BibTex RIS Kaynak Göster

Current Overview of The Diagnosis and Treatment of Lymphoedema

Yıl 2020, Sayı: 1, 14 - 22, 01.03.2020

Öz

Lymphoedema is a complex condition caused by the collection of protein-rich interstitial fluid in the cutaneous and subcutaneous tissue. Cosmetic changes in cutaneous tissue and the volumetric changes of the extremity affect the daily life and psychosocial state of the patient negatively and continue to progress if not treated. Lymphedema may be the result of primary or secondary causes. The most common type of anomaly in the primary lymphedema is the hypoplasic lymphatic vessel type. The most common type of secondary lymphoedema is parasites filariasis in developing countries, while in the developed countries lymphoedema is mostly seen after breast cancer surgery. There is no gold standard yet for the diagnosis, staging, and severity of lymphoedema. After taking the patient’s’ history and physical examination, technical ultrasonography is often used firstly in clinical practice. The first step in the treatment of lymphoedema is to bring the extremity close to normal size and prevent complications hence there is no cure in the treatment. Complete decongestive therapy is a 4-component therapy consisting of manual lymph drainage, compression therapy, remedial exercises, and skin care, and is used in lymphatic and related conditions. This treatment has 2 phases. Phase 1 is intense or decongestive treatment. In Phase 2, it is aimed to sustain the gains of phase one with pressure garments and night bandages. This period lasts for life. As a result, lymphedema can be an isolated picture or a systemic syndrome that is life-threatening. A multidisciplinary approach should be performed during diagnosis, treatment, and follow-up

Kaynakça

  • Zuther JE. Complete decongestive therapy. In: Zuther JE, Norton S, editors. Lymphedema Management: The Comprehensive Guide for Practitioners, 3rd ed. New York: Thieme; 2013. pp.128–63.
  • Executive Committee. The diagnosis and treatment of peripheral lymphedema: 2016 consensus document of the International Society of Lymphology. Lymphology 2016;49:170–84.
  • Rockson SG, Rivera KK. Estimating the population burden of lymphedema. Ann N Y Acad Sci 2008;1131:147–54. [CrossRef]
  • Alper S, Akalın E, Gündüz B. Lenfödem Tanı ve Tedavi: Lenfatik sistem anatomisi. İzmir: O’Tıp kitapevi, 2017:1–11.
  • Zuther JE. Anatomy. In: Zuther JE, Norton S, editors. Lymphedema Management: The Comprehensive Guide for Practitioners, 3rd ed. New York: Thieme; 2013. pp.2–27.
  • Suami H, Scaglioni MF. Anatomy of the Lymphatic System and the Lymphosome Concept with Reference to Lymphedema. Semin Plast Surg 2018;32:5–11. [CrossRef]
  • Guyton AC, Hall JE. Guyton ve Hall Tıbbi Fizyoloji: Güneş Tıp Kitabevleri, 2017.
  • Zuther JE. Physiology. In: Zuther JE, Norton S, editors. Lymphedema Management: The Comprehensive Guide for Practitioners, 3rd ed. New York: Thieme; 2013. pp.29–43.
  • Quéré I, Moffatt C. Care of children with lymphoedema: International lymphoedema framework; 2010. https://www.lympho.org/ portfolio/care-of-children-with-lymphoedema/
  • Rockson SG. Lymphedema. Am J Med 2001;110:288–95. [CrossRef]
  • Douglass J, Graves P, Gordon S. Self-Care for Management of Secondary Lymphedema: A Systematic Review. PLoS Negl Trop Dis 2016;10:e0004740. 10.1371/journal.pntd.000474
  • World Health Organization. Lymphatic filariasis: Epidemiology. http://www.who.int/lymphatic_filariasis/epidemiology/en/
  • Smile TD, Tendulkar R, Schwarz G, Arthur D, Grobmyer S, Valente S, et al. A review of treatment for breast cancer-related lymphedema. Am J Clin Oncol 2018;41:178–90. [CrossRef]
  • Nguyen TT, Hoskin TL, Habermann EB, Cheville AL, Boughey JC. Breast cancer-related lymphedema risk is related to multidisciplinary treatment and not surgery alone: results from a large cohort study. Annals of Surgical Oncology 2017;24:2972–80. [CrossRef]
  • Gebruers N, Verbelen H, De Vrieze T, Vos L, Devoogdt N, Fias L, Tjalma W. Current and future perspectives on the evaluation, prevention and conservative management of breast cancer related lymphoedema: A best practice guideline. Eur J Obstet Gynecol Reprod Biol 2017;216:245–53. [CrossRef]
  • Shaitelman SF, Chiang Y-J, Griffin KD, DeSnyder SM, Smith BD, Schaverien MV, et al. Radiation therapy targets and the risk of breast cancer-related lymphedema: a systematic review and network meta-analysis. Breast Cancer Res Treat 2017;162:201–15. [CrossRef]
  • Kilbreath SL, Refshauge KM, Beith JM, Ward LC, Ung OA, Dylke ES, et al. Risk factors for lymphoedema in women with breast cancer: A large prospective cohort. Breast (Edinburgh, Scotland) 2016;28:29– 36. [CrossRef]
  • Zhu W, Li D, Li X, Ren J, Chen W, Gu H, et al. Association between adjuvant docetaxel-based chemotherapy and breast cancer-related lymphedema. Anti-Cancer Drugs 2017;28:350–5. [CrossRef]
  • Swaroop MN, Ferguson CM, Horick NK, Skolny MN, Miller CL, Jammallo LS, et al. Impact of adjuvant taxane-based chemotherapy on development of breast cancer-related lymphedema: results from a large prospective cohort. Breast Cancer Res Treat 2015;151:393– 403. [CrossRef]
  • Hareyama H, Hada K, Goto K, Watanabe S, Hakoyama M, Oku K, et al. Prevalence, classification, and risk factors for postoperative lower extremity lymphedema in women with gynecologic malignancies: a retrospective study. Int J Gynecol Cancer 2015;25:751–7. [CrossRef]
  • Farrow W. Phlebolymphedema - a common underdiagnosed and undertreated problem in the wound care clinic. J Am Col Certif Wound Spec 2010;2:14–23. [CrossRef]
  • Jung SY, Shin KH, Kim M, Chung SH, Lee S, Kang HS, et al. Treatment factors affecting breast cancer-related lymphedema after systemic chemotherapy and radiotherapy in stage II/III breast cancer patients. Breast Cancer Res Treat 2014;148:91–8. [CrossRef]
  • Greene AK, Goss JA. Diagnosis and Staging of Lymphedema. Semin Plast Surg 2018;32:12–6. [CrossRef]
  • Johnson KC, Kennedy AG, Henry SM. Clinical measurements of lymphedema. Lymphat Res Biol 2014;12:216–21. [CrossRef]
  • Delialioğlu S. Lenfödemde klinik değerlendirme. İçinde: Alper S, Akalın E, Gündüz B, editörler. Lenfödem Tanı ve Tedavi: Lenfatik sistem anatomisi. İzmir: O’Tıp kitapevi 2017.
  • Qin ES, Bowen MJ, Chen WF. Diagnostic accuracy of bioimpedance spectroscopy in patients with lymphedema: A retrospective cohort analysis. J Plast Reconstr Aesthet Surg 2018;71:1041–50. [CrossRef]
  • Whitworth PW, Cooper A. Reducing chronic breast cancer‐related lymphedema utilizing a program of prospective surveillance with bioimpedance spectroscopy. Breast J 2018;24:62–5. [CrossRef] International Lymphoedema Framework. Best Practice for the Management of Lymphoedema 2006. Available from: https://www.lympho.org/portfolio/ best-practice-for-the-management-of-lymphoedema/
  • Sandel SL, Judge JO, Landry N, Faria L, Ouellette R, Majczak M. Dance and movement program improves quality-of-life measures in breast cancer survivors. Cancer Nurs 2005;28:301–9. [CrossRef]
  • Schaverien MV, Moeller JA, Cleveland SD. Nonoperative Treatment of Lymphedema. Semin Plast Surg 2018;32:17–21. [CrossRef]
  • Grushina TI. What physiotherapeutic method for the treatment of post-mastectomy lymphedema is the most effective? Vopr Kurortol Fizioter Lech Fiz Kult 2017;94:59–66. [CrossRef]
  • Poage EG, Rodrick JR, Wanchai A, Stewart BR, Cormier JN, Armer JM. Exploring the usefulness of botanicals as an adjunctive treatment for lymphedema: a systematic search and review. PM R 2015;7:296– 310. 10.1016/j.pmrj.2014.09.01
  • Gallagher K, Marulanda K, Gray S. Surgical Intervention for Lymphedema. Surg Oncol Clin North Am 2018;27:195–215. [CrossRef]
  • Soran A, Kamalı Polat A. Lenfödemde cerrahi tedavi. İçinde: Alper S, Akalın E, Gündüz B, editörler. Lenfödem Tanı ve Tedavi: Lenfatik sistem anatomisi. İzmir: O’Tıp kitapevi 2017. ss.155–63.

Lenfödem Tanı ve Tedavisine Güncel Bakış

Yıl 2020, Sayı: 1, 14 - 22, 01.03.2020

Öz

Lenfödem, cilt ve cilt altı dokuda proteinden zengin interstisyel sıvının birikmesi ile oluşan kompleks bir durumdur. Ekstremitedeki hacimsel ve cilt dokusundaki kozmetik değişiklikler hastanın günlük yaşamını ve psikososyal durumunu olumsuz etkilemektedir ve tedavi edilmez ise ilerlemeye devam etmektedir. Lenfödem, primer ya da sekonder nedenlere bağlı olabilir. Primer lenfödemde en sık görülen anomali tipi, hipoplazik tip lenf damarlarıdır. Sekonder lenfödemin en sık tipi, gelişmiş ülkelerde meme kanseri cerrahisi sonrası görülürken gelişmekte olan ülkelerde, parazitlerdir filaryazis . Lenfödemin tanısı, evrelendirilmesi ve şiddetinin ölçülmesinde henüz altın standart bulunmamaktadır. Öykü ve muayeneden sonra, klinik pratikte en sık kullanılan teknik ultrasonografidir. Lenfödem tedavisinin ilk basamağı ekstremiteyi normal ya da normale yakın boyuta ulaştırmak ve komplikasyonları önlemektir, çünkü tedavide kür yoktur. Komplet dekonjestif terapi, lenfödem ve ilişkili durumlarda kullanılan, manuel lenf drenajı, kompresyon tedavisi, remedeal egzersizler, cilt bakımından oluşan 4 bileşenli bir tedavidir. Bu tedavi 2 fazlı olarak yapılmaktadır. Faz 1 yoğun veya dekonjestif tedavidir. Faz 2 de ise bası giysileri ve gece bandajı ile faz 1 deki kazanımları sürdürebilmesi amaçlanır. Bu dönem ömür boyu devam eder. Sonuç olarak lenfödem, izole bir tablo veya hayatı tehdit eden sistemik bir sendrom olabilir. Tanı, tedavi ve takip aşamasında multidisipliner yaklaşılmalıdır

Kaynakça

  • Zuther JE. Complete decongestive therapy. In: Zuther JE, Norton S, editors. Lymphedema Management: The Comprehensive Guide for Practitioners, 3rd ed. New York: Thieme; 2013. pp.128–63.
  • Executive Committee. The diagnosis and treatment of peripheral lymphedema: 2016 consensus document of the International Society of Lymphology. Lymphology 2016;49:170–84.
  • Rockson SG, Rivera KK. Estimating the population burden of lymphedema. Ann N Y Acad Sci 2008;1131:147–54. [CrossRef]
  • Alper S, Akalın E, Gündüz B. Lenfödem Tanı ve Tedavi: Lenfatik sistem anatomisi. İzmir: O’Tıp kitapevi, 2017:1–11.
  • Zuther JE. Anatomy. In: Zuther JE, Norton S, editors. Lymphedema Management: The Comprehensive Guide for Practitioners, 3rd ed. New York: Thieme; 2013. pp.2–27.
  • Suami H, Scaglioni MF. Anatomy of the Lymphatic System and the Lymphosome Concept with Reference to Lymphedema. Semin Plast Surg 2018;32:5–11. [CrossRef]
  • Guyton AC, Hall JE. Guyton ve Hall Tıbbi Fizyoloji: Güneş Tıp Kitabevleri, 2017.
  • Zuther JE. Physiology. In: Zuther JE, Norton S, editors. Lymphedema Management: The Comprehensive Guide for Practitioners, 3rd ed. New York: Thieme; 2013. pp.29–43.
  • Quéré I, Moffatt C. Care of children with lymphoedema: International lymphoedema framework; 2010. https://www.lympho.org/ portfolio/care-of-children-with-lymphoedema/
  • Rockson SG. Lymphedema. Am J Med 2001;110:288–95. [CrossRef]
  • Douglass J, Graves P, Gordon S. Self-Care for Management of Secondary Lymphedema: A Systematic Review. PLoS Negl Trop Dis 2016;10:e0004740. 10.1371/journal.pntd.000474
  • World Health Organization. Lymphatic filariasis: Epidemiology. http://www.who.int/lymphatic_filariasis/epidemiology/en/
  • Smile TD, Tendulkar R, Schwarz G, Arthur D, Grobmyer S, Valente S, et al. A review of treatment for breast cancer-related lymphedema. Am J Clin Oncol 2018;41:178–90. [CrossRef]
  • Nguyen TT, Hoskin TL, Habermann EB, Cheville AL, Boughey JC. Breast cancer-related lymphedema risk is related to multidisciplinary treatment and not surgery alone: results from a large cohort study. Annals of Surgical Oncology 2017;24:2972–80. [CrossRef]
  • Gebruers N, Verbelen H, De Vrieze T, Vos L, Devoogdt N, Fias L, Tjalma W. Current and future perspectives on the evaluation, prevention and conservative management of breast cancer related lymphoedema: A best practice guideline. Eur J Obstet Gynecol Reprod Biol 2017;216:245–53. [CrossRef]
  • Shaitelman SF, Chiang Y-J, Griffin KD, DeSnyder SM, Smith BD, Schaverien MV, et al. Radiation therapy targets and the risk of breast cancer-related lymphedema: a systematic review and network meta-analysis. Breast Cancer Res Treat 2017;162:201–15. [CrossRef]
  • Kilbreath SL, Refshauge KM, Beith JM, Ward LC, Ung OA, Dylke ES, et al. Risk factors for lymphoedema in women with breast cancer: A large prospective cohort. Breast (Edinburgh, Scotland) 2016;28:29– 36. [CrossRef]
  • Zhu W, Li D, Li X, Ren J, Chen W, Gu H, et al. Association between adjuvant docetaxel-based chemotherapy and breast cancer-related lymphedema. Anti-Cancer Drugs 2017;28:350–5. [CrossRef]
  • Swaroop MN, Ferguson CM, Horick NK, Skolny MN, Miller CL, Jammallo LS, et al. Impact of adjuvant taxane-based chemotherapy on development of breast cancer-related lymphedema: results from a large prospective cohort. Breast Cancer Res Treat 2015;151:393– 403. [CrossRef]
  • Hareyama H, Hada K, Goto K, Watanabe S, Hakoyama M, Oku K, et al. Prevalence, classification, and risk factors for postoperative lower extremity lymphedema in women with gynecologic malignancies: a retrospective study. Int J Gynecol Cancer 2015;25:751–7. [CrossRef]
  • Farrow W. Phlebolymphedema - a common underdiagnosed and undertreated problem in the wound care clinic. J Am Col Certif Wound Spec 2010;2:14–23. [CrossRef]
  • Jung SY, Shin KH, Kim M, Chung SH, Lee S, Kang HS, et al. Treatment factors affecting breast cancer-related lymphedema after systemic chemotherapy and radiotherapy in stage II/III breast cancer patients. Breast Cancer Res Treat 2014;148:91–8. [CrossRef]
  • Greene AK, Goss JA. Diagnosis and Staging of Lymphedema. Semin Plast Surg 2018;32:12–6. [CrossRef]
  • Johnson KC, Kennedy AG, Henry SM. Clinical measurements of lymphedema. Lymphat Res Biol 2014;12:216–21. [CrossRef]
  • Delialioğlu S. Lenfödemde klinik değerlendirme. İçinde: Alper S, Akalın E, Gündüz B, editörler. Lenfödem Tanı ve Tedavi: Lenfatik sistem anatomisi. İzmir: O’Tıp kitapevi 2017.
  • Qin ES, Bowen MJ, Chen WF. Diagnostic accuracy of bioimpedance spectroscopy in patients with lymphedema: A retrospective cohort analysis. J Plast Reconstr Aesthet Surg 2018;71:1041–50. [CrossRef]
  • Whitworth PW, Cooper A. Reducing chronic breast cancer‐related lymphedema utilizing a program of prospective surveillance with bioimpedance spectroscopy. Breast J 2018;24:62–5. [CrossRef] International Lymphoedema Framework. Best Practice for the Management of Lymphoedema 2006. Available from: https://www.lympho.org/portfolio/ best-practice-for-the-management-of-lymphoedema/
  • Sandel SL, Judge JO, Landry N, Faria L, Ouellette R, Majczak M. Dance and movement program improves quality-of-life measures in breast cancer survivors. Cancer Nurs 2005;28:301–9. [CrossRef]
  • Schaverien MV, Moeller JA, Cleveland SD. Nonoperative Treatment of Lymphedema. Semin Plast Surg 2018;32:17–21. [CrossRef]
  • Grushina TI. What physiotherapeutic method for the treatment of post-mastectomy lymphedema is the most effective? Vopr Kurortol Fizioter Lech Fiz Kult 2017;94:59–66. [CrossRef]
  • Poage EG, Rodrick JR, Wanchai A, Stewart BR, Cormier JN, Armer JM. Exploring the usefulness of botanicals as an adjunctive treatment for lymphedema: a systematic search and review. PM R 2015;7:296– 310. 10.1016/j.pmrj.2014.09.01
  • Gallagher K, Marulanda K, Gray S. Surgical Intervention for Lymphedema. Surg Oncol Clin North Am 2018;27:195–215. [CrossRef]
  • Soran A, Kamalı Polat A. Lenfödemde cerrahi tedavi. İçinde: Alper S, Akalın E, Gündüz B, editörler. Lenfödem Tanı ve Tedavi: Lenfatik sistem anatomisi. İzmir: O’Tıp kitapevi 2017. ss.155–63.
Toplam 33 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Bölüm Collection
Yazarlar

Işıl Fazilet Turna

Yayımlanma Tarihi 1 Mart 2020
Yayımlandığı Sayı Yıl 2020Sayı: 1

Kaynak Göster

EndNote Turna IF (01 Mart 2020) Lenfödem Tanı ve Tedavisine Güncel Bakış. Acıbadem Üniversitesi Sağlık Bilimleri Dergisi 1 14–22.