Malignant Lymphedema

[lymphede...@gmail.com]

Malignant Lymphedema

What is Malignant Lymphedema?

Lymphedema caused by an impaired lymph flow due to malignant tumor
infiltratration and blockage or compression of lymphatic vessels and
lymph nodes.

This is different then secondary lymphedema which is caused by removal
of lymph nodes, damage to the lymph system from trauma; cancer
treament, biopsy. See risk factors for lymphedema for causes of
secondary lymphedema. Secondary lymphedema tends to develop slowly
over an extended period of time versus the rapid development of
malignant lymphedema.

Diagnosis

Physical exam and history which typically reveal rapid onset,
neuropathic pain, weakness, skin discoloration or unusual lesions,
proximal or genital location, lymphadenopathy, tense edema (1)

*Important to understand that malignant lymphedema develops quickly,
can be quite painful and has a firm tissue texture. Malignant
lymphedema in the abdominal/truncal regions can also result in pleural
effusions, so patients experiencing this should be tested.

Diagnosis can be achieved through ultrasound, CT, MRI,
lymphoscintigraphy.

Treatment

Palliative or curative treatment of tumor with radiation, surgery or
chemotherapy.

If terminal then no contraindication to MLD and compression bandages
or garments.

If not terminal, then treat with bandages and garments alone.

Primary treatment focuses on resolution of the tumor and/or malignancy
causing the lymphatic obstruction.

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FDG PET in the differentiation of benign from malignant lymphedema
J Nucl Med. 2007

Mijin Yun1, Taesung Kim1, Arthur Cho1 and Jongdoo Lee1 1 Yonsei
University College of Medicine, Seoul, South Korea 1278

Objectives:

This study was undertaken to assess the role of FDG PET in the
differentiation of benign from malignant lymphedema in patients with a
history of various malignancies.

Methods:

We performed a retrospective review of medical records to select
patients with lymphedema in one of the extremities who had underdone
FDG PET imaging. Twenty three patients (18F: 5M, mean age: 60, age
range: 38-75) were included in this study. Of the 23 patients, 7 were
diagnosed with breast cancer, 4 with cancer of uterine cervix, 4 with
colorectal cancer, 2 with ovarian cancer, 2 with soft tissue sarcoma,
and 1 of the following diseases; skin cancer, melanoma, lymphoma, and
endometrial cancer. All patients had undergone FDG PET to evaluate for
tumor recurrence or surveillance. If the degree of FDG uptake in the
lesion was less than the uptake in the liver (mild), it was considered
to be negative. Conversely, if the uptake in the lesion was similar to
(moderate) or greater than that in the liver (high), the findings
considered positive.

Results:

Of the 23 patients, 8 showed upper extremity lymphedema and 15 lower
extremity lymphedema. There were 9 patients with positive FDG uptake
in the ipsilateral axilla, groin or pelvis. All patients except for
one were found to have recurrent diseases which were responsible for
lymphedema. In addition, PET was useful in detecting recurrent
diseases other than the recurrence in the axilla, groin, or pelvis in
6 of the 8 patients. There was a false positive patient showing a
focus of increased FDG uptake in the Rt. pelvis. The lesion was not
confirmed by other imaging modalities or follow up, which could have
been due to physiologic bowel uptake. The other 14 patients showed no
increase of FDG uptake proximal to the extremities with lymphedema. No
patient was proven to have recurrent disease.

Conclusions:

It can be difficult to detect malignant causes of lymphedema by
anatomical imaging because of altered anatomy after surgery and/or
radiation therapy. Based on our study, FDG PET seems to be extremely
useful in the differentiation of benign from malignant lymphedema. It
has potential in early diagnosis and in initiate proper treatment of
malignant lymphedema, which can change patient survival and prevent
the progression of diseases. Journal of Nuclear Medicine

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Secondary malignant lymphedema
Wien Med Wochenschr. 2006 May

Keywords
Malignant lymphedema - Complications - Physical treatment

Soucek-Hadwiger B, Döller W. Abteilung für Innere Medizin,
Landesklinikum Thermenregion Baden, Osterreich. bettina.soucek-
hadw...@baden.lknoe.at

The diagnosis of a secondary malignant lymphoedema which is caused by
tumor infiltration or tumor compression is a very important sign for
an unknown primary, but also for a tumor relapse. It is a big
challenge, because it is often associated with a long story of woe,
severe pain and a big reduction in mobility. Only an early diagnosis
and introduction of a tumor-specific therapy is able to prevent the
progress of this disease. As the secondary lymphedema is a chronic
progressive disease, the early beginning of the “Complex physical
Oedematherapy” is necessary, which consists of a combination of manual
lymph drainage, compression by the use of bandages and special
stockings for compression, physical training to improve mobility,
dermatological care and drug therapy. Lymphedema is a chronic
incurable disease. Therefore the therapeutic goal is to reach a stable
disease without symptoms, which means reducing the lymphedema to
“Stadium 0, latent stage”.

Springer Link - http://www.springerlink.com/content/u016734105517511/

Diagnosis and therapy of Malignant Lymphedema
Rüger K Fachklinik für Lymphologie und Odemkrankheiten, St. Blasien.

In addition to the typical clinical symptoms, the diagnosis “malignant
lymphedema” also requires the confirmation of a tumor or a metastasis
obstructing lymph flow. With the standard physical treatment of edema
described by Asdonk successful clinical management of malignant
lymphedema is also possible. The sole contraindication of manual lymph
drainage is, we believe, locoregional tumor recurrence, which can be
completely eliminated by the immediate initiation of radical tumor
treatment. The tumor recurrence is the result not of falsely indicated
manual lymph drainage, but of inadequate primary treatment that leaves
behind residual tumor tissue, the early detection of which still
remains an unresolved problem. Manual lymph drainage is indispensable
for improving the quality of life of tumor patients with lymphedema.

Medscape - http://www.medscape.com/medline/abstract/9622972

Pat O'Connor