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Lymphland International Lymphedema Online
| Nature Published online: 27 July 2005; | doi:10.1038/436456a Lymphatic system: Unlocking the drains Phyllida Brown After centuries of playing second fiddle to the blood system, our lymphatic circulation is coming into its own as a key player in diseases ranging from cancer to asthma. Phyllida Brown reports.Circulation warWe are all familiar with the blood circulatory system. But its 'twin', the lymphatic system has been neglected in the past. Not now though, as cancer biologists, developmental biologists and even palaeontologists begin to show that it has many vital functions Sometimes it's hard to be a scientist. Just five years ago, Mihaela Skobe, a molecular biologist now at Mount Sinai School of Medicine in New York, and her team were struggling to publish their work on the lymphatic system. Editors and reviewers thought it boring. The polite but yawning rejection letters came. "They would say that everything in the paper was fine but that lymphatics were unimportant," says Skobe. "There was a complete lack of interest." Not any more. Once dismissed as a mere drainage network, the body's 'second circulation' system (see Graphic, below) is emerging as a crucial player in numerous diseases from cancer to asthma, and as a vital part of the normal immune system. As a result of these discoveries, researchers are trying to intervene in its activities, for example to reduce the spread of tumours, to boost the efficiency of vaccines, or to treat the painful and disfiguring swelling known as lymphoedema. "It's a hot field now," says Michael Detmar, a dermatologist and lymphatic system researcher at Harvard Medical School in Boston, Massachusetts. These days, he says, many laboratories are switching from the study of blood vessels to the lymphatic system. Detmar is one of several researchers showing how important the lymphatic system is for tumour spread. Other groups are finding it plays a key role in inflammatory diseases such as asthma or transplant rejection. "We are in the pioneering phase," says Detmar. "There is a feeling that there is still so much to discover." Mystery vessels It might seem strange that one of the body's major organs is terra incognita. Lymphatic vessels may be drains, but they are pretty sophisticated ones. Not only do they collect fluid that has leaked into tissues from the bloodstream and return it to the blood; they also process that fluid, sending it through lymph nodes where key cells of the immune system, called dendritic cells, present fragments of foreign molecules to other cells to mount an immune response. But the fact is that the lymphatic system has played second fiddle to the blood system for centuries. Only properly discovered in the 1600s (see A brief history of our second circulation), it faded into obscurity and, apart from a brief flurry of interest around 1900, was largely neglected until about ten years ago. The turning point came in the early 1990s when Kari Alitalo, a cancer researcher at the University of Helsinki, began studying a family of proteins involved in generating new blood vessels. These proteins, called vascular endothelial growth factors, or VEGFs, stimulate the growth of cells lining blood vessels and enable new vessels to sprout. Tumours often subvert these signals to build a blood supply that nourishes their invading mass. Like other scientists, Alitalo reasoned that if these signals, or the receptor proteins that enable cells to receive them were blocked, blood vessels could be prevented from growing, and tumours could be starved to death. But what Alitalo and his team discovered next was to lead their focus away from blood-vessel growth signals and into the backwater of the lymphatic system. He and his team happened upon a new VEGF receptor that was present mainly on the cells that line the insides of lymphatic vessels1. The receptor was similar to a known receptor for VEGFs but neither of the two members of this family, VEGF-A or VEGF- B, activated it. So the hunt for the signal was on. High hopes When they eventually found this signal, they discovered that it was an endothelial growth factor similar to the known VEGFs. They named it VEGF-C and the receptor VEGF receptor 3 (ref. 2). In mice that had been genetically engineered to express excessive amounts of VEGF-C, the lymphatic vessels proliferated but — crucially — the blood vessels did not. This was the first signal known to act specifically on the lymphatic system3. Meanwhile, on the other side of the world, Marc Achen and Steven Stacker at the Ludwig Institute for Cancer Research, Melbourne, were hunting for further VEGFs. Faxes flew from Melbourne to Helsinki and back. Together, the researchers soon identified another signal that also acted on VEGF receptor 3. This one was dubbed, not surprisingly, VEGF-D (ref. 4). "It was very exciting," says Alitalo. He and the Australians hoped that their discoveries could eventually lead to treatments to help build new lymphatic vessels in people suffering from lymphoedema — for example after breast cancer surgery. But progress was hampered by the fact that there were no 'markers' for the lymphatic system. These are proteins characteristic of the tissue being studied that scientists use to specifically target dyes, and so to see the tissue more easily. It was not until 1999, when David Jackson, a biochemist at the Weatherall Institute of Molecular Medicine in Oxford, discovered such a marker, a protein called LYVE-1 (ref. 5), that lymphatic research really went into orbit. For one thing, researchers could now probe the role of the lymphatic system in the spread of cancerous tumours. Many tumours, such as breast cancer and melanoma, spread from the original tumour via the lymphatic system to other organs, and a person's prognosis is worse if lymph nodes are involved. Yet, although the role of blood vessels in tumour spread had been well studied, researchers knew almost nothing about whether tumour cells actively persuaded lymphatic vessels to grow and assist their spread or whether lymphatics were just passive ducts. Alitalo's group, together with Michael Pepper at the University of Geneva Medical Centre, and Gerhard Christofori at the Research Institute of Molecular Pathology in Vienna, created genetically engineered mice that developed tumours in the pancreas and had abnormally high levels of VEGF-C in the same organ. The team found lymphatic vessels sprouting in the animals' tumours. What is more, the animals' lymphatic vessels often contained tumour cells that had originated in the pancreas6. Other teams also found evidence pointing the finger at the lymphatic system as an active agent in spreading tumours. Detmar and Skobe transplanted human breast cancers, engineered to make a lot of VEGF-C, into mice, and found lymphatic vessels sprouting within the transplanted tumours. Indeed, the greater the degree of lymph-vessel growth, the more the tumours spread in the animals' lymph nodes and lungs7. There is now little doubt that this interplay between tumours and the lymphatic system is the main route used by solid cancers to spread. But could clinicians one day intervene to stop it? Quite possibly. Stacker and Achen and colleagues from Melbourne showed that VEGF-D was, like VEGF-C, capable of triggering lymphatic vessels to grow inside transplanted tumours in mice. It also increased the spread of tumours to lymph nodes. But when VEGF-D was blocked, this increased spread could be checked8 Alitalo's group meanwhile, showed that mice genetically engineered to have VEGF-C and VEGF-D signalling blocked could not make new lymphatic vessels; their existing vessels even shrank9. The team then blocked VEGF-C and VEGF-D signalling in mice with human-breast-tumour transplants, and found it could reduce the amount of tumour spread by two-thirds10. The implications were clear: if VEGF-C and VEGF- D could be blocked in a mouse, then perhaps they could also be blocked in people with cancer to help prevent tumour spread. Mice to men Evidence shows that tumours in people behave like those in mice. Across a range of different human tumours, those that contain high levels of VEGF-C or VEGF-D are more likely to spread11. As a general rule, the more lymphatic vessels there are in the tumour, the greater the risk. Stacker and Achen are hopeful that trials testing agents that block VEGF-C and VEGF-D can begin soon. After all, points out Achen, an antibody called bevacizumab, or Avastin, that slows the growth of blood vessels in spreading colon cancer by blocking VEGF-A, has already prolonged some patients' lives. But Alitalo warns that such trials may be a long time coming. One problem, he says, is that tumour spread can be a slow process, and pharmaceutical companies are wary of embarking on costly trials that take as long as three years to reveal results. As if all this were not news enough, it seems that the lymphatic system has been hiding an even bigger surprise up its sleeve. Over the past year, several research teams have begun to uncover evidence that the lymphatic system could be a major culprit in unwanted inflammation. Inflammation plays a key role in asthma, which affects an estimated five million people in Britain alone. It is also associated with other common conditions including psoriasis and rheumatoid arthritis, and with some medical problems such as transplant rejection. Dontscho Kerjaschki, a pathologist at the Medical University of Vienna, has been studying what happens when kidney transplants are rejected. Normally, the kidney cortex, the part that filters blood, has hardly any lymphatic vessels. But in about a third of biopsies from transplanted kidneys, Kerjaschki found a 50-fold increase in the number of lymphatic vessels12. In most cases, such biopsies came from patients with chronic rejection, a condition in which the graft continues to be attacked by the host's immune system after initial immunosuppression treatment, until the transplant breaks down. Kerjaschki thinks the unusually extensive lymphatics could be involved, speculating that they may bring a continual supply of immune cells into the graft. "Maybe the lymphatics are organizing the whole catastrophe," he says. Hints that the lymphatics can mastermind an immune response come from the discovery of a protein called podoplanin by Kerjaschki's team. Podoplanin sticks to a signalling mol-ecule called CCL21, which is found mainly in lymphatic vessels. CCL21 is a powerful attractant to immune cells such as dendritic cells and macrophages13. In kidney grafts, where some inflammatory cells are already present, the complex of CCL21 and podoplanin breaks down, releasing CCL21 into the vessel, and so attracting further inflammatory cells. Key controllers Another piece of the jigsaw implicating lymphatic vessels in harmful immune responses comes from Donald McDonald, a vascular biologist at the University of California, San Francisco, and his colleagues. They have studied a mouse model of asthma. The animals' lungs are chronically infected with Mycoplasma pulmonis, a bacterial infection that produces swelling of the mucous membranes, alterations to vessel linings and scarring — all symptoms that resemble those of human asthma. McDonald's group found that infected mice grew additional lymphatic vessels in their tracheas, and their airway blood vessels also proliferated. When the team treated the mice with antibiotics, the blood vessels shrank but the extra lymphatic vessels persisted14. "This was a surprise," says McDonald. He speculates that the new lymphatic vessels help to set the lung up for more rapid and accentuated immune responses to subsequent infections, exacerbating inflammation. His team is now looking at the signalling molecules involved, hoping that it may eventually be possible to manipulate the inflammatory immune responses to help control asthma. Back in Helsinki, where it all began, Alitalo is upbeat. He is happy that there are still fundamental questions to answer, including how cancer cells move beyond the lymph nodes as they travel through the vessels to distant organs, and how exactly tumour cells enter lymphatic vessels in the first place. And Skobe? She and her team are getting to grips with the molecules in lymphatic vessels that are involved in tumour spread. Skobe is not giving away details of her latest work yet. But when she does have new results to report, it seems unlikely, this time around, that the journal editors will need convincing. 1. Kaipainen, A. et al. J. Exp. Med. 178, 2077–2088 (1993). 2. Joukov, V. et al. EMBO J. 15, 290–298 (1996). 3. Jeltsch, M. et al. Science 276, 1423–1425 (1997). 4. Achen, M. G. et al. Proc. Natl Acad. Sci. USA 95, 548–553 (1998). 5. Banerji, S. et al. J. Cell Biol. 22, 789–801 (1999). 6. Mandriota, S. J. et al. EMBO J. 20, 672–682 (2001). 7. Skobe, M. et al. Nature Med. 7, 192–198 (2001). 8. Stacker, S. et al. Nature Med. 7, 186–191 (2001). 9. M¨akinen, T. et al. Nature Med. 7, 199–205 (2001). 10. Karpanen, T. et al. Cancer Res. 61, 1786–1790 (2001). 11. Achen, M. G., McColl, B. K. & Stacker, S. A. Cancer Cell 7, 121–127 (2005). 12. Kerjaschki, D. et al. J. Am. Soc. Nephrol. 15, 603–612 (2004). 13. Yoneyama, H., Matusuno, K. & Matsushimaa, K. Int. J. Haematol. 81, 204–207 (2005). 14. Baluk, P. et al. J. Clin. Invest. 115, 247–257 (2005). 15. Pullinger, B. D. & Florey, H. W. J. Pathol. Bact. 45, 157–170 (1937). --------------------------------------- TRUNCAL LYMPHEDEMA: http://www.lymphnotes.com/article.php/id/149/ Truncal Lymphedema Introduction Truncal lymphedema, which affects the chest region, frequently develops following breast or lung cancer treatment and can be present with or without significant involvement of the adjacent arm. Some studies suggest that up to 80% of women may develop truncal lymphedema after certain breast cancer diagnosis and treatment procedures, yet the condition often remains undiagnosed or treated. Symptoms Pain is a significant symptom of truncal lymphedema and it usually affects the shoulder and chest wall. The pain accompanying truncal lymphedema is usually more severe than pain associated with lymphedema of the arm. Anterior chest wall swelling is most commonly located in the affected breast or on chest wall, over the collarbone (area of the neck), in the axillary cavity (the area under the arm), on the inner surface of the upper portion of the adjacent arm, and along the scar lines. Swelling of the back usually appears as extra rolls of fat along the side of the trunk, fullness over the shoulder blades or upper back, and (if the right side is affected) fullness across the waistline on the right side of the trunk. Swelling of the arm may, or may not, be present. Differential diagnosis of truncal lymphedema can be difficult if the patient does not also present with lymphedema of the upper extremities. Reconstruction complaints include that the reconstructed breast is too large, misshapen, and uncomfortable during the activities of daily living. Treatment Modalities Manual lymph drainage is very important in removing excess fluid, softening fibrotic tissues, and easing pain in the area. Patients with truncal lymphedema may require frequent visits for MLD treatment. Photo Courtesy of Bellisse. Compression is difficult to obtain; however, the specialized Compressure Comfort Bra is designed to meet the compression needs in this area. It is also designed to provide comfort in the underarm area where swelling may remain. Because this bra has a pocket to hold a prosthesis, insurance will often pay for this garment under the terms of the Women’s Health and Cancer Rights Act. Specialized quilted compression pads are available to be worn under a bra. These aids encourage lymph drainage and help to soften fibrotic tissue. These are available from several manufacturers and are often custom made to fit the areas of greatest need. Bandaging is of limited value on the chest for two reasons: First, bandages are designed to work with the pumping action of muscles and this kind of muscle action is not present in the chest. Second, because of the constant changes in chest size while breathing, it is difficult to bandage effectively and to keep these bandages in place. Exercise is particularly important in managing truncal lymphedema. The movements of muscles and the flexing of joints stimulate the flow of lymph and stimulate natural drainage. Exercises in chest deep water is particularly important because the pressure of the water provides compression over the entire affected area. See Aquatic Therapy. Self-Massage is extremely important in managing truncal lymphedema because it helps to compensate for the difficulty in obtaining compression. Self-massage should be performed regularly as recommended by your lymphedema therapist. Avoiding a Tourniquet Effect The term "tourniquet effect" is used to describe any garment that blocks or slows lymph drainage. You can take steps to avoid such damaging areas of blockage. Courtesy of Bosom Buddy. Avoid a heavy prosthesis. A heavy prosthesis places pressure against the chest wall, but not where you want compression. It also drags on the bra straps. Wearing a light-weight prosthesis can ease this problem. Avoid narrow bra straps. Bra straps that dig into the shoulders block the flow of lymph at the terminus. Wearing a bra with wide padded straps, such as those on the Compressure Bra shown above, eases this problem. Avoid an underwire bra. This type of bra is not recommended for anyone who has had breast cancer treatment and is at risk of developing lymphedema Avoid constriction around the chest. If the lower band of a bra band is too tight, and without elasticity, it blocks the flow of lymph. Therefore the bra band should be wide and flexible. Avoid constriction around the waist. This includes tight waistbands on clothing and long-line bras. They have a girdle-like effect around the waist that blocks the flow of lymph. References For more photographs and information about truncal information read the Bellisse article “What Does Truncal Lymphedema Look Like?” Living Well with Lymphedema by A. Ehrlich, A, Vinjé-Harrewijn PT, CLT, and E. McMahon PhD. Lymph Notes. 2005, pages 41-42. Truncal Lymphedema by E. Muscari-Lin, RN, MSN. APRN, BC, AOCN. Lymph Link, Vol 16, No 1, January-March 2004. LymphNotes.This information does not replace the advice of a qualified health care professional. ================================= ======================================================= http://www.lymphnotes.com/article.php/id/250/ Lymphatic Malformations Introduction Lymphatic malformations are rare conditions in which there is abnormal prenatal development of the lymphatic system that can affect any body part. These conditions, which often can be detected on prenatal ultrasounds, cannot be cured. What are Lymphatic Malformations? A lymphatic malformation is a rare condition in which abnormal prenatal development of the lymphatic system results in tumor-like formations that can occur in the skin and in just about any portion of the body. The most common locations are in the face, neck, torso, groin and the extremities. They can also occur in the intestines, abdominal cavity and even in bones. Lymphatic malformations are commonly disfiguring and often associated with other medical problems. The children and their families face medical problems, emotional difficulties and the isolation that comes with having such a rare condition. C.A.L.M., an acronym for “Children Anguished with Lymphatic Malformations,” is a support group that was founded in 1993 to help families afflicted with this rare and misunderstood disfiguring disorder. To learn more about this condition and the activities of the Stay Calm organization visit the Stay Calm web site. Intestinal Lymphangiectasia Intestinal lymphangiectasia, which is also known as lymphangiectasis, is a fairly rare condition that affects the digestive system and causes difficulties including constipation, diarrhea, and abdominal pain. According to medical dictionaries lymphangiectasia means, “the dilation (expansion) of lymphatic vessels” or “a malformation of lymphatic vessels.” To the families of children with intestinal lymphangiectasia, this means multiple hospital trips, special diets, and surgeries to control this potentially life threatening condition. One side effect of intestinal lymphangiectasia is the development of lymphedema in various parts of the body. For example, we heard from the mother of an eight year old son. He suffers from lymphangiectasia and now has developed lymphedema in both legs, the right arm, abdomen, scrotum, and penis. To learn more about this condition, and how the families affected by it manage, also visit these web sites. http://littleleakers.com/ http://www2.caringbridge.org/ca/ironkidmike/ -------------------------------------------------- Lymphedema-Distichiasis Lymphedema-Distichiasis is an autosomal dominant disorder that classically presents as lower-limb lymphedema and distichiasis which is a double row of eyelashes. Irritation of the cornea, with corneal ulceration in some cases, brings the patients to the attention of ophthalmologists. Other complications may include cardiac defects, cleft palate, spinal extradural cysts, and photophobia. This condition, which occurs primarily in males, is transmitted by an autosomal dominant chromosome, which means that it can be transmitted when only one parent who has this condition. =============================================== ================================================================== http://www.lymphnotes.com/article.php/id/349/ Lumpy Jaw is Not Part of Lymphedema A dental abscess can cause of "lumpy jaw" to develop. Introduction Yes, there really is a disease known as lumpy jaw and it is not related to lymphedema! However information about this condition may answer some of the questions we have received from visitors who are worried about swellings in the head and neck area. The medical name for this condition is actinomycosis and it is caused by the bacteria actinomyces. These bacteria are normally present in a healthy mouth without causing any problems. An infection does not occur unless these bacteria are introduced into the tissues of the mouth due to an injury, a dental abscess, or oral surgery.[1] Important These lumps are not swollen glands; however, because infection is present in the area nearby lymph nodes under the jaw or along the neck can become swollen. Signs and Symptoms Once in the tissues these bacteria form an abscess. This is usually a chronic condition and there may be several abscesses present that produce hard, red-to-reddish-purple lumps either on exterior of the jaw bone or on the lower portion of the face. This is why the condition is known as lumpy jaw. [2] With the passage of time an abscess can form a fistula. Eventually this breaks through the surface of the skin and allows pus to drain out of the abscess. Unfortunately just because it is draining does not mean that it has healed. Treatment Usually this condition is chronic before it is diagnosed and then it often requires treatment for several weeks with IV antibiotics and this is followed by months of oral antibiotics. To speed healing, sometimes surgery is performed to open and drain the abscess. ========================================= ============================================================== http://www.lymphnotes.com/article.php/id/188/ Swollen Lymph Nodes Introduction The term swollen glands, also known as lymphadenitis or swollen lymph nodes, refers to an abnormal enlargement of one or more lymph nodes. Swollen glands are most commonly caused by an infection. [1] Swollen Glands and Lymphedema Swollen glands are not a symptom of lymphedema; however if you have lymphedema, and you develop swollen glands, this is most commonly a symptom of an infection. A lymphedema related infection requires prompt treatment including a diagnosis of the cause of the swollen glands. Additional Causes of Swollen Glands In addition to infection, other conditions that are associated with swollen lymph nodes include: an abscessed or impacted tooth chronic fatigue syndrome ear infection gingivitis HIV or AIDS Hodgkin's disease infectious mononucleosis leukemia mumps non-Hodgkin's lymphoma rheumatoid arthritis rubella sexually transmitted diseases tonsillitis tuberculosis Shotty Lymph Nodes Shotty lymph nodes are clusters of small swollen lymph nodes that may occur when the immune system is reacting to an infection. These nodes are so named because they feel like buckshot under the skin. Who Treats Swollen Glands? When swollen glands occur, a primary care provider is consulted first. Then, based on the patient’s condition, a referral may be made to the appropriate specialist. =============================== ============================================================ http://www.lymphnotes.com/article.php/id/316/ When Lymphedema Affects Your Hand Introduction Lymphedema that affects the arm often also affects the hand. For some patients this is only a minor inconvenience. For others it is a major problem that interferes with the activities of daily living and even the ability to continue working. What Happens According to Christine Thomas LPT, CLT-LANA, a member of the Lymph Notes Editorial Advisory Board, “Most patients with arm edema will also have some hand edema (NOT everyone, but most). The reason for this is that gravity is constantly acting on the swelling, pulling it to the lowest possible point. The basic principle of bandaging or wearing a compression sleeve is that it must provide more compression at the bottom than it does at the top (to help counteract gravity, and boost the fluid up and out). “When you wear just a compression sleeve, the hand is left with no compression. Any fluid that is in the hand will not be able to move up and out because it will be blocked by the compression that the sleeve provides at the wrist. Wearing just a sleeve without a glove will often make any hand swelling worse. “The natural solution is to add compression to the hand. When bandaging, this begins at the fingers and continues upward to the shoulder. When wearing a compression sleeve, the best solution is to wear a compression glove. "There are companies that carry ready-made or standard size gloves; however, the best fit and compression are usually gained with a custom made glove." Compression Garments for the Hands Courtesy of Lymflo Therapies Inc. Some manufacturers make a sleeve and glove combination; however, except in the lightest weights, these are very more difficult to put on and take off. For this reason the sleeve and glove are usually worn as separate garments. The most effective garment of hand compression is a glove with "finger stubs" that hold the glove in place and provide the more effective compression over most of the hand. Wearing a Gauntlet Courtesy of Juzo USA. Another option, is wearing a gauntlet such as the one shown here. This leaves the fingers completely exposed with only a "thumb stub" to hold the glove in place. This is more convenient because the fingers are free; however, the compression is not as effective because the fingers are not covered. This means that any fluid trapped in the fingers will stay there. Courtesy of JoVi Pak. Compression Aids for the Hands Compression garments are only worn during the day when you are active. At night your therapist usually recommends either bandaging or a compression aid. These cover the hand. Shown here are bandages being placed over a compression aid. Notice that this covers the hand and fingers. Helpful Tips Wearing a compression glove throughout the day can get messy—particularly if your dominant hand is involved; however, there are steps that you can take to minimize the inconvenience. Have two gloves. This allows one to be worn while the other is being laundered. (You don’t want to take changes with infection due to dirty gloves.) Teach yourself to do more tasks with your non-affected hand. This reduces the chance of getting the glove dirty. Keep inexpensive plastic food handler gloves, in a large size, conveniently located where you can readily put on a glove before performing messy tasks such as preparing food or cleaning up in the kitchen. TRAMPOLINES Trampolines for lymphedema..... After reading about the use of a mini-trampoline for helping lymphatic circulation, (article cite listed below) I asked my lymphedema doctor about it. He said had heard of it working best for leg lymphedema, but had not heard anything about it particularly helping arm or hand lymphedema. He was sure it wouldn’t hurt me to try. So I started slowly, to see if it would help resolve my right hand and arm lymphedema (LE), which had not been responding well to conventional treatment. My mini-trampoline is about 40 inches in diameter. I got it at a sporting goods store for $40. A friend of mine keeps hers behind her couch when she’s not using it. I keep mine near the TV. That way I can watch part of a movie every day while I exercise. It makes the time go much faster. And if I get busy, 2-15 minute sessions count the same. Five minutes a day is all I did to start. I was told that doing too much, too fast, would leave me with flu-like symptoms. I stayed at 5 minutes a day for at least a couple of weeks, until I felt comfortable (I was recuperating from chemo, with significant neuropathy in my hands and feet, at the time; you may be able to advance more quickly than I could then, just watch carefully to see how you feel, as you increase time). I kept a chair-back next to the trampoline, at first, in case I needed support. It is possible to buy a mini- trampoline with a bar handle for support, if that would make you feel safer. I happened to have this one already here. I wear shoes (and my orthotics) on the trampoline. Pumping my arms and legs, I walk in place on the trampoline. My feet never leave the surface of the trampoline. It looks like an exaggerated race-walk stance. It is the muscle-pumping action of the legs and the arms that is so important for draining the lymphatics. This is one of the reasons that walking is such good exercise. The difference for me is that I can easily talk myself out of walking in bad weather, too hot or too cold. With the trampoline right here in my living room, I have fewer excuses! Increasing the time by 2 ½ minute increments, I spent about 3-4 months getting up to my present 30 minutes a day. I just tried to listen to how good, or how tired, I was feeling, and to take my time about it. I do take days off, most often when I am away from home (the trampoline does not fit into the trunk of my car). An added bonus is that my weight has decreased, as my time on the trampoline has increased, which also helps LE! It is low-impact aerobic exercise. I have increased my tempo as my endurance has grown. The best part is that my lymphedema is now under control, with hand and arm measurements as good, or better, than when I was first treated for LE. It is a simple, inexpensive, weatherproof way to exercise for LE. Trampoline Article: p. 110 Supernutrition For Menopause, Ann Louise Gittleman, Avery publishing Group, 1998. Author: Cynthia Adams of the Marin Lymphedema Information and Support group. ---------------------------------------------------------------------- Living Well with Lymphedema by Ann B. Ehrlich, Alma Vinji-Harrewijn, Elizabeth J. McMahon Living Well with Lymphedema is the comprehensive resource for those with, or at risk of developing, lymphedema. This easy-to-read, generously illustrated, 280 page book contains the information necessary to understand what is lymphedema, what causes it, how it is treated, self-management steps to control your condition, practical suggestions on how to master the emotional challenges that accompany living with a chronic condition, plus an illustrated guide to understanding the lymphatic system. ---------------------------------------------- Massage & Bodywork June/July 2005 page 18 states "The fear that touch modalities will cause metastasis is no longer an issue in the oncology community, even if the bodywork has a circulatory or mechanical aspect" Tadpole to help in the fight against Lymphedema Contact: Ann Van Gysel 32-92-446-611 VIB, Flanders Interuniversity Institute of Biotechnology http://www.eurekalert.org/pub_releases/2005-08/vfii-tst081205.php http://www.abreastinthewest.ca/active2.cfm?Num=61 ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ ELYMPHNOTES I'm the new forums coordinator on ELymphnotes, drop by to say hi! http://www.elymphnotes.com/forums.asp?fn=dis&cn=qa I'm also a part of the LAF Community Network and will be around in chat to set up times to talk to those who need help, come to the Lymphland chatroom. I'm also writing articles for ELymphNotes and was interviewed by a national magazine called Beyond which will come out in late May. UNTIE MASSAGE THERAPY TECHNIQUE: UNTIE UNTIE was developed in the United States in the early 1980s as an alternative to exerting force into soft tissues that may already be painful to the touch. It is basic to UNTIE that soft tissue dysfunction, no matter how deep within the body, can be felt in the skin. These patterns of dysfunction are palpable once the proper awareness and sensitivity have been developed. Patterns are infinitely variable expressions of soft tissue dysfunctions that are synergistically related to the dysfunctions. The skilled practitioner can readily access even the deepest layers of soft tissue by working with the associated patterns. Changes in the patterns are stimulated by the presence of the practitioner’s fingers and determined by the body’s natural desire to reach homeostasis. The fingers respond to the changes without any application of force, will, or preconceived routine. The hands move gently in concert with the changes. Once the patterns release, the soft tissues are re-evaluated to confirm they have normalized and musculoskeletal integrity has improved. Although other approaches may not specifically address soft tissue patterns, the patterns are affected, since there is contact with the skin as soft tissues are manipulated. The more thorough the method used, the more likely it is that the patterns will be released, allowing for more complete, long-term change. Because the foundation of UNTIE is sensitivity, it readily deals with the unique patterns of the individual. It is a procedure for working “with” the body, not “on” the body. In conjunction with manual lymph drainage therapy, scar tissues can be helped dramatically. More details coming on this new therapy technique.... --------------------------------------------------- Bubonulus 1. An abscess occurring along the course of a lymphatic vessel. 2. One of a number of hard nodules, often breaking down into ulcers, which form along the course of acutely inflamed lymphatic vessels of the dorsum of the penis. Data Synopsis: Early Diagnosis and Treatment Intervention for Lymphedema By NL Stout Gergich, MPT and PW Soballe, MD, Breast Care Center, National Naval Medical Center, Bethesda, MD LA Pfalzer, PT, PhD, University of Michigan-Flint, Flint, MI CL McGarvey, DPT, MS, National Institutes of Health, Bethesda, MD, Physical Therapy Dept Relevance 2.3 million women are survivors of breast cancer (BC)1. Incidence of lymphedema (LE) 33% axillary lymph node dissection (ALND) and radiation therapy (RT)2 14% after sentinel lymph node biopsy and RT3 LE impacts quality of life; range of motion (ROM), strength and function2 LE is a chronic condition that is progressive if untreated Diagnosing Lymphedema Traditionally, the diagnosis of LE occurs after the condition becomes clinically apparent resulting in delayed treatment and progression of the condition Current Valid/Reliable Measurement Techniques Circumferential limb girth4 Water displacement2&5 Infrared optoelectronic5 Bioimpedence devices 6&8 Early detection and treatment prevents the progression of LE to an advanced stage Purpose To investigate the efficacy of a prospective PT screening method to accurately diagnose sub-clinical lymphedema and to evaluate the effectiveness of an early intervention in patients recently treated for breast cancer Methods Design: A subset analysis of a cohort of women from a large IRB approved study* Pre-operative and follow-up bilateral arm volume measurements taken at 80% of limb length measured from ulnar styloid to tip of acromion at 1, 3, 6, 9, 12 and 18 months by optoelectronic volumeter (Perometer®)6 from 1999-2006. Diagnostic Criteria: 34 women 34-85 years old (mean=55.4) reported symptoms of LE including heaviness or increased limb volume Intervention was introduced if the volume change equated to approximately 100 ml or 3% volume change compared to the pre-op inter-limb measures Intervention: Diagnosis of LE - a Jobst Ready-Made Compression Class I sleeve and gauntlet issued for daily wear and advised to follow up in 4-6 weeks Volume assessment was repeated on follow up Upon confirmation of volume decrease, continued garment wear was prescribed with Strenuous exercise Lifting The appearance of visible swelling Sensations of heaviness, fullness, aching Follow up in 3 months for repeated measures Results Volume increase in the AA at intervention was significant (p=0.001). Baseline to intervention averaged 6.9 mos. A significant (p=0.0000) mean volume decrease of 111 ml (7.6%) in the AA using the sleeve. Time to post intervention avg= 4.4 weeks Limb volume was maintained through follow up. Avg = 5.8 months Conclusions Pre-operative assessment, prospective surveillance and early intervention may have prevented the onset of irreversible LE in this small cohort The garment significantly reduced affected limb volume to nearly that of the unaffected limb and therefore provides effective treatment when sub-clinical LE can be detected. Further research is warranted to confirm the long term effectiveness and cost effectiveness of this preventive model compared to a traditional impairment based model. References: American Cancer Society (ACS). “Breast Cancer Facts and Figures 2006.” Retrieved from the World Wide Web on July 19, 2006 at http://www.cancer.org/downloads/STT/CAFF2005BrF.pdf Petrek JA, Pressman PI, and Smith RA. Lymphedema: current issues in research and management. CA Cancer J Clin. 2000 Sep-Oct;50(5):pp:292-307. Haid A, Koberle-Wuhrer R, Knauer M, Burtscher J, Fritzsche H, Peschina W et al. Morbidity of breast cancer patients following complete axillary dissection or sentinel node biopsy only: a comparative evaluation. Breast Cancer Res Treat 2002; 73(1):31-36. Armer J, Radina M, and Culbertson S. “Predicting Breast Cancer-Related Lymphedema Using Self- Reported Symptoms.” Nursing Research. Volume 52, No.6 (2003):pp. 370-379. Hayes S, Cornish B, and Newman B. “Comparison of methods to diagnose lymphedema among breast cancer survivors: 6 months follow-up.” Breast Cancer Research and Treatment. Volume 89 (2005):pp.221- 226. Stanton AW, Northfied JW, Holroyd B, Mortimer PS, and Levick, JR. Validation of an optoelectronic limb volumeter (Perometer). Lymphology. 1997 vol:30 (2): pp:77 -97. Cheville AL, McGarvey CL, Petrek JA, Russo SA, Thiadens SR, Taylor ME. “The Grading of Lymphedema in Oncology Clinical Trials”. Semin Radiat Oncol. 2003 Jul; 13(3): pp: 214-25. American Cancer Society (ACS). “Lymphedema: What Every Woman With Breast Cancer Should Know.” Retrieved from the World Wide Web on July 01, 2006 at http://www.cancer. org/docroot/MIT/content/MIT_7_2x_Lymphedema_and_Breast_Cancer.asp *http://clinicaltrials.gov/ct/show/NCT00027118?order=5 DIURETICS - HOW EFFECTIVE ARE THEY? Reputable health authorities advise against using diuretics in the treatment of lymphedema pointing out that the therapy is generally not effective and can be damaging when used over a long period of time: The Canadian Medical Association Journal, Clinical practice guidelines for the care and treatment of breast cancer: 11. Lymphedema (CMAJ 2001;164(2):191-9) released in January of 2001 by Susan R. Harris, Maria R. Hugi, Ivo A. Olivotto, Mark Levine, for the Steering Committee for Clinical Practice Guidelines for the Care and Treatment of Breast Cancer notes: Diuretics, which have been recommended in the past, may temporarily mobilize water, but the increased interstitial oncotic pressure exerted by the high protein concentration of lymph fluid will cause rapid recurrence of edema. The diuretic effect in the rest of the body may cause adverse side effects, such as hypotension, dehydration and electrolyte imbalance. The National Cancer Institute (NCI) points out that, " Diuretics encourage vascular fluid depletion, but do nothing for excess protein deposits and could hasten connective tissue fibrosis. Therefore, diuretics should be used with caution and only for treatment of excess vascular fluid due to other causes (1998)". The 1995 consensus document of the International Society of Lymphology Executive Committee reports that although diuretics may be occasionally be useful during the initial phase of physiotherapy or in certain unique medical situations, their use on a long term basis is not generally effective. "Long-term administration of diuretics is discouraged as being of marginal benefit and potentially complicated by fluid and electolyte disturbances.". Managing your lymphedema takes time and practice. You're therapist will teach you how to properly bandage or wear compressions combined with self massage. Practice makes perfect so have patience. Although there is no cure and lymphedema is usually progressive, we can hope for research and studies to arise in the future to help those with the condition and also measure to prevent others from ever having it. Therapist Hygiene If you have open wounds or leaking fluid, your therapist may wear gloves. Gloves protect contact with fluids, substances, and chemicals. If working in the mouth to drain nodes, a therapist will wear gloves. Be sure if you have any known allergy to latex you inform your therapist BEFORE bodywork with gloves We are called to be architects of the future, not its victims. ~ R. Buckminster Fuller Managing Lymphedema At a Glance Your doctor and nurse are more likely to take your symptoms seriously and be attentive to your progress if they regularly measure the circumference of your arm and compare it with your unaffected arm, documenting the measurements over time. You can usually control lymphedema by practicing good care and following basic guidelines. The health care professionals who specialize in the management of arm lymphedema are physical medicine doctors (physiatrists), physical therapists, and occupational therapists. But don't assume that anyone in these specialties is an expert in treating lymphedema. Ask about experience and references before you let anyone work on your edema problem. Most metropolitan areas have occupational or physical therapists with practices dedicated to managing the physical, psychological, and activity-related side effects of breast cancer treatment. If you can't find a therapist who specializes in breast cancer, look for a general occupational or physical therapist in a rehabilitation center or department who has experience taking care of women with breast cancer Title: Early Intervention and Treatment Intervention for Lymphedema Authors: Gergich N,1 Washington F,2 Pfalzer3 L, Soballe P1 and McGarvey C4 Affiliations: 1. Breast Care Center, National Naval Medical Center, Bethesda, MD. 2. University of Maryland School of Medicine, Baltimore, MD. 3. University of Michigan-Flint, Flint, MI. 4.National Institutes of Health, Bethesda, MD, Physical Therapy Dept., Abstract: DESIGN: This observational (case-control) outcome study investigated the frequency and severity of morbidities in a population of approximately 165 patients diagnosed with breast cancer before and after medical and surgical treatment. METHODS: A subset analysis of a cohort of women of women diagnosed with subclinical lymphedema (LE) was conducted. Pre-operative and follow-up arm volume measurements taken at 80% of limb length measured from ulnar styloid to tip of acromion at 1, 3, 6, 9, 12 and 18 months by optoelectronic volumeter (Perometer®) from 2001-2006. Quantitative girth measurements were collected over this period using an optoelectric limb volumeter. The device is an framed infrared scanning system (Perometer, Pero-system MeBgerate GmbH, Wuppertal, Germany). This instrument was designed specifically to measure girth (cm) and volume (ml) of the upper or lower extremities and has been validated for use in a clinical environment by Stanton1 and others. ANALYSIS: 2-way Repeated ANOVA with Time and Limb as factors and mean values calculated for Affected and Unaffected Arms. RESULTS: 43 women 34-82 years old (mean =55.3 + SD 12.1) reported symptoms of LE including heaviness or increased limb volume. Intervention was introduced if the volume change equated to approximately 100 ml or 3% volume change compared to preop measure. At intervention the volume increase in the affected arm was significant (83.0 ml + 118.8 [2.1 % + 5.2] p=0.001). Baseline to onset of lymphedema and intervention averaged 7.6 mos. Average time to follow up was 5.0 months, during which time the cohort demonstrated a significant (p=0.0000) mean volume decrease of 119.9 ml [8.6%] in their affected arm by using the sleeve. CONCLUSIONS: Pre-operative assessment, prospective surveillance and early intervention may have prevented the onset of irreversible LE in this small cohort. The garment significantly reduced affected limb volume to nearly that of the unaffected limb and therefore provides effective treatment when sub-clinical LE can be detected. Further research is warranted to confirm the long term effectiveness and cost effectiveness of this preventive model compared to a traditional impairment based model. 1. Stanton AW, Northfied JW, Holroyd B, Mortimer PS, and Levick, JR. Validation of an optoelectronic limb volumeter (Perometer). Lymphology. 1997 vol:30 (2): pp:77 -97 The gold standard treatment is a form of medical massage that can be called: Manual Lymph Drainage (MLD) Lymph Drainage Therapy (LDT) Complete/Complex Decongestive Therapy (CDT) The goal of therap is to activate fluid circulation, to drain stagnant areas, stimulate the immune system, reduce pain, and keep muscle spasms to a minimum. To perform Lymphedema therapy, one must be certified and properly trained, look for your therapists credentials. Therapy feels like a massage only lighter. Your therapist will work on your body, usually head to toe. He/she will drain the nodes which again, feels like a massage. The main nodes are the waterwheel (behind earlobe), clavicle (near collarbone), axilla (under arms) and the iliac/inguinal nodes which are in the abdomen. A good deal of time is spent going back and forth to the main nodes to ensure good movement of fluids. Extra time will be spent on areas of swelling. Before you are worked on, the therapist will take your medical history and measure your areas of swelling. This is done so they can keep a record of how you progress to a smaller level. You will be taught to perform self bodywork, how to care for your skin, possibly skin brushing, do's and don'ts, special exercises to promote lymph flow, and how to wrap yourself. You usually are wrapped after each session. After you maintain the same size for a period of time, you will be ordered compression garments (sleeve, stockings) to wear instead of wraps. When NOT to go to or schedule therapy You should not schedule or go to an appointment if: You have active or acute infections You have a fever or inflammed red skin and possible infection Thrombosis (serious circulatory problems) Major heart problems (bodywork increases the cardiac load) Bleeding You are unable to urinate Also if you have any unexplained lumps or possible malignancies, you need to check in with your doctor and therapist. NEVER forget to tell your therapist about any problems you are having, and ALWAYS have your therapist update your health records to any new medications or problems. You should always have a current prescription for bodywork. Most therapist will not treat you without a referral. ALWAYS check your therapists credentials before you have bodywork done. DIURETICS - HOW EFFECTIVE ARE THEY? Reputable health authorities advise against using diuretics in the treatment of lymphedema pointing out that the therapy is generally not effective and can be damaging when used over a long period of time: The Canadian Medical Association Journal, Clinical practice guidelines for the care and treatment of breast cancer: 11. Lymphedema (CMAJ 2001;164(2):191-9) released in January of 2001 by Susan R. Harris, Maria R. Hugi, Ivo A. Olivotto, Mark Levine, for the Steering Committee for Clinical Practice Guidelines for the Care and Treatment of Breast Cancer notes: Diuretics, which have been recommended in the past, may temporarily mobilize water, but the increased interstitial oncotic pressure exerted by the high protein concentration of lymph fluid will cause rapid recurrence of edema. The diuretic effect in the rest of the body may cause adverse side effects, such as hypotension, dehydration and electrolyte imbalance. The National Cancer Institute (NCI) points out that, " Diuretics encourage vascular fluid depletion, but do nothing for excess protein deposits and could hasten connective tissue fibrosis. Therefore, diuretics should be used with caution and only for treatment of excess vascular fluid due to other causes (1998)". The 1995 consensus document of the International Society of Lymphology Executive Committee reports that although diuretics may be occasionally be useful during the initial phase of physiotherapy or in certain unique medical situations, their use on a long term basis is not generally effective. "Long-term administration of diuretics is discouraged as being of marginal benefit and potentially complicated by fluid and electolyte disturbances.". Managing your lymphedema takes time and practice. You're therapist will teach you how to properly bandage or wear compressions combined with self massage. Practice makes perfect so have patience. Although there is no cure and lymphedema is usually progressive, we can hope for research and studies to arise in the future to help those with the condition and also measure to prevent others from ever having it. Therapist Hygiene If you have open wounds or leaking fluid, your therapist may wear gloves. Gloves protect contact with fluids, substances, and chemicals. If working in the mouth to drain nodes, a therapist will wear gloves. Be sure if you have any known allergy to latex you inform your therapist BEFORE bodywork with gloves We are called to be architects of the future, not its victims. ~ R. Buckminster Fuller Managing Lymphedema At a Glance Your doctor and nurse are more likely to take your symptoms seriously and be attentive to your progress if they regularly measure the circumference of your arm and compare it with your unaffected arm, documenting the measurements over time. You can usually control lymphedema by practicing good care and following basic guidelines. The health care professionals who specialize in the management of arm lymphedema are physical medicine doctors (physiatrists), physical therapists, and occupational therapists. But don't assume that anyone in these specialties is an expert in treating lymphedema. Ask about experience and references before you let anyone work on your edema problem. Most metropolitan areas have occupational or physical therapists with practices dedicated to managing the physical, psychological, and activity-related side effects of breast cancer treatment. If you can't find a therapist who specializes in breast cancer, look for a general occupational or physical therapist in a rehabilitation center or department who has experience taking care of women with breast cancer Title: Early Intervention and Treatment Intervention for Lymphedema Authors: Gergich N,1 Washington F,2 Pfalzer3 L, Soballe P1 and McGarvey C4 Affiliations: 1. Breast Care Center, National Naval Medical Center, Bethesda, MD. 2. University of Maryland School of Medicine, Baltimore, MD. 3. University of Michigan-Flint, Flint, MI. 4.National Institutes of Health, Bethesda, MD, Physical Therapy Dept., Abstract: DESIGN: This observational (case-control) outcome study investigated the frequency and severity of morbidities in a population of approximately 165 patients diagnosed with breast cancer before and after medical and surgical treatment. METHODS: A subset analysis of a cohort of women of women diagnosed with subclinical lymphedema (LE) was conducted. Pre-operative and follow-up arm volume measurements taken at 80% of limb length measured from ulnar styloid to tip of acromion at 1, 3, 6, 9, 12 and 18 months by optoelectronic volumeter (Perometer®) from 2001-2006. Quantitative girth measurements were collected over this period using an optoelectric limb volumeter. The device is an framed infrared scanning system (Perometer, Pero-system MeBgerate GmbH, Wuppertal, Germany). This instrument was designed specifically to measure girth (cm) and volume (ml) of the upper or lower extremities and has been validated for use in a clinical environment by Stanton1 and others. ANALYSIS: 2-way Repeated ANOVA with Time and Limb as factors and mean values calculated for Affected and Unaffected Arms. RESULTS: 43 women 34-82 years old (mean =55.3 + SD 12.1) reported symptoms of LE including heaviness or increased limb volume. Intervention was introduced if the volume change equated to approximately 100 ml or 3% volume change compared to preop measure. At intervention the volume increase in the affected arm was significant (83.0 ml + 118.8 [2.1 % + 5.2] p=0.001). Baseline to onset of lymphedema and intervention averaged 7.6 mos. Average time to follow up was 5.0 months, during which time the cohort demonstrated a significant (p=0.0000) mean volume decrease of 119.9 ml [8.6%] in their affected arm by using the sleeve. CONCLUSIONS: Pre-operative assessment, prospective surveillance and early intervention may have prevented the onset of irreversible LE in this small cohort. The garment significantly reduced affected limb volume to nearly that of the unaffected limb and therefore provides effective treatment when sub-clinical LE can be detected. Further research is warranted to confirm the long term effectiveness and cost effectiveness of this preventive model compared to a traditional impairment based model. 1. Stanton AW, Northfied JW, Holroyd B, Mortimer PS, and Levick, JR. Validation of an optoelectronic limb volumeter (Perometer). Lymphology. 1997 vol:30 (2): pp:77 -97 This page is a mix of content from Lymphology magazine in the last article, exerpts from Dr. Chikly's book, Silent Waves, and additions from Tina Budde. Dr. Chikly's information can be found on the many pages of the site dedicated to him, such as History of Lymph 1, 2, and 3, and Dr. Chikly. Information here is used with Dr. Chikly's consent. Information on this page was listed and edited by the Lymphland Editorial Team on January 1, 2008. -------------------------------------- "Expert Patients" With Fibromyalgia and Other Chronic Illnesses: Not Quite What the Doctor Ordered ImmuneSupport.com 08-10-2005 Few GPs support a new initiative that aims to empower the sick. Cassandra Jardine meets two long-term sufferers who argue that the medical profession has nothing to fear. Lillian Balliston: Fibromyalgia patient When Lillian Balliston was in her early twenties, she suffered a knock on the knee. It appeared to be a minor injury, but triggered terrible pains. Unable to wash or dress herself, she had to give up her job in personnel and move back to her mother's home. Sometimes, in the street, the pain was so bad that she would fall over and, even now, 15 years later, she is still so sore that she can't let her eight-year-old daughter, Isha, hug her. But the worst aspect of her condition, she says, is that the health professionals didn't listen to her. "Whenever I went to the doctor, I felt criticised: I was told that I shouldn't be in such pain, so I must be depressed and should get out more. A physiotherapist gave me exercises to do but, when I said I couldn't do them because of the pain, I was told to make more effort. I was made to feel as if I was the problem and, eventually, I began to doubt myself so much that I was scared I would have to go into a mental home." It was only in 1999 that a rheumatologist diagnosed fibromyalgia, a form of arthritis that strikes the muscles, rather than the joints. "I broke down in tears when he told me. I was so relieved that I wasn't responsible for my own symptoms," says Balliston. To understand the condition, one UK website suggests that you take the muscle that leads from your shoulder to your neck in your hand and squeeze hard; that's what it feels like all over the body, all the time. Living with that pain is miserable, but Balliston feels that her frustration with doctors and physios made her symptoms worse and that, because of self-doubt, she led an even more restricted life than she need have done. "If only there had been an Expert Patient Initiative in the early 1990s, my life could have been so different," she says. The NHS's Expert Patient Initiative is designed to give patients with chronic disorders - some 17 million people; a third of the population - more control over their treatment. Balliston signed up for it when she read of a pilot scheme in her GP's surgery in White City, west London. The course involved six sessions of two and a half hours, covering exercise, diet and complementary therapies to how to communicate with health professionals. Perhaps it is this last element of the course that accounts for doctors' lack of enthusiasm for the initiative. Only 21 per cent of GPs surveyed were in favour; more than half predicted that it will mean more work. Perhaps they envisage stroppy patients storming into the surgery and demanding the latest, very expensive drug, which the doctor doesn't think suitable. Certainly, an element of patient empowerment lay behind the initial idea, which was developed by Kate Lorig, a professor at Stanford University in California. In the 1970s, while working with arthritis patients, she was shocked by the paternalism of doctors. Suffering from a metabolic disorder herself, she developed the self-help course for patients, which has been adapted for Britain. James Locke: Ill for 21 years James Locke was one of the first chronic invalids to take it. A health administrator who was diagnosed with HIV in 1984, he has had 21 years to discover what it is like to live with his condition: the pills that have undesirable side effects, the near-death moments, the isolation and the patches of despair. Now working as an unpaid tutor on the expert patient courses, he has discovered that whatever the illness - diabetes, heart problems, cancer, kidney failure or MS - everyone's experience is much the same. "The first time a group meets, there is a powerful emotional moment," he says. "Each person has to introduce themselves, their illness and explain how it affects their life. For some, it will be the first time they have been so open, but they soon find that the others share the same feelings of anger, fear and frustration." Chronic conditions often mean the end of dreams, a loss of motivation and a sense of being out of control, he explains. "On these programmes, we encourage people to dream again. Everyone has to set a goal each week and an action plan for achieving that goal. If someone is unable to get there - many overestimate themselves to begin with - the group looks at solutions." Locke found that becoming an expert patient didn't mean becoming better informed about therapies and treatments - he had always kept abreast of developments. Nor did it mean going to see his doctor more often. The impact lay in a reduction of feelings of isolation and the realisation that he could make himself think more positively. "On those days when it's cold and wet, instead of hiding in bed, I might now say to myself: 'It's a great day for the cinema.'" The course made an even greater difference to Lillian Balliston. "I was a mess," she says. "I was scared of my emotions because I felt that, if I expressed them, it would be further evidence that I was losing my mind. When I started going to expert patient meetings, all that disappeared. I'm still disabled, but I don't feel so bothered any more, because I know my condition has nothing to do with my personality. I've realised how much life I still have." Since taking the course, Balliston goes out more, often with a colleague from the course to give her confidence. She has read up about fibromyalgia and her other problem, chronic pain syndrome, so she goes to the doctor less regularly because she feels more in control. This matches research that shows that expert patients use their GPs, and A&E and outpatients departments less than before; they are also more likely to take their medication. Most important, Balliston has learnt to talk to medical professionals: "Whenever I had an appointment, I used to get upset and forget to ask questions that had been bothering me. Now, I feel able to put those feelings aside. I say: 'This is what I've done and this is how I feel. Is there another direction you can point me in?'" That doesn't sound too scary for doctors. With the initiative now expanding, Locke and Balliston hope that more GPs will realise that it is no bad thing if patients and doctors talk to each other on a more equal footing. ---------------------------------------- Help for Lymphedema By Rebekah Addy, Ivanhoe Health Correspondent ORLANDO, Fla. (Ivanhoe Newswire) -- The removal of lymph nodes is an important part of breast cancer surgery, but studies show between 5 percent and 50 percent of patients develop lymphedema, or swelling of the arms, from it. Now, one surgeon has developed a new procedure to prevent the painful side effect. V. Suzanne Klimberg, M.D., director at the University of Arkansas for Medical Sciences, Favetteville, developed a procedure called Axillary Reverse Mapping (ARM), where doctors inject a blue dye in the patient's arm, allowing them to clearly see where the lymph nodes are located and enabling them to have more precision, thereby preventing lymphedema. There are currently no other procedures available to prevent lymphedema. "This is a big deal because it should prevent lymphedema because we haven't injured the lymph vessels coming out of the arm," Dr. Klimberg told Ivanhoe. Dr. Klimberg says for some patients, the pain of lymphedema can feel worse than getting a mastectomy. Patient Pat Sharpitis got lymphedema after five years of battling breast cancer. "I couldn't unbend my hand -- it was so tight," Sharpitis told Ivanhoe. "I had to go through some heavy therapy. Now some of the swelling is down, but it's embarrassing sometimes." Sharpitis has learned to live with it over the years saying, "It is a sad thing. You can't wear jewelry on your hands, and I was a jewelry person." The procedure can be done while in the operating room. Dr. Klimberg recently presented her procedure at the Society of Surgical Oncology 60th Annual Cancer Symposium in Washington, D.C. Ethicon, a branch of Johnson and Johnson has agreed to travel the country and present a teaching seminar on ARM. Dr. Klimberg and her colleagues are looking into starting clinical trials to better understand ARM. This article was reported by Ivanhoe.com, which offers Medical Alerts by e-mail every day of the week. To subscribe, click on: http://www.ivanhoe.com/newsalert/. SOURCE: Ivanhoe interview with V. Suzanne Klimberg, M.D., University of Arkansas for Medical Science -------------------------------- Guna-Lympho Drug name: Guna-lympho Active Ingredients: Homeopathic substances Therapeutic actions: Guna-lympho works by activating detoxification and micro-circulation functions. By reducing the phlogosis of the lymphatic system, Guna-lympho eliminates the lymphatic spasm that is a cause of lymphatic stasis. Thus Guna-lympho reduces exudation and lymphedema. Guna-Lympho possesses not only lymphatic detoxification function, but also anti-inflammatory and immune stimulating properties. Indications: Guna-lympho is used to treat the following disease: Lymphatic stasis (lymphedemas) Inflammation of the lymphatic organs (lymphadenitis, lymphangitis) ; Hyperplasia or hypertrophy of the lymphatic organs. Extracellular matrix detoxification Contraindications and cautions: Do not use Guna-lympho in allergy or hypersensitivity to any of its active ingredients Do not use Guna-lumpho in pregnancy and breastfeeding If you don't feel any improvement while taking Guna-lympho within 5 days, stop using this medication Use this medication with caution in liver diseases Adverse effects: There are possible side-effects associated with this medicine that can affect individuals in different ways. If a side effect is stated here, that does not necessarily mean the fact that all people using Guna-lympho will experience it or any other. allergic reactions: skin rash Hypersalivation The side effects listed above may not include all of the side effects reported by the drug's manufacturer. For more information about any other possible risks associated with Guna-lympho, please read the information provided with Guna-lympho or consult your doctor or pharmacist. Interactions: It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with Guna- lympho. Similarly, check with your doctor or pharmacist before taking any new medication while taking this one, to ensure that the combination is safe. Additional Information: DO NOT SHARE Guna-lympho with others. DO NOT USE THIS MEDICINE for other health conditions. KEEP THIS PRODUCT, as well as syringes and needles, if needed during treatment, out of the reach of children. Do not reuse needles, syringes, or other materials. ------------------------------------------- Sources: Data Synopsis: Early Diagnosis and Treatment Intervention for Lymphedema By NL Stout Gergich, MPT and PW Soballe, MD, Breast Care Center, National Naval Medical Center, Bethesda, MD LA Pfalzer, PT, PhD, University of Michigan-Flint, Flint, MI CL McGarvey, DPT, MS, National Institutes of Health, Bethesda, MD, Physical Therapy Dept NaturePublished online: 27 July 2005; | doi:10.1038/436456aLymphatic system: Unlocking the drainsPhyllida Brown Authors: Gergich N,1 Washington F,2 Pfalzer3 L, Soballe P1 and McGarvey C4Affiliations: 1. Breast Care Center, National Naval Medical Center, Bethesda, MD.2. University of Maryland School of Medicine, Baltimore, MD.3. University of Michigan-Flint, Flint, MI.4.National Institutes of Health, Bethesda, MD, Physical Therapy Dept., The Canadian Medical Association Journal, Clinical practice guidelines for the care and treatment of breast cancer: 11. Lymphedema (CMAJ 2001;164(2):191-9) released in January of 2001 by Susan R. Harris, Maria R. Hugi, Ivo A. Olivotto, Mark Levine, for the Steering Committee for Clinical Practice Guidelines for the Care and Treatment of Breast Cancer notes. ---- 25 February 2009 - Identification Of Metastasis-Promoting Protein Could Provide A Prognostic Test Or Target For Breast Cancer Tumors that are about to progress and metastasize go through a process also seen in normal embryonic development, known as the epithelial to mesenchymal transition (EMT). Tumor cells revert to a less- differentiated state, stop adhering to each another and become more mobile and prone to invade and proliferate. Now, researchers at Children's Hospital Boston show, for the first time, that a small protein called lipocalin 2 triggers the EMT in human breast cancer - and that the same protein, when measured in tissues and urine, can predict a cancer's invasiveness. Their findings were published online February 23 by the Proceedings of the National Academy of Sciences. Researchers led by Marsha A. Moses, PhD, and Jiang Yang, PhD, of the Vascular Biology Program at Children's, induced human breast cancer cells to make large amounts of lipocalin 2, and showed that cell motility and invasiveness increased significantly. They then took cells from aggressive breast cancers and silenced lipocalin 2, and found that cell migration was significantly inhibited. When they transplanted human breast cancer cells into animals, those from tumors making lipocalin 2 were more locally invasive and more likely to metastasize to lymph nodes. Further laboratory studies indicated that lipocalin 2 decreases the levels of estrogen receptor alpha, thereby reducing the cells' response to the hormone estrogen, which is associated with poor prognosis of breast cancer. Inhibiting the production of estrogen receptor alpha is also the mechanism that triggers the EMT pathway, the researchers show. Finally, tissue samples, and even urine samples, from women with invasive breast cancer consistently showed elevated lipocalin 2 levels, suggesting that testing for lipocalin 2 may be a way of detecting cancer progression and the need for more aggressive treatment. "Our study identifies a novel, additional player in the complex development of invasive breast cancer," says Moses, the Vascular Biology Program's interim director. "It suggests that this protein may represent a prognostic and/or therapeutic target for this devastating disease." ---------------------------- Article adapted by Medical News Today from original press release. ---------------------------- Lipocalin 2, along with other urine biomarkers of cancer identified in Moses's lab, has been licensed to Predictive Biosciences, Inc. (Lexington, Mass.) for clinical development. The study was funded by the National Institutes of Health, the JoAnn Webb Fund for Angiogenesis Research, the Riehl Family Foundation, the S. Elizabeth O'Brien Trust and the Advanced Medical Foundation. Children's Hospital Boston is home to the world's largest research enterprise based at a pediatric medical center, where its discoveries have benefited both children and adults since 1869. More than 500 scientists, including eight members of the National Academy of Sciences, 11 members of the Institute of Medicine and 13 members of the Howard Hughes Medical Institute comprise Children's research community. Founded as a 20-bed hospital for children, Children's Hospital Boston today is a 397-bed comprehensive center for pediatric and adolescent health care grounded in the values of excellence in patient care and sensitivity to the complex needs and diversity of children and families. Children's also is the primary pediatric teaching affiliate of Harvard Medical School. For more information about the hospital and its research visit: http://www. childrenshospital.org/newsroom. Source: Rob Graham Children's Hospital Boston 21 February 2009 - Blood Testing Identifies Abnormal Cells Up To Six Years Prior To Leukemia Diagnosis Testing of blood specimens may detect abnormal white blood cells in patients years before the chronic form of lymphocytic leukemia (CLL) develops, according to research published in the current issue of the New England Journal of Medicine. The finding may lead to a better understanding of cellular changes that characterize the earliest stages of the disease and how it progresses. Researchers at the National Cancer Institute (NCI), part of the National Institutes of Health, and the U.S. Food and Drug Administration, led the study, which was co-authored by two researchers with Quest Diagnostics Incorporated (NYSE: DGX), Maher Albitar, M.D., Medical Director and Chief of Research and Development, Hematology and Oncology, and Wanlong Ma, M.S., Research and Development Manager, Hematology and Oncology. For the study, Dr. Albitar and Ms. Ma developed a method to identify abnormal B-cell clones in blood specimens. Quest Diagnostics plans to use a similar approach to develop tests that may one day be used by physicians as an aid in identifying patients who will develop CLL. "We searched for tumor cells by performing a sophisticated form of flow cytometry as well as molecular testing on frozen samples of whole blood and blood plasma," said Dr. Albitar. "The findings of this study lead to better understanding of biological processes underlying the development of CLL, and give us hope that in the future we will be able to develop new testing techniques to look at blood from patients with abnormal cells and distinguish those who will develop overt cancer from those who will not." "Quest Diagnostics is the leader in cancer testing, and this study demonstrates the commitment of our science and innovation team to advancing cancer research," said Surya N. Mohapatra, Ph.D., Chairman and Chief Executive Officer, Quest Diagnostics. CLL is a blood cancer that usually progresses slowly over many years. In this disease, abnormal white blood cells called B-cells accumulate in the blood and the bone marrow. The lymph nodes, spleen, and other organs may also be affected. Although CLL is the most common form of leukemia in adults in Western countries, little is known about what causes the disease or how it develops. Previous research by the NCI/FDA team and others showed that some family members of CLL patients can have B-cells in their blood that have outer-surface proteins that are similar to proteins found on CLL cells. This abnormal condition, known as monoclonal B-cell lymphocytosis (MBL), occurs in over 10 percent of CLL family members and in about 3 percent to 5 percent of healthy adults over the age of 50, suggesting it might be a precursor of CLL. In the current study, the research team identified 45 individuals among the more than 77,000 participants in the nationwide Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial who were cancer- free upon entering the trial, were later diagnosed with CLL, and had frozen blood samples available for analysis that had been collected upon their enrollment in PLCO. Using sophisticated laboratory techniques developed by Quest Diagnostics to analyze the blood samples, the researchers found that 44 of the 45 CLL patients had MBL between six months to more than six years prior to their CLL diagnosis. Prior research shows that the MBL cells were identified by examining cell-surface proteins, or CLL markers, using a method called flow cytometry, and by using molecular techniques to confirm the presence of certain rearranged genes, known as immunoglobulin heavy variable (IGHV) group genes, found in CLL. In 41 patients, MBL was confirmed by both methods. The study, titled "B-Cell Clones as Early Markers for Chronic Lymphocytic Leukemia," (Vol. 360, No. 7, Feb. 12, 2009) was accompanied by the editorial "The Secret Lives of Monoclonal B Cells." About Quest Diagnostics and Blood-based Tumor Testing Quest Diagnostics is a leader in noninvasive blood-based biomarker testing used by physicians to screen for, diagnose and monitor carcinomas and other tissue-based disease. The company's proprietary Leumeta(TM) portfolio of tests helps physicians identify and analyze genetic components of leukemia and lymphoma tumors using blood plasma instead of bone marrow, which can only be tested after extraction through painful biopsy. In addition, the company is the exclusive national reference laboratory provider of the blood-based HE4 Ovarian Cancer Monitoring test, which is FDA cleared as an aid in monitoring recurrent or progressive disease in women with epithelial ovarian cancer. The company is also developing a molecular blood test based on Epigenomics AG's Septin 9 DNA methylation biomarker that can help physicians detect colorectal cancer based on a patient's blood specimen. About Quest Diagnostics Quest Diagnostics is the world's leading provider of diagnostic testing, information and services that patients and doctors need to make better healthcare decisions. The company offers the broadest access to diagnostic testing services through its network of laboratories and patient service centers, and provides interpretive consultation through its extensive medical and scientific staff. Quest Diagnostics is a pioneer in developing innovative diagnostic tests and advanced healthcare information technology solutions that help improve patient care. Additional company information is available at http://www.questdiagnostics.com. The statements in this press release that are not historical facts or information may be forward-looking statements. These forward-looking statements involve risks and uncertainties that could cause actual results and outcomes to be materially different. Certain of these risks and uncertainties may include, but are not limited to, competitive environment, changes in government regulations, changing relationships with customers, payers, suppliers and strategic partners and other factors described in the Quest Diagnostics Incorporated 2007 Form 10-K and subsequent SEC filings. Quest Diagnostics http://www.questdiagnostics.com 20 February 2009 - Update On Lymphoma Drug Trial: Potential Breakthrough For T- Cell Lymphoma Patients With Drug That Mimics A Vitamin Final results of a pivotal Phase 2 clinical trial of pralatrexate (PDX) for patients with relapsed or refractory peripheral T-cell lymphoma (PTCL) were reported by the study's principal investigator, Dr. Owen A. O'Connor of the Herbert Irving Comprehensive Cancer Center at Columbia University Medical Center and NewYork-Presbyterian Hospital/Columbia. T-cell lymphoma (PTCL) is a biologically diverse group of blood cancers that account for as many as 15 percent of non-Hodgkin's lymphoma (NHL) cases in the United States. Data from the PROPEL (Pralatrexate in patients with Relapsed Or refractory PEripheral T-cell Lymphoma) trial show that pralatrexate, a drug that partially works by mimicking the vitamin folic acid, has an estimated median duration of response of 287 days, or 9.4 months. As previously reported, 29 of 109 evaluable patients, or 27 percent, showed a complete or partial response. "Until now, these patients could only expect to survive several weeks. This study shows that it may be possible to extend this to many months - a result that is nothing short of spectacular and may likely represent a breakthrough in the development of new drugs for T-cell lymphoma," said Dr. O'Connor, director of the Lymphoid Development and Malignancy Program and chief of the Lymphoma Service at the Herbert Irving Comprehensive Cancer Center at NewYork-Presbyterian Hospital/Columbia University Medical Center, and associate professor of medicine at Columbia University College of Physicians and Surgeons. "Based on these promising data, pralatrexate has the potential to play a clinically meaningful role in the treatment of patients with relapsed or refractory PTCL." Pralatrexate, designed to look like the natural vitamin folic acid, disrupts DNA synthesis in tumor cells. The drug is designed to selectively accumulate in tumor cells, after which it then induces programmed cell death, or apoptosis, in the cancer cell. There are currently no pharmaceutical agents approved for use in the treatment of either first-line or relapsed or refractory PTCL, and overall five-year survival is approximately 25 percent after first-line therapy. In addition to those PTCL patients who do not respond to first-line treatment, a significant number of first-line multi-agent chemotherapy responders relapse or become refractory after treatment. The PROPEL trial is organized by Allos Therapeutics Inc., the maker of the drug. The company expects to submit a New Drug Application to the U.S. Food and Drug Administration for marketing approval of pralatrexate sometime in the first half of 2009. The results of the trial will be submitted for presentation at an upcoming scientific meeting and for publication in a peer-reviewed journal. Pralatrexate was developed by a team of researchers at Memorial Sloan-Kettering Cancer Center (MSKCC) and the Southern Research Institute, including Dr. O'Connor, while at MSKCC. Dr. O'Connor and his colleagues identified the unique activity of pralatrexate in patients with lymphoma. Dr. O'Connor has continued to study pralatrexate at NewYork-Presbyterian/Columbia, now focusing on determining how the drug works in T-cell lymphoma, and on how best to combine it with other drugs to improve the treatment of patient with hematologic cancers. PROPEL Trial Details The critical PROPEL (Pralatrexate in patients with Relapsed Or refractory PEripheral T-cell Lymphoma) trial - an international, multicenter, open-label, single-arm study - enrolled a total of 115 patients with relapsed or refractory PTCL, 109 of whom are considered evaluable for response according to the trial protocol. It is believed that PROPEL is the largest prospectively designed single-agent trial conducted to date for this patient population. To be eligible for the trial, patients' disease must have progressed after at least one prior treatment. Patients were considered evaluable if they received at least one dose of pralatrexate and their diagnosis of PTCL was confirmed by independent pathology review. Patients received 30 mg/m2 of pralatrexate intravenously once every week for six weeks followed by one week of rest per cycle of treatment. Patients also received vitamin B12 and folic acid supplementation. The primary endpoint of the trial is objective response rate, as assessed by central, independent oncology review using International Workshop Criteria (IWC). Duration of response is the key secondary endpoint. Of the 29 patients who achieved a response according to central independent oncology review, 7 patients had a complete response (CR), 2 patients had a complete response unconfirmed (CRu) and 20 patients had a partial response (PR). According to the PROPEL investigators, 42 of 109 evaluable patients, or 39 percent, achieved a response. Of these, 15 patients had a CR, 4 patients had a CRu and 23 patients had a PR. PROPEL patients received a median of three prior systemic treatment regimens (range of 1 to 12), including 18 patients, or 16 percent, who had previously undergone an autologous stem cell transplant. In the trial, 66 percent of the patients who responded did so after cycle one of therapy. Patients will continue to be followed for long-term survival. Peripheral T-Cell Lymphoma According to the American Cancer Society, approximately 66,000 patients are expected to be diagnosed with non-Hodgkin's lymphoma in the United States in 2009. Annual prevalence is estimated to be approximately 9,500 patients. In addition to the 30 percent to 50 percent of PTCL patients that do not respond to first-line treatment, a significant number of first-line, multi-agent chemotherapy responders relapse or become refractory after treatment. NewYork-Presbyterian Hospital NewYork-Presbyterian Hospital, based in New York City, is the nation's largest not-for-profit, non- sectarian hospital, with 2,242 beds. The Hospital has nearly 2 million inpatient and outpatient visits in a year, including more than 230,000 visits to its emergency departments - more than any other area hospital. NewYork-Presbyterian provides state-of-the-art inpatient, ambulatory and preventive care in all areas of medicine at five major centers: NewYork-Presbyterian Hospital/Weill Cornell Medical Center, NewYork- Presbyterian Hospital/Columbia University Medical Center, Morgan Stanley Children's Hospital of NewYork-Presbyterian, NewYork-Presbyterian Hospital/The Allen Pavilion and NewYork-Presbyterian Hospital/Westchester Division. One of the largest and most comprehensive health care institutions in the world, the Hospital is committed to excellence in patient care, research, education and community service. It ranks sixth in U.S.News & World Report's guide to "America's Best Hospitals," ranks first on New York magazine's "Best Hospitals" survey, has the greatest number of physicians listed in New York magazine's "Best Doctors" issue, and is included among Solucient's top 15 major teaching hospitals. The Hospital's mortality rates are among the lowest for heart attack and heart failure in the country, according to a 2007 U. S. Department of Health and Human Services (HHS) report card. The Hospital has academic affiliations with two of the nation's leading medical colleges: Weill Cornell Medical College and Columbia University College of Physicians and Surgeons. For more information, visit www.nyp.org. Columbia University Medical Center Columbia University Medical Center provides international leadership in basic, pre-clinical and clinical research, in medical and health sciences education, and in patient care. The Medical Center trains future leaders and includes the dedicated work of many physicians, scientists, public health professionals, dentists, and nurses at the College of Physicians & Surgeons, the Mailman School of Public Health, the College of Dental Medicine, the School of Nursing, the biomedical departments of the Graduate School of Arts and Sciences, and allied research centers and institutions. Established in 1767, Columbia's College of Physicians and Surgeons was the first institution in the country to grant the M.D. degree and is now among the most selective medical schools in the country. Columbia University Medical Center is home to the largest medical research enterprise in New York City and state and one of the largest in the United States. For more information, please visit http://www.cumc.columbia.edu. NewYork-Presbyterian Hospital 627 W 165th St., SB-621 New York NY 10032 United States http://www.nyp.org 14 February 2009 - gical Evaluation Improves Women's Cancer Outcome Many women scheduled to undergo hysterectomy for pre-cancerous cell changes actually need a more comprehensive surgery, something they should discuss with a gynecologic oncologist, say researchers at the University of Alabama at Birmingham (UAB). If seen by a specialist, it should be recommended they undergo a procedure that focuses on lymph nodes and other organs not involved in a traditional hysterectomy, said Warner Huh, M.D., a researcher at the UAB Comprehensive Cancer Center. The finding was presented at the Society of Gynecologic Oncologists' 2009 Annual Meeting on Women's Cancer in San Antonio. "Given the high rate of endometrial cancer, these data strongly suggest all women who have abnormal bleeding and a diagnosis of pre-cancerous lesions of the uterus should be evaluated by a gynecologic oncologist," Huh said. Huh and his research team analyzed medical records of more than 3,322 patients treated at seven community hospitals across Alabama from 1999 to 2008. They specifically looked women diagnosed with pre-cancerous changes called complex atypical hyperplasia (CAH). Of patients who underwent a traditional hysterectomy, about half were found to have invasive endometrial cancer after their procedure. That means too many hysterectomy patients should've had a more comprehensive cancer surgery, something a gynecologist oncologist is trained to do, Huh said. To avoid unwanted outcomes, women diagnosed with CAH should be referred to a gynecologic oncologist for evaluation, he said. ---------------------------- Article adapted by Medical News Today from original press release. ---------------------------- Source: Troy Goodman University of Alabama at Birmingham 12 February 2009 - Bone Marrow Transplant Patients May Benefit From New Immune Research Many women scheduled to undergo hysterectomy for pre-cancerous cell changes actually need a more comprehensive surgery, something they should discuss with a gynecologic oncologist, say researchers at the University of Alabama at Birmingham (UAB). If seen by a specialist, it should be recommended they undergo a procedure that focuses on lymph nodes and other organs not involved in a traditional hysterectomy, said Warner Huh, M.D., a researcher at the UAB Comprehensive Cancer Center. The finding was presented at the Society of Gynecologic Oncologists' 2009 Annual Meeting on Women's Cancer in San Antonio. "Given the high rate of endometrial cancer, these data strongly suggest all women who have abnormal bleeding and a diagnosis of pre-cancerous lesions of the uterus should be evaluated by a gynecologic oncologist," Huh said. Huh and his research team analyzed medical records of more than 3,322 patients treated at seven community hospitals across Alabama from 1999 to 2008. They specifically looked women diagnosed with pre-cancerous changes called complex atypical hyperplasia (CAH). Of patients who underwent a traditional hysterectomy, about half were found to have invasive endometrial cancer after their procedure. That means too many hysterectomy patients should've had a more comprehensive cancer surgery, something a gynecologist oncologist is trained to do, Huh said. To avoid unwanted outcomes, women diagnosed with CAH should be referred to a gynecologic oncologist for evaluation, he said. ---------------------------- Article adapted by Medical News Today from original press release. ---------------------------- Source: Troy Goodman University of Alabama at Birmingham Lymphoedema - PCT Funds Research Into Treament Of Breast Cancer Side Effects Through Dragon Boat Racing NHS North Lancashire is funding groundbreaking research into the benefits of the Chinese sport of dragon boat racing in the prevention of some of the distressing side-effects associated with breast cancer treatment. The Primary Care Trust (PCT) has awarded a research bursary of £10,000 to researchers at Sheffield Hallam University in order to study the connection between physical activity and breast cancer related lymphoedema - an often distressing side effect of breast cancer treatment. The project is one of five being funded by NHS North Lancashire in celebration of the NHS 60th birthday this year. Earlier this year the PCT announced that individuals or organisations with an interest in conducting research into innovative improvements in health in the region could apply for a bursary and Dr Helen Crank, Senior Research Fellow at Sheffield Hallam University was one of the successful applicants. Dr Crank is using the bursary funds to work closely with Paddlers for Life, a massively successful charity in the region, who take to Windermere each week, and which is helping cancer survivors regain their confidence and health through dragon boat racing, to investigate whether the sport can be an effective way to manage lymphoedema and improve the physical and psychological wellbeing of breast cancer survivors. The information gathered from this research will be passed on to healthcare professionals and women and men who have been treated for breast cancer so as to help shape the future of exercise and cancer rehabilitation referral schemes. Lymphoedema is a condition characterised by swelling caused by a build up of lymph fluid in the tissues. Breast cancer related lymphoedema occurs as a result of damage to the lymphatic system which can be caused by breast surgery and radiotherapy to the lymph nodes in the armpit and surrounding areas such as the neck or chest. Up to 40% of women who receive treatment for breast cancer experience the condition. Typically patients experience swelling of the arm or hand on the surgical side, which can be accompanied by sensations of pain or heaviness, and so negatively affecting survivor's quality of life. Commonly, the advice offered to women who suffer with breast cancer related lymphoedema recommends only very gentle exercise and much caution, but dragon boat research carried out in Canada suggests that in fact more strenuous exercise might play a vital role in recovery from breast cancer. The physical demands of dragon boat paddling and related exercise training can improve cardio-respiratory fitness, shoulder joint range of movement and muscle tone which all combine to assist lymph fluid propulsion and prevent further increases in arm swelling. However, UK-based studies must be carried out to understand how much and what type of training is needed to gain health improvements and if the effects seen in Canada can be achieved by breast cancer survivors here in the UK. This research programme will therefore be an important step in obtaining evidence before exercise programmes such as dragon boat racing can formally be offered by the NHS for breast cancer survivors. Ian Cumming, Chief Executive of NHS North Lancashire, says: "We are very pleased to be able to support this worthwhile research project which will lead to a better insight into the role of exercise in speeding recovery from breast cancer related lymphoedema. "We hope that through funding this research, more cancer survivors right across the UK can experience the physical and mental benefits that team sports such as dragon boat racing can provide. "Funding research projects such as this is an ideal way to celebrate the NHS 60th birthday: They will ensure that new insights and developments can continue to be made in healthcare in the Lancaster, Fylde and Wyre districts that we serve so that we continue to ensure a first class health service for the next 60 years." Dr Helen Crank says: "I am delighted that NHS North Lancashire has been able to fund this research. Through the project I'm working closely with Paddlers for Life, but I hope that breast cancer survivors across the UK will be able to benefit from the results of this work. Dragon boat training and racing might prove to be ideal for breast cancer survivors for a number of reasons, not least because it provides survivors with a vehicle for physical recovery, but being a team activity it also seems to help build a sense of camaraderie, motivation for exercise, and provide a vital network of social support amongst paddlers. By following a dragon-boat exercise training plan, paddlers can work according to their own fitness abilities to improve their cardiovascular fitness and physical strength". "Paddlers for Life is an excellent example of how cancer survivors can improve their physical and mental health through exercise. Team members who started the exercise programme with existing lymphoedema experienced reductions in arm swelling and those members who did not have lymphoedema did not experience any adverse effects from this type of exercise training. Clearly, the friendships and sense of camaraderie that dragon boat racing fosters within the team has been absolutely vital in giving paddlers a sense of wellbeing." Paddlers for Life is a crew of cancer survivors from across Lancashire and Cumbria, who take to Lake Windermere each weekend in dragon boats, go to http://www.paddlersforlife.co.uk for more information on Paddlers for Life. Dragon boat racing originated in China. Dragon boats themselves are long boats that seat between 14 and 18 paddlers together with a drummer. At the head of the boat there is typically an ornately carved dragon head. Races typically involve between two and four boats over a 200 metre stretch of water. Source Alexandra Bogin Communications Assistant Corporate Communications Dept. North Lancashire Teaching PCT Moor Lane Mills Moor Lane Lancaster LA1 1QD http://www.northlancshealth.nhs.uk 04 February 2009 ----- 24 September 2009 - Ultrasound Can Predict Tumor Burden And Survival In Melanoma Patients Researchers have shown for the first time that patterns of ultrasound signals can be used to identify whether or not cancer has started to spread in melanoma patients, and to what extent. The discovery enables doctors to decide on how much surgery, if any, is required and to predict the patient's probable survival. Dr Christiane Voit told Europe's largest cancer congress, ECCO 15 - ESMO 34 [1], in Berlin 23 September: "We have identified two ultrasound patterns of lymph node metastasis in melanoma patients which can identify correctly any amount of tumour cells in the sentinel lymph nodes in 75-90% of cases before proceeding to surgery on the sentinel lymph nodes." Dr Voit, who is a dermatologist and head of the diagnostic unit at the Skin Cancer Centre at Charité - Universitätsmedizin Berlin, the Medical University of Berlin, Germany, said that although her research needs to be confirmed in multi-centre, randomised clinical trials, it had the potential to spare patients unnecessary surgery, especially if it was combined with ultrasound-guided fine needle biopsy of lymph nodes rather than conventional surgery. Since 2001 Dr Voit and her colleagues in Germany and The Netherlands have included 850 melanoma patients in a prospective study to investigate the use of ultrasound in diagnosis and treatment planning. They have already demonstrated that ultrasound-guided fine needle biopsy of sentinel nodes before conventional sentinel node surgery can identify up to 65% of patients in whom the cancer has started to spread. The study presented today shows how far ultrasound patterns correlate with disease progression, tumour burden, survival and prognosis in the first 400 of these patients with stage I/II melanoma and with the longest follow- up. Before having sentinel node surgery the patients were investigated using ultrasound, and these results were checked against the results of the subsequent surgery. The researchers found that two ultrasound patterns together could correctly identify the amount of cancer cells in the lymph nodes in 80% of cases. A balloon shape ultrasound pattern with or without loss of central echoes (where the lymph node has lost central echoes or still has some residual central echoes, but these are wandering toward the rim, giving an asymmetrical shape to the centre) was an indicator in up to 83% of cases of a large amount of cancer cells in the sentinel node. "This ultrasound pattern was a late sign, only occurring in cases of advanced metastasis," said Dr Voit. A pattern of peripheral perfusion (where small blood vessels start to surround the lymph node) was an early sign of a small number of cancer cells present. "The early signs are signs of first disruption of the normal lymph node architecture by an early stage metastasis. The most important one is peripheral perfusion, which shows angiogenesis (the formation of new blood vessels) is occurring," she explained. The researchers found that these two ultrasound patterns could predict overall survival. Estimates for overall survival after five years for patients with stage I/II is between 50-90% depending on the state of the tumour. Dr Voit found that 93% of patients with neither of these ultrasound patterns, 87% of patients with peripheral perfusion, and 56% of patients with balloon shapes with or without loss of central echoes, survived for at least five years; survival without cancer spreading to other parts of the body was 74%, 60% and 26% respectively. Dr Voit said: "For the first time we have established that ultrasound patterns can be used as criteria for diagnosing disease progression and tumour burden. Balloon shaped lymph nodes with or without loss of central echoes and peripheral perfusion are independent prognostic factors for survival." Discovering if cancer has spread to the lymph nodes is the most important factor influencing the prognosis and treatment of melanoma patients. Doctors usually cut out one or two key lymph nodes, called sentinel nodes, and use these as an indicator of whether or not the cancer has spread to the other lymph nodes. If the sentinel node is free of cancer, patients don't need to have more extensive lymph node removal. However, only 20% of patients who have a sentinel node biopsy have cancer that has spread there, and so the operation, which can be accompanied by side effects such as chronic swelling and seroma, is unnecessary for 80% of patients. Using ultrasound first to detect the presence or not of sentinel node metastases could be a non-invasive way of limiting the numbers of patients who require subsequent surgery or simply watchful follow-up care. Abstract no: 9303. Melanoma session, Wednesday 14.45 -17.00 hrs CEST (Hall 7) [1] ECCO 15 - ESMO 34 is the 15th congress of the European CanCer Organisation and the 34th congress of the European Society for Medical Oncology. Source: Emma Mason ECCO-the European CanCer Organisation |