Specialized Surgery, Therapy Bring Relief to Cancer Patients

By the time cancer survivor Sydnee Meth found an effective treatment for the pain she had coped with for years, her right arm was so swollen and heavy that she could not lift it past her shoulder. She had trouble finding blouses that fit. Seemingly simple tasks, like blow-drying her hair, were impossible.

“I was miserable, depressed and didn’t have much of a life,” said Meth, who developed the painful condition called lymphedema after her second bout of breast cancer in 2014 and subsequent removal of lymph nodes from her right armpit. It worsened after multiple rounds of radiation therapy to treat the cancer.  

Lymphedema is caused when fluids, blocked from draining through the body’s lymphatic system, collect in the arms and legs and cause swelling. The normal drainage process can be blocked when lymph nodes are removed (a procedure called axillary lymph node dissection) during surgery for breast cancer.

According to the National Institutes of Health, lymphedema affects as many as 40% of breast cancer patients who have had axillary lymph node dissection. It also can affect people who have had other cancers and related surgery or radiation treatments. Sometimes it may not have a known underlying cause—and in rare cases, patients can develop lymphedema because of inherited genetics.

Like many patients with lymphedema, Meth knew little about the condition and had difficulty finding information about effective ways to treat it.

“I feel that the lymphedema patient community needs more information,” Meth said. “People need to know where to go for help. I had been to a physical therapist and had been wrapping my arm to help with the swelling, but that wasn’t working. I was losing hope.”

She began to regain hope after a healthcare provider referred her to plastic and reconstructive surgeon Ketan Patel, MD, a professor of Surgery in the Department of Surgery at Cedars-Sinai. Patel is one of the few U.S. physicians specializing in surgical treatment for lymphedema. He also helps coordinate nonsurgical treatment for patients, including complete decongestive therapy, in which specialized therapists perform manual lymphatic drainage massage and compression wrapping, guide patients through specific exercises, and more.

“There is no cure for lymphedema, so the goals of treatment are to improve symptoms and quality of life,” Patel said. “We put patients on the right treatment path for them, making appropriate referrals or performing surgery as needed. In many ways, we coordinate lymphedema care because not everyone is a surgical candidate.”

Meth was a candidate for surgery.

Patel first performed a vascularized lymph node transfer, moving lymph nodes from Meth’s abdomen to her right underarm to help rewire her lymphatic system. Three weeks after the surgery, Meth was able to fit her arm—significantly less swollen—into a dress she had previously been unable to wear. He also referred her for complete decongestive therapy, to help further reduce pain and swelling, and to help improve her arm movement and functionality.

Meth went on to have additional surgeries to further relieve lymphedema symptoms. Patel performed liposuction to remove extra fat in her arm caused by the condition. He also rerouted part of Meth’s lymphatic system during a procedure called a lymphovenous bypass. 

Each procedure, delicate and requiring extreme precision, called upon Patel’s expertise in advanced microsurgery and microsurgery techniques.

Meth wishes that, in preparing for breast cancer surgery, she had known that developing lymphedema was possible and that if she needed treatment, a range of options was available.

“I have a life now,” Meth said. “Before surgery, I was not managing well. Now, I am.”

Patel agrees that knowledge about lymphedema treatment options among many healthcare professionals and patients needs improvement but adds that awareness—and funding for lymphedema research—has increased over the past decade, and he expects that to continue.

He, along with other Cedars-Sinai surgeons and lymphedema-trained therapists, is focused on lymphedema awareness, prevention and earlier treatment options as part of expanding offerings for patients.

“Treatment for lymphedema has, for the most part, still been relegated to therapy,” Patel said. “There is no medical treatment administered by a doctor, so the surgical techniques that we offer are just starting to gain more traction.”

Patel also is working to improve patient care by emphasizing among physicians that being proactive about the possibility of patients developing lymphedema—and effectively getting ahead of it before it develops—is important.

“If we can identify patients who are at a higher risk of developing lymphedema,” Patel said, “then we can have them see a therapist before surgery, get them wrapped at the time of surgery, and basically treat patients like they already have lymphedema in hopes that we prevent long-term swelling. So, it’s not just rehab after the fact, but prehab, before the fact. In the future, we see this being at the forefront of lymphedema treatment planning for all at-risk patients.”

Cristina Ferrone, MD, chair of the Department of Surgery, said that Patel and team are working to make awareness, prevention and earlier treatment the standard of care for patients at risk of developing lymphedema.

“We hear from many patients that they did not know an operation for lymphedema was a possibility,” Ferrone said. “It’s important that patients are aware and that providers are aware. The more collaborative we can all be, the better it is for our patients. Lymphedema is a difficult medical condition to treat. Dr. Patel is a worldwide leader and pioneer in this area.”

Read more on the Cedars-Sinai Blog: Practical Advice for Breast Cancer Patients