Head and neck lymphedema (HNL) is an increasingly recognized complication of head and neck cancer and its treatment. However, no consensus exists on the "gold-standard" assessment tool for the purposes of diagnosis, classification, or monitoring of HNL. We conducted a systematic review of the literature regarding HNL assessment to determine the optimal method/s of assessment for patients with HNL. A review of publications between January 2000 and September 2021 was undertaken on four electronic databases. Studies were excluded if no clear assessment method of HNL was documented. Sixty-seven articles were included in the study. A wide range of assessment methods for HNL have been reported in the literature. For the purposes of diagnosis and classification of physical findings, computed tomography (CT) appears the most promising tool available for both external and internal HNL. In terms of monitoring, ultrasound appears optimal for external HNL, while a clinician-reported rating scale on laryngoscopy is the gold standard for internal HNL. Patient-reported assessment must be considered alongside objective methods to classify symptom burden and monitor improvement with treatment.
Topics: Head; Head and Neck Neoplasms; Humans; Lymphedema; Neck; Tomography, X-Ray Computed
PubMed: 35818729
DOI: 10.1002/hed.27136 -
Surgical Oncology Clinics of North... Oct 2023In the setting where breast cancer-related lymphedema (BCRL) remains a feared and common complication of breast cancer, here we review important factors for the... (Review)
Review
In the setting where breast cancer-related lymphedema (BCRL) remains a feared and common complication of breast cancer, here we review important factors for the development, diagnosis, prevention, and treatment of BCRL. We find that race/ethnicity affect BCRL development risk, that future studies should focus on understanding the biological reasons behind the increased susceptibility of certain racial minorities to BCRL, that surveillance, early detection, exercise programs, and arm compression can reduce the risk of BCRL, and that surgical techniques to preserve and restore lymphatic drainage being evaluated in randomized trials may become transformative in reducing BCRL risk for high-risk patients.
Topics: Humans; Female; Lymphedema; Morbidity; Breast Neoplasms; Risk Assessment; Upper Extremity
PubMed: 37714638
DOI: 10.1016/j.soc.2023.05.004 -
Pediatric Dermatology Sep 2022Milroy disease is a form of congenital primary lymphedema that usually affects the lower limbs. Predominant genital lymphedema in Milroy disease is uncommon and...
Milroy disease is a form of congenital primary lymphedema that usually affects the lower limbs. Predominant genital lymphedema in Milroy disease is uncommon and disabling. When conservative management is ineffective, surgical treatment becomes necessary. Here, we present a rare case of congenital primary penile lymphedema in a 4-year-old child.
Topics: Child, Preschool; Humans; Lymphedema; Male; Penile Diseases; Penis
PubMed: 35510811
DOI: 10.1111/pde.15025 -
International Journal of Molecular... Jul 2022Secondary lymphedema is a common complication of lymph node dissection or radiation therapy for cancer treatment. Conventional therapies such as compression sleeve... (Review)
Review
Secondary lymphedema is a common complication of lymph node dissection or radiation therapy for cancer treatment. Conventional therapies such as compression sleeve therapy, complete decongestive physiotherapy, and surgical therapies decrease edema; however, they are not curative because they cannot modulate the pathophysiology of lymphedema. Recent advances reveal that the activation and accumulation of CD4+ T cells are key in the development of lymphedema. Based on this pathophysiology, the efficacy of pharmacotherapy (tacrolimus, anti-IL-4/IL-13 antibody, or fingolimod) and cell-based therapy for lymphedema has been demonstrated in animal models and pilot studies. In addition, mesenchymal stem/stromal cells (MSCs) have attracted attention as candidates for cell-based lymphedema therapy because they improve symptoms and decrease edema volume in the long term with no serious adverse effects in pilot studies. Furthermore, MSC transplantation promotes functional lymphatic regeneration and improves the microenvironment in animal models. In this review, we focus on inflammatory cells involved in the pathogenesis of lymphedema and discuss the efficacy and challenges of pharmacotherapy and cell-based therapies for lymphedema.
Topics: Animals; Anti-Inflammatory Agents; Lymph Node Excision; Lymphatic System; Lymphatic Vessels; Lymphedema
PubMed: 35886961
DOI: 10.3390/ijms23147614 -
Journal of Vascular Surgery. Venous and... Jan 2023In super-microsurgery, such as lymphaticovenular anastomosis (LVA), the diameter of the target vessel can be small and difficult to manage, and the basic surgical...
BACKGROUND
In super-microsurgery, such as lymphaticovenular anastomosis (LVA), the diameter of the target vessel can be small and difficult to manage, and the basic surgical technique of microsurgery, such as inserting a forceps into the lumen and applying countertraction, can be difficult. In addition, it can be difficult to confirm the success or failure of the postoperative anastomosis, unlike with normal free-flap transfer, or to learn the technique by reviewing the results.
METHODS
We have described a safe, quick, and accurate technique for LVA based on our experience performing several hundred such cases at our institution.
RESULTS
Before LVA, the location of the significant lymphatic vessels and veins proximal to the lymphatic vessels should be marked using indocyanine green fluorescence angiography and a vein viewer to help determine the skin incision site. We used super-microsurgical titanium needles and surgical scissors and an end-to-end anastomosis. The lymphatic vessels should be dissected as far as possible from the skin incision to the center, and the veins should be dissected as far as possible from the periphery. First, a stay suture should be applied to the upper and lower ends of the anastomosis at 180°. Next, the anterior wall should be sutured. In some cases, countertraction can be applied by inserting the tip of a forceps into the vascular vessel. However, because its insertion could damage the lymphatic vessel wall, it would be more appropriate to perform the anastomosis using the involved stitch technique. After anastomosis of the anterior wall, the vessel should be inverted and the posterior wall anastomosed using the same technique.
CONCLUSIONS
We have reported the key points necessary to perform LVA quickly and accurately and the precautions necessary to maintain long-term patency. This sophisticated LVA technique can be applied to improve the outcomes for patients with lymphedema.
Topics: Humans; Microsurgery; Anastomosis, Surgical; Lymphatic Vessels; Lymphedema; Veins
PubMed: 36182085
DOI: 10.1016/j.jvsv.2022.08.008 -
Lymphatic Research and Biology Oct 2022The coronavirus disease 2019 (COVID-19) pandemic poses a challenge to management of lymphedema. The aim of this study was to assess general health conditions and...
The coronavirus disease 2019 (COVID-19) pandemic poses a challenge to management of lymphedema. The aim of this study was to assess general health conditions and evaluate the problems and concerns of lymphedema patients with regard to access to care and provision of management and control follow-ups during the lockdown period between March and June 2020. A web-based online survey, which included questions about demographic and clinical properties, compliance with restrictions and self-management, complications, needs, and difficulties in accessing health care, as well as the presence of psychological symptoms, was applied. Two hundred three patients (190 female and 13 male) replied. Majority of them (73.4%) were between 30 and 60 years old and had high school/university education (67%). The duration of lymphedema was more than 3 years and sites were commonly extremities with mild to moderate intensity in 70.5% patients. Majority of them adhered to stay home warnings (88.7%). Weight gain was a common problem and self-care methods were generally skipped (81.8%). Seventeen percent of them had wounds and/or cellulitis. Forty percent of patients needed to apply to health centers to renew the pressure garment, but could not reach it. More than 70% of patients had sleep disorders and anxiety/stress. Majority of patients used television and social media to get information related to COVID-19 and the exposure time was commonly 2 to 6 hours. The COVID-19 lockdown had a great impact on lymphedema patients' health care not only from medical but also from psychosocial aspects. All these implications have to be identified and dealt with properly to avoid concerns and consequences of future pandemic lockdowns. Lymphedema services should be well prepared to be delivered virtually, enable effective care, and share knowledge to meet the needs of patients suffering from lymphedema.
Topics: Humans; Male; Female; Adult; Middle Aged; COVID-19; Communicable Disease Control; Pandemics; Surveys and Questionnaires; Lymphedema
PubMed: 35021887
DOI: 10.1089/lrb.2021.0070