Researchers Closer to Identifying Criteria for Early Detection of Lymphoedema Among High Risk Groups

March 25, 2012 - PRLog -- Researchers from the University of Sydney, University of Queensland, and Royal North Shore Hospital today announced they are conducting the largest known study of its kind into early clinical detection of lymphoedema, a disorder that affects up to 30% of those undergoing treatment for some cancers.

Professor Sharon Kilbreath, a member of the Australasian Lymphology Association and a National Breast Cancer Research Foundation Research Fellow said, “Our research is examining the relationship between the clinical measures of lymphoedema and the underlying lymphatic function and anatomical changes among women treated for breast cancer with the aim of identifying a means of early clinical detection of the disorder among high risk groups.”

Secondary lymphoedema, a feared consequence of the surgery and treatment for cancer, is a chronic condition in which the limb swells and changes to the limb composition occur.  Those most at-risk in Australia are patients being treated for cancer in which the lymph nodes are removed or damaged during treatment and a life threatening illness can be replaced with a life-long, painful and debilitating condition.  

However, if diagnosed and treated early, this distressing and debilitating swelling can be controlled and reduced, infection prevented, the range of movement of the affected area can be improved, and the quality of life for people with the disorder can be greatly enhanced.

According to The National Breast and Ovarian Cancer Centre (NBOCC- now Cancer Australia),  following a review of research on Secondary Lymphoedema, a conservative estimate of the incidences of survivors experiencing the disorder varies depending on cancer type and treatment but the incidence after treatment for breast cancer is accepted to be up to 1 in 5 (1).  These statistics substantiate how vitally important it is for people in high risk groups to learn and recognise the symptoms and seek early diagnosis and treatment by an ALA accredited practitioner (2).

67 volunteers with lymphoedema and 16 without a history of lymphoedema or treatment for cancer have so far participated in the study which is being undertaken at Royal North Shore Hospital, Sydney, Castlereagh Imaging and University of Queensland.

“There are several clinical methods by which lymphoedema can be diagnosed and monitored including changes in limb size and amount of extracellular fluid present in the limb, as well as sensations experienced by the woman,” said Professor  Kilbreath.

“To date, these indirect clinical measures used to assess and monitor lymphoedema have not been related to those of the direct measures of lymphatic function or to underlying anatomical changes.  

“Women participating in the research undergo clinical assessments including arm circumference measures and measurement of extracellular fluid with bioimpedance spectroscopy and complete questionnaires.  

“These findings are compared to those from lymphoscintigraphy in which a small amount of nuclear isotope is injected into the back of the hand to visualise the lymphatic pathway and to dexa and MRI scans which provide indication of anatomical changes in limb composition ,” said Professor Kilbreath.

The results of this study will enable us to identify what are the criteria for detection of onset of lympheodema, thereby enabling  treatment to be started as soon as possible to minimise the development of the disorder.  

In addition, we will be able to identify what are the underlying changes that occur with different levels of severity and which may require different clinical approaches.  

This project is the first study in which all of these relationships are explored and is supported from a grant from Cancer Australia and National Breast Cancer Foundation.  

To date, lymphoedema has not been widely researched and its incidence is often under reported due to missed diagnosis, and variations in definition and methods of measurement.  

Penelope Sanderson, President of the Australasian Lymphology Association said, “The work being conducted by Professor Kilbreath and her colleagues will help minimise the physical and emotional damage caused to sufferers of lymphoedema because their condition will be diagnosed and treated in the early stages to minimise its development.  

“Until we have a means of screening for lymphoedema,  it is essential that high risk groups, including survivors of breast, gynaecological, prostate and melanoma cancers,  learn the symptoms of lymphoedema and seek early diagnosis and treatment,” Ms Sanderson said.

Early signs and symptoms of lymphoedema can be intermittent and may include:
•   transient swelling of a limb or other region of the body
•   infection (due to lymph stasis) is often the first sign of a problem
•   feelings of aching, heaviness, stiffness in the affected body part
•   limitation of movement
•   tightness or temperature changes to areas of the body
•   clothing, jewellery or shoes may feel tighter
•   swelling may be aggravated by heat, overuse, sustained positions and prolonged inactivity and be more obvious at the end of the day

For information about the early signs and symptoms of lymphoedema, to learn if you are at risk or to locate an accredited lymphoedema therapist, please visit http://www.lymphology.asn.au

If you are interested in participating in the study (people with and without lymphoedema) please contact The Breast Cancer Research Group at (02) 9036 7309 or visit our website:
http://sydney.edu.au/health_sciences/clinical_rehabilitat...

ENDS

REFERENCES
1 Girgis, A.Stacey, F. Lee, T. Black, D. Kilbreath, S. (2011). Priorities for women with lymphoedema after treatment for breast cancer: population based cohort study. British Medical Journal. 342
2 National Breast and Ovarian Cancer Centre. Review of research evidence on secondary lymphoedema: Incidence, prevention, risk factors and treatment, NBOCC, Surry Hills, NSW, 2008

NOTES
Lymphoedema, a progressive chronic disorder of the lymphatic system, occurs when the lymphatic circulation fails to function correctly, causing severe, painful and debilitating swelling where early diagnosis and specialised management by an ALA accredited practitioner is the primary effective treatment.  Lymphoedema usually affects the limb(s) and can affect the trunk of the body, breast, head, neck or the genital area.
There is no cure,it affects people of all ages and if not treated early, the onset of can lead to regular hospitalisation due to infection and have devastating, ongoing effects on both the physical and emotional wellbeing of patients. Only early diagnosis and treatment by an accredited practitioner can reduce the progression, minimise its impact, limit complications, reduce doctor visits and hospital admissions,  and  importantly, minimises the affect the disorder has on the physical and emotional well-being of patients.

There are multiple causes including a genetic predisposition, any major damage to the lymphatic system which can range from 24-66% depending on the cancer and treatment.  

Professor Sharon Kilbreath - National Breast Cancer Foundation Research Fellow, Breast Cancer Research Group, Faculty of Health Sciences, University of Sydney
Sharon Kilbreath is a Professor in Physiotherapy, Faculty of Health Sciences at the University of Sydney and a National Breast Cancer Research Foundation Research Fellow.  She received her physiotherapy undergraduate and master’s degrees in Canada, whilst her PhD degree in neurophysiology was conferred from the University of New South Wales. Dr Kilbreath’s research focuses on issues arising from treatment for breast cancer. She leads a team of senior researchers, clinicians and several postdoctoral students in projects that aim firstly to prevent physical morbidities from occurring as result from treatment of breast cancer and secondly to diagnose and treat lymphoedema, one of the major complications of treatment.

# # #

The Australasian Lymphology Association (ALA) is the peak professional organisation promoting best practice in lymphoedema management, research and education in Australia and is committed to promoting the development of lymphology in Australasia.
Our vision is to make a difference in all aspects of lymphology. We strive to improve the management of those with, or at risk of developing lymphoedema and enhance communication between health professionals, educators, relevant authorities and government in regard to oedemas and lymphoedema.
The ALA is a public company limited by guarantee and registered as a health promotion organisation with charitable tax deductibility status. For information about managing lymphoedema or for more information about the ALA, please visit www.lymphology.asn.au

Donations can be made at http://www.mycause.com.au/mycause/raise_money/event.php?i...