Lymphedema after breast and gynecological cancer - a frequent, chronic, disabling condition in cancer survivors.

The goal of our study was to determine clinical characteristics of women cancer survivors treated for secondary lymphedema, the time from cancer treatment to the development of lymphedema, and the effect of therapy on reduction of lymphedema and occurrence of erysipelas. We performed a retrospective study of women with secondary lymphedema after breast cancer (BR) and gynecological (cervical, uterine, ovarian, vulvar) cancers (GYN) treated at our Department from 2004 to 2010. The average time from cancer treatment to the development of lymphedema in our patients was 2.2 and 4.75 years in the BR and GYN groups, respectively, ranging from within days after the procedure to as long as 31 years. The duration of lymphedema in our patients before they first received appropriate therapy was on average 4.1 and 2.65 years in the BR and GYN groups, respectively. In our series, untreated lymphedema was a strong predisposing risk factor for erysipelas, whereas no cases of erysipelas were noticed after the establishment of therapy. Compression therapy was shown to be an effective measure to reduce lymphedema. The duration of required initial decongesting therapy with short-stretch elastic bandages was longer in patients with more long-standing edema. Lymphedema may first appear several years after the cancer procedure. Our findings emphasize the need for awareness of lymphedema as a possible long-term iatrogenic complication in cancer survivors to avoid a delay in diagnosis and therapy. Physicians in care of cancer survivors should actively look for lymphedema. Untreated lymphedema is a strong predisposing risk factor for erysipelas.

[Compression therapy for lymphedema: our experience]. / Nasa iskustva s kompresijskom terapijom limfedema.

The term lymphedema refers to a chronic, progressive edema, usually of a limb, due to insufficient lymphatic flow. It may appear as a primary disturbance or secondary to other causes, e.g., after infections or surgery. The most common cause of lymphedema in the Western world is cancer surgery and/or radiotherapy. The authors summarize the etiology, pathophysiology and clinical staging of lymphedema. The diagnosis of lymphedema is usually based on history and clinical appearance. However, lymphoscintigraphy is the gold standard of imaging in doubtful cases. Adequate and early compression therapy and good patient compliance are the cornerstones of management of lymphedema. The authors present their experience with compression therapy for lymphedema. While no differences were found in the efficiency of compression therapy between oncologic and non-oncologic patients, compression stockings of class III seemed to be efficient in the majority of secondary lower limb lymphedemas but not as maintenance therapy for primary lower limb lymphedema.