Lymphatic Disorders In Patients with Cancer

摘要

Lymphedema (LE) is a common complication in patients with cancer. LE results from an imbalance between the generation and the removal of interstitial fluid and macromolecules. Both congenital (primary) and acquired (secondary) LE demonstrate variability in their onset and severity. Although edema can result from any process causing an accumulation of interstitial fluid, LE refers to swelling resulting from lymphatic insufficiency. The onset of LE follows factors that trigger an imbalance in interstitial fluid dynamics. LE in cancer patients usually results from destruction of lymphatic tissue by surgery and/or radiation. When less extensive surgery and radiation are carefully used in the management of malignancies, the incidence and severity of LE appear to be reduced. Sentinel lymph node procedures can mitigate the incidence and severity of LE when complete lymph node dissections can be replaced by sentinel node sampling alone. It is important to clarify the diagnosis of LE in contrast to other conditions that may mimic it, such as lipedema, phleboedema, or heart failure. Many imaging modalities can demonstrate various features of LE including MRI, CT, and ultrasound of the epifascial compartment, which is the tissue most commonly involved with LE. Lymphatic function and lymph drainage are readily evaluated with lymphoscintigraphy (LS). Lymphatic imaging plays an important role in diagnosing, classifying, and determining the severity of swollen extremities and in predicting the success of common therapies. LE is a chronic and treatable disorder, and early recognition and treatment should be promulgated.