There's good news for those with breast cancer: doctors say cure rates are getting better. However, many women are left with unwanted, and sometimes devastating, side effects. There's a new treatment that's making a big difference in the lives of survivors.
When Katie Brophy learned she had breast cancer, she wasn't surprised.
"I sort of expected it, obviously when you have a lump, you just assume," says Brophy.
A lumpectomy and radiation took care of her cancer, but left her with the risk of lymphedema, a side effect of treatment that causes fluid build-up in the limbs.
As an interior designer, that worried her.
"I'm physical. I paint walls. I wallpaper, refinish wood. The last thing you need to do is have an impaired arm," says Brophy.
Mayo Clinic Doctor Andrea Cheville says radiation may destroy arm-draining lymph nodes. Once they're damaged, the risk of lymphedema rises, so does the risk of infection.
"It's unattractive and so I think socially it's a very difficult condition for people. Our best hope is to prevent people from getting it," says Dr. Cheville.
To do that, she's testing a new technique that combines CT scans with SPECT-imaging, that powerful combo pinpoints exact locations of critical lymph nodes.
"The physicians who are planning a woman's radiation can know exactly where those critical nodes are and avoid them, block them from the radiation field," says Dr. Cheville.
Studies show it reduces the number of critical lymph nodes that receive harmful radiation by more than 55 percent.
"We treated 30 women. None of those women have developed lymphedema," she says.
Brophy was one of those women.
Dr. Cheville says a big advantage of this approach is many medical centers already have both of these technologies. Training physicians to use them together may be all that's needed to help women reduce their risk of lymphedema.
BACKGROUND: Between 5 percent and 40 percent of women are estimated to experience some form of lymphedema after breast cancer surgery; however, the condition is often overlooked or misdiagnosed. Lymphedema occurs when the lymph system is damaged or blocked. It can cause fluid buildup and swelling and usually affects an arm or a leg, but it can affect other parts of the body. Lymph fluid, tumors, lymph vessels and lymph nodes all can play a part in lymphedema.
(SOURCES: www.breastcancer.org, www.cancer.gov)
CAUSES AND SYMPTOMS: Lymphedema can be either primary or secondary. Primary lymphedema is caused by abnormal development and can occur at birth or develop later in life. Secondary lymphedema is caused by damage to the lymph system due to infection, injury, cancer, scar tissue, or radiation therapy. People can be at risk of developing lymphedema if they are obese, smoke heavily, have diabetes or have had a mastectomy or previous surgery to the armpit area. Along with swelling, people with lymphedema may experience a feeling of heaviness or tightness in the arm or leg. They may also feel aching or discomfort and possibly hardening of the skin around the affected area.
(SOURCES: www.cancer.gov, www.breastcancer.org and Mayo Clinic)
NEW PREVENTION TECHNIQUES: Using single photon emission computed tomography (SPECT) along with computerized tomography (CT) scans, doctors may be able to offer substantial protection against lymphedema. Although a person may have as many as 62 lymph nodes under the arm, only a few are responsible for the removal of fluids from the arm. The SPECT-CT technique works best for patients who do not require radiation targeting any remaining lymph nodes. The risk of developing lymphedema may be as much as 50 percent without taking measures to preserve the function of a person's lymphatic system. Because lymphedema can occur years after a surgery, patients will continue to be monitored by their physicians for signs of lymphedema. Currently, there are two treatment plans for each patient: a standard plan and one adapted for lymph node sparing based on the SPECT-CT scans.