Greater Manchester Cancer Lymphoedema in Cancer Karen Livingstone

Greater Manchester Cancer Lymphoedema in Cancer Karen Livingstone Macmillan Clinical lead K. livingstone 2@nhs. net Macmillan GMC Lymphoedema Programme

Greater Manchester Cancer What is Lymphoedema? Lymphoedema is the build up of excess protein-rich fluid in body tissues due to lymphatic insufficiency or obstruction of lymphatic drainage back into the blood stream(1) Lymphoedema may affect 1 or more limbs and corresponding quadrants of the trunk, face, breast and genitals. Lymphoedema of more than 3 months and is essentially incurable. Affects 6. 4 in every 1000(2) population Primary from birth or congenital Secondary which occurs as a result of an external event or trauma to the lymphatic system

Greater Manchester Cancer Role of the lymphatic system • Integral to the immune system • Defence mechanism against bacteria and mutant cells • Drains and transports ‘waste materials’ from interstitial tissues to the blood stream, including cell products such as protein water and fat

Greater Manchester Cancer Incidence of Lymphoedema in Cancer 25% Breast - 80% in first 3 years 30% Gynaecology 40% Urology 75% Head and Neck 31% Melanoma (3)

Greater Manchester Cancer Causes of Cancer-related Lymphoedema Cancer and treatment Site and stage of tumour Surgery – lymph node removal complex scarring, seroma, infection Chemotherapy Radiotherapy ? Genetic component

Greater Manchester Cancer Comorbitities • • • Obesity Venous disease Age Previous cellulitis Immobility http: //wales. gov. uk

Greater Manchester Cancer Development of lymphoedema • Initially slight • Feeling of tension, heaviness, tightness • Observable swelling • Tissues soft and pitting • Uneven distribution • Limb or root of limb, face and trunk • Inflammation • Worse as day progresses or after activity unless H&N Courtesy MFT

Greater Manchester Cancer Treatments Supported self management Specialist intervention Skin Care Exercise Assessment Education Support Simple Lymph Drainage Compression Courtesy MFT

Greater Manchester Cancer Infection - cellulitis • More common following trauma to lymphatics • Important to catch it early to prevent further damage to drainage routes ? ? Refer to Lymphoedema services Signs and Symptoms Area becomes red, hot, increased swelling, increased tenderness. May be accompanied by flu-like symptoms, fever, headache or vomiting Same day antibiotics are required

Greater Manchester Cancer Safe to Exercise after cancer treatment ? Yes Evidence shows physical exercise and resistance training do not increase the risk of developing lymphedema (4) BUT -Think lymphatics ! Recurrent seroma? Wounds? Cellulitis? Start low level exercise as advised Slow progressive increase after treatment

Greater Manchester Cancer Safe to Exercise? • Ideally working proximately to distally, combination of stretches, aerobic and strengthening exs • Progressive time/intensity • No maximum weights limit as long introduced slowly & patient is free of symptoms • Feed back from the limb – ‘what exercise it likes and what it doesn’t’(5) • Compression garments must be worn when exercising if prescribed

Greater Manchester Cancer Could there be symptoms of lymphoedema? Rule out DVT or infection If lymphoedema suspected refer to CNS, Oncology team, GP Early intervention is key - REFER IT! Encourage skin care, and encourage pt to elevate Adapt exercise and treatment regimes

Greater Manchester Cancer GM Lymphoedema Services

Greater Manchester Cancer Directory of GM Lymphoedema Services

Greater Manchester Cancer Finally ‘Its just a bit of swelling…………’ Please don’t ignore it. Remember early intervention is vital. Poor service in your area? You can help

References 1. International Society of Lymphology. The diagnosis and treatment of peripheral lymphoedema: 2013 Consensus Document of the International Society of Lymphology. 2013: 46(1): 1 -11 2. Welsh Assembly Government (2009) Strategy for Lymphoedema in Wales: Designed for Lymphoedema. Available at http: //gov. wales/docs/dhss/publications/091208/lymphoedemastrategyforwales. pdf 3 Commissioning Guidance for Lymphoedema Services for Adults in the United Kingdom. The National Lymphoedema Partnership March 2019 4. Rehabilitation of Cancer Survivors with Long-Term Toxicities Oncol Res Treat. 2017; 40(12): 764 -771. doi: 10. 1159/000485187. Epub 2017 Nov 29. 5. Lets Talk Lymphoedema. Mortimer and Lavine 2017. ISBN: 978 -1 -78396 -285 -3. Elliott and Thompson Ltd. Wwweandtbooks. com