Innovative Surgeries Help Free Cancer Survivors from a Lifetime of Lymphedema

Roman Skoracki

This guest blog post was written by Roman Skoracki, MD, Division Chief of Reconstructive Oncological Plastic Surgery, at The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute

Thanks to the tireless efforts of advocates, survivors and health care providers, most of us know by now that October is national Breast Cancer Awareness Month. It’s hard to go anywhere or watch anything on television without seeing pink, the official color of the breast cancer awareness campaign.

The good news is we’re making great strides in our battle against breast cancer. During October, internet searches for breast cancer information have been shown to go up considerably, compared to similar causes, and since Breast Cancer Awareness Month began in the late 1980’s, screenings have gone up as well. The American Cancer Society states during that time breast cancer mortality among women who got a mammogram dropped by 38 percent.

Most significantly, the 5-year relative survival rate has grown. In 1975, fewer than 75 percent of breast cancer patients survived 5-years after diagnosis. Today, that number is more than 90 percent, and if breast cancer is caught in its earliest stages, survival rates are nearly 99 percent.

But for all the headway we’ve made in treating breast cancer and the inspirational stories of survival we hear this time of year, we often don’t hear much about the struggles that can come with survivorship.

Unfortunately, for millions of women, the challenges don’t stop when the cancer is gone. It’s estimated that as many as 5 million patients in the United States are facing a lifetime of lymphedema, a painful swelling of the arm on the side of the prior cancer, many of whom are women who’ve survived breast cancer.

During the operation to remove tumors and cancerous breast tissue, surgeons also remove lymph nodes to see if there is any indication that the cancer has spread, a procedure known as lymph node dissection. The role of the lymphatic system is a surveillance system as part of the bodies immune defenses as well as to circulate fluid and proteins throughout the body. In some cases, it can carry cancer cells from breast tissue to other parts of the body, which is why lymph nodes are biopsied at the time of surgery.

However, once surgeons begin removing lymph nodes, the risk of lymphedema goes up. It’s estimated that up to 40 percent or more of those who have lymph node dissection will develop lymphedema, a permanent and often debilitating condition.

To varying degrees, lymphedema causes chronic and painful swelling in the extremities, increases the risk of infection and severely diminishes a patient’s quality of life. Until now, most patients could only hope to control the swelling through the use of compression garments, massage and specialized lymphedema physical therapy.

But two innovative surgeries are giving patients more options to better control lymphedema or prevent it from developing at all. During lymphovenous bypass surgery, my colleagues David Cabiling, MD, and Albert Chao, MD, and I utilize a supermicrosurgical technique to create tiny shunts between lymphatic channels and blood vessels that channels the lymph fluid around the blocked areas where lymph nodes have been removed. I helped to conduct a study of 100 patients who underwent this type of surgery, and we saw symptom improvement in 96 percent of patients. This technique proved especially effective for those who’ve already developed early stage lymphedema in their arms and hands. We are now offering the same approach in a prophylactic fashion to minimize the risk of ever developing lymphedema.

By performing this procedure preventatively at the time of a lumpectomy or mastectomy, we can lower a woman’s risk of developing lymphedema by 90 percent.

Beyond the bypass approach, we’re also pioneering a type of vascularized lymph node transfer surgery to treat lymphedema. At The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, my colleagues and I are able to remove lymph nodes from a different area of the body and then transplant them into the affected limb. This technique allows for the re-establishment of flow of lymph fluid, without the risk of developing lymphedema in the area of the body from which the lymph nodes were harvested.

These types of procedures are still fairly rare and are only performed by a handful of surgeons in the United States. But my hope is that they will quickly become more widely available to the  people who need them so that breast cancer survivors will no longer be burdened by lymphedema - a painful and permanent battle that goes on long after cancer is gone.