Doctors say bypass can prevent lymphedema after cancer surgery

DOYLESTOWN, Pa. (WPVI) -- Lymphedema has been a long-standing worry after cancer surgery or radiation, particularly breast cancer.

But it's now possible to reduce, or even prevent these swelling problems.

Like many women, Jen Gluch got behind on getting her mammogram last year as she juggled work and family.

"But then I just felt a mass one morning," Gluch recalls.

The diagnosis was inflammatory breast cancer.

And Gluch learned that 17 underarm lymph nodes would be removed along with the tumor to get all the cancer.

"Before I was diagnosed, I had no idea what lymphedema was," she says.

The lymphatic system helps move excess fluid out of soft tissue.

Swelling, or lymphedema, occurs when lymph channels get blocked after injury, surgery or radiation.

"It's sort of like traffic that backs up at construction at an intersection. So they try to take a different route, but what happens is that fluid will then go back into the tissues before it can get back into the veins," says Dr. Richard Bleicher, a surgical oncologist at Fox Chase Cancer Center.

Dr. Bleicher says lymphedema can occur in an arm or leg up to 30% over the patient's lifetime when cancerous nodes are removed, and it can occur at any time in life.

It's most common in breast cancer and melanoma patients.

It's uncomfortable. And if left untreated, can lead to infection.

The conventional treatment has been to wait to see if lymphedema develops, then using compression treatments to push out the fluid.

But now, doctors at Fox Chase can lessen or prevent the swelling, with a lymphovenous bypass.

"Lymphovenous bypass basically takes one set of channels that exists in the body and connects them to another," says Dr. Bleicher.

Dr. Sameer Patel, chief of plastic and reconstructive surgery, adds, "We're just kind of helping it to get back there."

Dr. Patel says the bypass doesn't greatly affect surgery time or recovery.

"A few small incisions on the affected extremity. These incisions are usually anywhere from an inch to maybe 2 inches at most," he notes.

"And the location of those incisions really depends on where we're able to identify usable lymphatics (channels), he says.

The prime time for the bypass procedure is during the tumor removal, or in early lymphedema.

"We've seen actually dramatic results in some women who have had significant lymphedema," notes Dr. Bleicher.

Gluch bypass was during her initial surgery.

"Thank goodness, I have not had any signs of lymphedema," she says.

"We've been doing this more and more," says Dr. Bleicher of the rising number of lymphovenous bypass procedures done at Fox Chase.

Although the procedures are becoming more common around the country, Doctors Bleicher and Patel say success depends on experience.

"Look for an institution that has a good deal of experience at it, like Fox Chase Cancer Center. And also find out, you know, how many cases have they done? and what situations?" Dr. Bleicher says.

Fox Chase says surgeons can also transfer lymph nodes to affected areas, though that's more complicated.

Dr. Patel says lymphedema may be occurring less frequently among breast cancer patients because fewer lymph nodes are being removed during surgery these days, thanks to better diagnostic techniques.

"There's recently been some data that suggests that lymph node dissections may not always be necessary in patients that have a low burden of disease in the axillary lymph nodes," he says.
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