CANCER AWARE LYMPHEDEMA AWARE WHAT IS THE LYMPHATIC

CANCER AWARE LYMPHEDEMA AWARE

WHAT IS THE LYMPHATIC SYSTEM? • The lymphatic system is part of the immune system. • The main components are • Lymph vessels • Lymph nodes • Thoracic duct • Other lymphatic tissues • The job of the lymphatic system is: • Fight infection • Produces white blood cells • Attacks unknown cells • Manage lymphatic fluid • Cleans • Filters • Returns

THE LYMPHATIC SYSTEM WORKS IN CONCERT WITH THE CIRCULATORY SYSTEM • The circulatory system delivers oxygenated blood and nutrients to the body through the arteries. • The veins pick up de-oxygenated blood and debris and returning to the heart to begin the cycle once more. • The lymphatic system interacts with the circulatory system by picking up any left over debris in the interstitial space that the circulatory system could ntot pick up. • This debris is filtered through lymph nodes before being returned to the subclavian veins for return to the circulatory system.

THE LYMPHATIC SYSTEM IS TOWARDS THE SKIN SURFACE • The lymphatic system lies just below the skin’s surface (superficial to the skin layer). • The circulatory system lies deeper. Skin, Lymphatic System Circulatory System • How is this familiar with Levels of Touch? Light, Level 1 Touch, Lotion application, Lymphatic System Medium, Level 2 Touch

LYMPHATIC COLLECTION CENTERS • Neck Nodes • Axilla Nodes • Inguinal Nodes

WATERSHEDS • Watershed boundaries are imaginary lines that divide the body into five regions. • Lymphatic fluid (water) flows only within its watershed. • Lymph nodes are generally towards the front of the body (shown in the diagram facing forward) BUT watershed boundaries divide the entire body.

WATERSHEDS • When the lymphatic system is working properly, lymphatic fluid is easily cleaned, filtered, and removed. • In an UN-affected system, massage strokes can be in ANY direction. • Remember Site, Pressure, Position? Pressure includes • Direction of stroke – • ANY or ONE WAY In an Un-affected lymphatic system massage strokes can be in ANY direction

WHAT IS LYMPHEDEMA? • Lymphedema is the accumulation of protein-rich fluid in the interstitial space due to a compromise in the lymphatic system. • Lymphedema usually affects the extremities, but it can occur in the trunk, breasts, head, and neck. • There are two types of lymphedema • Primary lymphedema • Secondary lymphedema • Lymphedema cannot be cured. It is a LIFELONG condition that affects quality-of-life.

SIGNS AND SYMPTOMS OF LYMPHEDEMA • Slow onset, progressive • Pitting edema • Usually starts distally (fingers/toes) • Cellulitis is common • Rarely painful • Discomfort (heaviness/achiness) • Skin feels tight • Decreased flexibility in the joint of the affected side • Difficulty fitting into clothing • Jewelery feels tight • Skin changes (thickening/fibrosis) Signs and symptoms will ONLY appear in the AFFECTED side The side where lymph nodes have been removed!

LYMPHEDEMA TREATMENT • Lymphedema treatment includes complete decongestive therapy • Bandaging • Manual lymph drainage • Lifestyle education • Meticulous skin care • Exercise

WATERSHEDS • When lymph nodes have been removed, the system is compromised or affected. • In an affected system, massage strokes must go in ONE direction. In an affected lymphatic system massage strokes must go in ONE direction. TOWARDS WORKING LYMPH NODES Strokes should CROSS the watershed boundary (every 3 rd to 5 th stroke) from the affected side to the un-affected side.

HANDS ON ACTIVITY POSITION YOUR FOCUS: SITE, PRESSURE, • Diagraming on an actual body • Use felt circles • Use masking tape • Use arrows

TRAFFIC JAM ACTIVITYPOSITION YOUR FOCUS: SITE, PRESSURE, • Complete activity • What did you learn? • Did that help explain what happens when fluid backs up? This activity demonstrates working PROXIMAL TO DISTAL

3 PRINCIPLES OF MASSAGE FOR PRESSURE, CLIENT AT-RISK OF LYMPHEDEMA YOUR FOCUS: SITE, POSITION Direction • Towards the working lymph nodes • Proximal to distal on extremities • Lateral to medial on the back Pressure • Light-medium pressure (Level 2) • No Deep Tissue in affected area Time • Less Time • Last – massage last

CONNECTION BETWEEN LYMPHEDEMA AND CANCER • Lymphedema develops in people with a history of cancer due to lymph node trauma. • Lymph node removal (doesn’t matter how few or many nodes are removed) • Lymph node biopsy, including needle biopsy • Radiation to the lymph nodes • Any other damage to the lymph nodes • Lymph nodes are often removed or biopsied to determine whether cancer has spread. • Cancer that has spread to the lymph nodes often determines the stage of cancer and the course of treatment doctors will recommend. • Once lymph nodes are removed, radiated, or damage, that individual becomes AT-RISK of lymphedema for the remainder of their lives.

DIFFERENCE BETWEEN LYMPHEDEMA AND LYMPHOMA • Lymphedema is the accumulation of protein-rich fluid in the interstitial space due to trauma or removal to lymph nodes. • It is a life-long condition. • Lymphedema will ONLY occur in the area where lymph nodes have been removed. • Lymphoma is cancer of the lymph system. • It is characterized by painless swelling of lymph nodes in neck, armpit, or groin. • Swelling (edema) can be BILATERAL Lymphede ma Lymphoma

DIFFERENCE BETWEEN LYMPHEDEMA AND LYMPHOMA Lymphedema • Lymphedema as a result of radiation to the neck • Lymphatic fluid is backing up into this gentleman’s face Lymphoma • The lymph nodes are enlarged due to cancer in the lymph system • Only the nodes are enlarged – no back-up into the face

CELLULITIS • This is cellulitis from a bug bite. • The bug bite lead to an infection, which lead to cellulitis. • How can insect bites or infections lead to lymphedema?

Questions? Break

SCENARIO #1 Client diagnosed with breast cancer • Single mastectomy on the right with lymph node dissection 9 months ago • Chemotherapy 6 rounds, finished 2 months ago • Not currently taking any medications Impact on Massage Site Pressure Position

SCENARIO #2 Client diagnosed with colorectal cancer • Surgery 4 months ago • Finished radiation 1 month ago • Not currently taking any medications Impact on Massage Site Pressure Position

Questions? Break – quick! Come back in teams of 2 with 1 person ON THE TABLE