“Cancer was a piece of cake. It was the lymphedema that almost killed me”
In 2014, 47-year-old Virginia Harrod found a lump in her breast, which turned about to be stage III breast cancer. She was immediately started on shock-and-awe chemotherapy, but as it turned out, the cancer was chemo-resistant and the tumor only grew with each treatment. Harrod then underwent a double mastectomy to remove both of her breasts and also had 16 lymph nodes removed from the region around her breast and underneath her armpit. Following this procedure, she underwent radiation therapy.
Unfortunately, the removal of the 16 lymph nodes, combined with radiation therapy, put Harrod at risk for developing lymphedema – a painful condition characterized by the accumulation of lymph fluid under the skin, affecting the arms and legs. The condition also increases susceptibility to infection. As it turned out, the lymphatic system problem was a direct side effect of the cancer treatment that had saved her life. “Cancer was a piece of cake. It was the lymphedema that almost killed me” said Harrod.
Breast cancer’s first target
The lymphatic system is a network of tissues and organs that works by eliminating toxins, waste, and other unwanted materials from the body. Its main function is to transport lymph, a fluid that contains infection-fighting white blood cells, to and from the lymph nodes into the bones. When the lymphatic system becomes compromised – such as by the removal of a number of lymph nodes in Harrod’s case – fluid accumulates in the areas where the nodes used to be. For some individuals, the onset of a sudden infection is the first symptom.
Nine months following Harrod’s surgery, her recovery was going well when her cat scratched her right hand. At first, she did not think anything of it, but the next day, red blisters formed on her arm and it began to itch horribly. Harrod’s doctor recognized the symptoms as cellulitis, a severe and advancing bacterial skin infection, and sent her to the hospital for IV antibiotic treatment.
Harrod remained in the hospital under care for 8 days, during which time she learned that she had lymphedema. Over the next 10 months, she would be readmitted to the hospital two more times with severe infections.
In 2016, following her third hospital admission, Harrod received news from another healthcare professional that Dr. Joseph H. Dayan, a reconstructive surgeon at Memorial Sloan Kettering Cancer Center, was specializing in lymph node transfer (LNT). LNT is a surgical procedure that involves transplanting clusters of healthy lymph nodes from unaffected areas of the body for the purpose of restoring a healthy lymphatic system. Almost immediately, Harrod knew that she wanted to participate in the procedure and after undergoing a series of tests to determine whether she was a qualified candidate, she was given the green light.
Harrod had two clusters of nodes transplanted from her stomach into her armpit and forearm. The results were amazing. It was as if she had never experienced any issues with lymphedema.
An overshadowed condition
Medical experts have begun to pay a lot more attention to the physical, mental, and financial aspects of lymphedema, a condition which they say is a common, yet under-reported complication of breast cancer treatment.
The removal of one lymph node carries a 5-7% risk of developing lymphedema. The removal of many more lymph nodes, as in Harrod’s case, increases the risk of developing the condition by 20%. Moreover, undergoing radiation therapy can further increase the risk of developing lymphedema in those patients by 40%. Regardless of its association with breast cancer treatment, not many individuals have heard about lymphedema. “People just don’t see it. They don’t see the disability” said Dr. Dayan. Even many doctors may miss its diagnosis, seeing as how cancer tends to take priority.
Dr. Dayan stresses that the LNT procedure has been around for over 10 years, but it was only until recently that advancements in imaging have allowed for surgeons to be able to target which clusters of nodes are best for safe and effective use.
While the LNT procedure is not a cure, it can drastically lower the symptoms of lymphedema, especially when the condition is caught at an early stage. “We need to get the money to do the research and I'm committed to starting to raise more awareness” said Harrod.
The potential of preventing lymphedema
Dr. Sheldon Marc Feldman, a surgeon at Montefiore Health System in New York, has been working to create another type of surgery – one that aims to prevent lymphoma from developing in the first place. When nodes must be removed during cancer surgery, Dr. Feldman rejoins them to an adjoining vein, as opposed to tying off the lymphatic vessels. This way, he aims to preserve as much of the lymphatic system as possible.
49-year-old Luana DeAngelis is one of Dr. Feldman’s patients. Back in 2004, she was diagnosed with breast cancer. At the time, she started a foundation called “You Can Thrive” for the purpose of providing breast cancer support services to other survivors. When DeAngelis’s cancer returned and had spread to both of her breasts, she decided to get in touch with Dr. Feldman. “I knew if he was going in to remove a lot more lymph nodes that I had a very high risk of lymphedema. And I said to him, ‘Please, if you need to go in and take a lot out, let’s talk about this lymphovenous bypass’” she said. DeAngelis had 22 lymph nodes removed and so far, has not developed any signs of lymphedema.
At present, LNT and lymphovenous bypass procedures are performed solely at a couple of academic medical centers across the United States and around 20 centers around the globe. In due time, Dr. Feldman hopes that the revolutionary procedures will become more widespread, helping to reduce a cancer survivor’s risk of lymphedema from cancer treatment.