Leg Lymphedema in women after treatment gynecological cancer

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Leg Lymphedema in women after treatment gynecological cancer

Postby patoco » Sat May 12, 2007 3:14 am

Leg Lymphedema in women after treatment gynecological cancer

The experience of lower limb lymphedema for women after treatment for gynecologic cancer.

Oncol Nurs Forum. 2003 May-Jun;30

Ryan M, Stainton MC, Jaconelli C, Watts S, MacKenzie P, Mansberg T.
Gynaecological Cancer Centre of the Royal Hospital for Women,
Randwick, New South Wales, Australia. m...@mail.usyd.edu.au

PURPOSE/OBJECTIVES: To describe women's experiences with lower limb lymphedema to inform both preventive and management clinical practices.

DESIGN: A retrospective survey. SETTING: The gynecology/oncology unit of a tertiary referral women's hospital in Australia. SAMPLE: 82 women who developed lower limb lymphedema after surgical and radiation treatment for gynecologic cancers.

METHODS: Structured interviews.

MAIN RESEARCH VARIABLES: Psychosocial and emotional impact, physical effects, knowledge, support, treatment modalities.

FINDINGS: Women identified changes in appearance and sensation in the legs and the triggers that both preceded and exacerbated symptoms. Women described seeking help and receiving inappropriate advice with as many as three assessments prior to referral to lymphedema specialists. Many women implemented self-management strategies. Lower limb lymphedema had an impact on appearance, mobility, finances, and self-image.

CONCLUSIONS: Increasing longevity after gynecologic oncology treatment requires all practitioners to be aware of known or potential triggers of lower limb lymphedema and the appropriate referral and management strategies available. Women at risk need to know early signs and symptoms and where to seek early care.

IMPLICATIONS FOR NURSING: The role of nursing in acute and community care of women at risk for developing lower limb lymphedema includes (a) engaging women in protecting their legs from infection or trauma pre- and postoperatively, (b) providing nursing care and education during the pre- and postoperative phases, and (c) ensuring that women being discharged are aware of early signs and symptoms of lower limb lymphedema and how to access qualified, specialized therapists so that early and effective management can be initiated.

PMID: 12719742 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/entrez/quer ... lus&db=p...


Aetiology and prevalence of lower limb lymphoedema following treatment for gynaecological cancer.

Aust N Z J Obstet Gynaecol. 2003 Apr

Ryan M, Stainton MC, Slaytor EK, Jaconelli C, Watts S, Mackenzie P.
Gynaecological Cancer Centre, Royal Hospital for Women, Randwick, New
South Wales, Australia. r...@sesahs.nsw.gov.au

OBJECTIVE: To determine the prevalence and incidence of lower limb lymphoedema (LLL) in a cohort of women who had treatment for
gynaecological cancer between May 1995 and April 2000.

DESIGN: A retrospective survey.

SETTING: The study took place at an urban referral centre in an
Australian tertiary referral women's hospital.

SAMPLE: The data collection was based on 66% of 743 women on the database of the Gynaecological Cancer Centre.

METHODS: Interviews and assessments were conducted to determine the status of lower limbs; medical records were reviewed for age, weight, site and type of cancer and treatment.

MAIN OUTCOME MEASURES: Leg swelling, diagnosed lower limb lymphoedema, no swelling of the legs and type of surgery were determined as the main outcome measures.

RESULTS AND CONCLUSIONS: The diagnosis of lower limb lymphoedema was made in 18% of the total sample: 53% of these were diagnosed within 3 months of treatment, a further 18% within 6 months, 13% within 12 months and the remaining 16% up to 5 years following treatment.

Women most at risk for developing LLL were those who had treatment for
vulvar cancer with removal of lymph nodes and follow up radiotherapy.
For this subsample, the prevalence was 47%. The finding that LLL
occurs within the first year is earlier than hitherto generally
believed. It is therefore imperative for all health professionals to
include care and assessment of the legs particularly during the
immediate pre- and postoperative period.

PMID: 14712972 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/entrez/quer ... lus&db=p...


The incidence of symptomatic lower-extremity lymphedema following treatment of uterine corpus malignancies: a 12-year experience at Memorial Sloan-Kettering Cancer Center.
Gynecol Oncol. 2006 Nov

Abu-Rustum NR, Alektiar K, Iasonos A, Lev G, Sonoda Y, Aghajanian C,
Chi DS, Barakat RR.
Gynecology Service, Department of Surgery, Memorial Sloan-Kettering
Cancer Center, New York, NY 10021, USA. gynbre...@mskcc.org

OBJECTIVES: To describe the incidence of symptomatic postoperative lower-extremity lymphedema in women treated for uterine corpus cancer, and to evaluate its relationship to regional lymph node removal and postoperative therapy.

METHODS: A retrospective chart review of all patients with uterine
corpus cancer managed over a 12-year period (1/93-12/04). All patients
had a hysterectomy as part of their therapy. We identified patients
with leg lymphedema - as described by the physician or reported by the
patient - through medical records. We excluded cases of leg edema that
developed secondary to medical conditions such as cardiovascular and
renal disease, venous thrombosis, and end-stage recurrent malignancy.
Lymphedema dermal changes and related fibrosis were graded using the
common terminology criteria for adverse events.

RESULTS: In all, 1,289 patients with uterine corpus malignancy were evaluated. We excluded other chronic lower-extremity edema that was related to a variety of medical conditions in 74 patients (5.7%). With
a median follow-up of 3 years (interquartile range, 1.1-5.4 years),
new symptomatic post-treatment lower-extremity lymphedema was noted in 16 patients. Patients who had lymph nodes removed at initial surgery
had a higher rate of developing lymphedema (16/670, 2.4%) than those
who did not (0/619, 0%) (P = 0.0001). Furthermore, symptomatic
lymphedema was limited to patients who had 10 or more regional lymph
nodes removed 16/469 (3.4%). Lymphedema was noted at a median of 5.3 months after surgery (range, 1-32 months). Lymphedema was unilateral in 11 patients (69%) and bilateral in 5 (31%); moreover, it was
considered grade 1 in 12 patients (75%) and grade 2 in 4 (25%). Age,
weight, stage, type of hysterectomy, and type of postoperative
adjuvant therapy were not associated with lymphedema.

CONCLUSIONS: To date, this is the largest series evaluating
symptomatic lower-extremity lymphedema in women with uterine corpus
cancer. Patients who had 10 or more regional lymph nodes removed at
initial surgery appeared to be at higher risk for developing new
symptomatic leg lymphedema. Patients undergoing surgery with
lymphadenectomy for uterine corpus malignancy should be informed about the possibility of postoperative new symptomatic leg lymphedema.

A prospective evaluation of leg lymphedema is needed to accurately
determine the incidence, severity, and risk factors of this

PMID: 16740298 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/entrez/quer ... lus&db=p...


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Lower Limb Lymphedema Common in Gynecological Cancer

Postby patoco » Thu Jun 28, 2007 11:56 pm

Lower Limb LympLower Limb Lymphedema Common in Survivors of Gynecological Cancer

NEW YORK JUN 27, 2007 (Reuters Health) - A significant proportion of gynecological cancer survivors develop lower limb lymphedema, according to results of a study published in the June 15th issue of Cancer.

"Lower limb lymphedema is one of the most disabling side effects of surgical and radiotherapy treatment for gynecological cancer," note Dr. Vanessa Beesley, of the Queensland Institute of Medical Research, Australia, and colleagues. "For many gynecological cancer patients, lymph node dissection is an integral part of cancer treatment and surgical staging, and this procedure has been associated with lymphedema development."

The researchers conducted a population-based cross-sectional mail survey of gynecological cancer survivors in 2004. The questionnaire, which was completed by 802 women, included items on demographics, supportive care needs, and lymphedema-related needs.

Overall, 10% of subjects reported a diagnosis of lymphedema. Another 15% reported undiagnosed symptomatic lower leg swelling. The prevalence of diagnosed lymphedema was higher among survivors of vulvar cancer (36%) than all other gynecological cancer subgroups.

Multivariate analysis revealed that for cervical cancer survivors, the odds of developing lower limb swelling were 3.5 times higher if they had radiotherapy and 3.3 times higher if they had lymph nodes removed. The odds of developing lymphedema were higher for survivors of uterine and ovarian cancer who had lymph node dissection or who were overweight or obese.

"Whereas 31% reported being informed about lymphedema before their cancer treatment, 34% of women did not recall being informed about this condition until they were diagnosed," Dr. Beesley and colleagues report. "Others (30%) were informed after their cancer treatment but before symptoms arose, or they could not remember when they were informed (5%)."

The researchers note that supportive care needs in the information and symptom management domains were higher in gynecological cancer survivors with lymphedema than in those with no swelling.

"Women at risk for lymphedema would benefit from instructions about early signs and symptoms and provision of referral information," the team concludes.


Cancer 2007;109:2607-2614.



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