New approaches may cut lymphedema risk after breast ca therapy.(Partial Breast Irradiation)

MONTREAL -- The risk of developing lymphedema is significant in all women who've had breast cancer treatment, but too often oncologists give it little consideration, specialists said at a meeting sponsored by the World Federation for Ultrasound in Medicine and Biology.

Reducing cancer mortality is the oncologist's primary goal--as it should be--but this does not preclude the need to take greater care to reduce treatment morbidity, two oncologists advised.

"Both surgery and radiation are important contributors to the risk of lymphedema. We can avoid some of this risk with new approaches to our treatments," suggested Dr. Christine Lambert, a radiation oncologist at McGill University, Montreal.

Untreated, lymphedema can bloat body parts up to three times their normal size, causing pain and producing huge skin folds and elephantiasis. It can also cause permanent skin changes and cellulitis, and in severe cases it can lead to lymphangiosarcoma, a rare form of cancer.

Although all cancer treatments raise the risk of lymphedema, breast cancer treatments are the most commonly associated with the condition because of the need to treat axillary nodes with either surgery or radiotherapy. Both axillary node dissection and radiation therapy for breast cancer increase the risk of lymphedema by directly destroying lymph nodes and vessels and creating scar tissue.

"Radiation leads to fibrosis, which constricts lymph vessels and interrupts the lymphatic flow, causing lymphedema," Dr. Lambert said at the meeting, also sponsored by the American Institute of Ultrasound in Medicine.

Whereas surgery alone increases the risk of ...