LymphLink Question Corner - Archive from October 1998
Saskia R.J. Thiadens, R.N.
Q: How long would you wait after radiation to begin MLD?
A: Don't wait until after radiation if the patient has apparent lymphedema. My opinion is that the sooner therapy is instituted the better the chance the patient has for long term control and prevention of recurrence. To my knowledge, there is no proof of "mechanical dissemination" of cancer creating metastases such as by MLD.
Q: Any suggestions for preserving the already compromised lymphatic return in a mastectomy patient after node re-sec--tion who is about to undergo radiation of the clavicular area?
A: Yes, in these patients I try and spare from radiating the skin across the top of the shoulder, as there is collateral lymphatic drainage through this region in many patients. In addition, unless absolutely indicated, I avoid irradiating the full axilla, but only include the axillary apex in the clavicular field. The main indication for full axillary radiation post-mastectomy would be known gross residual disease in the axilla.
Q: Is the edema at the inferior/posterior axilla seen post-lumpectomy/mastectomy typical post-surgical swelling or, indeed, lymphedema which might benefit from MLD?
A: I believe this represents lymphedema as posterior thoracic lymphatics from about the umbilicus upwards drain into the axilla. I suspect this would respond to MLD.
Q: What creams do you recommend for the skin during radiation?
A: I generally recommend applying clear aloe vera gel preventively during radiation. If a first degree burn develops, I generally recommend applying Aquaphor. For a second degree burn, I usually recommend Xeroform or Silvadene. I also have low threshold for prescribing an anti-strep and staph antibiotic, once a second degree burn occurs, particularly if there is visible breast lymphedema. Once radiation is complete and the skin has healed, I recommend moisturizing on a daily basis.
Q: Can you give us the name of the journal article from Germany referred to last year and any other references relating lymph node surgery and status to lymphedema?
A: The German article is Schunemann et al, Dtsch. Med Wschr 1997; 122:536-541. Warning, article is in German! With respect to other references, there are too many to list here. However, there is a supplement being published to the journal, "Cancer," this fall, which is dedicated to the topic of breast cancer and lymphedema. This should be a good resource to answer your question.
Q: Can you continue MLD during radiation as long as the skin is okay?
A: Yes, MLD should continue unless there is moist desquamation (2nd degree burn) in the axillary fold or supra-clavicular region.
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