Edema and cancer
Edema, commonly referred to as fluid retention, occurs when excess fluid accumulates in body tissues, leading to noticeable swelling. In the context of cancer, edema can manifest as lymphedema, particularly following surgeries that involve the removal of lymph nodes, such as those for breast, colon, or other cancers. This condition can significantly impact a patient's mobility, comfort, and overall quality of life. Risk factors for developing edema include not only cancer treatment but also conditions such as heart failure, kidney disease, and certain medications, especially chemotherapy agents that may disrupt normal fluid balance.
Symptoms typically involve swelling of the limbs, and diagnosis may involve measuring limb circumference or employing imaging techniques to assess lymphatic function. Management strategies for edema encompass dietary changes, such as reducing salt intake, alongside supportive therapies like compression garments, elevation of limbs, and physical therapy. In more advanced cases, pharmacological treatments with diuretics or surgical options like lymphovenous bypass may be considered. Understanding the multifaceted nature of edema in cancer patients is crucial for improving their treatment outcomes and enhancing their quality of life.
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Subject Terms
Edema and cancer
ALSO KNOWN AS: Lymphedema, fluid retention
RELATED CONDITIONS: Cancers of the breast, colon, ovary, uterus, and testicles
DEFINITION: Edema, known as fluid retention, results from the accumulation of fluid in certain tissues, leading to swelling. In lymphedema, lymph (a fluid containing a high amount of lymphocytes or white blood cells) accumulates in tissues because the excess fluid and proteins cannot be returned to circulation. Edema can result in decreased mobility of the affected limb, pain, risk of infection, and poorer quality of life.
Risk factors: The main risk factor for edema is surgery for cancers in which removal of the primary tumor may lead to removal of nearby lymph nodes. Other risk factors for edema include heart failure, kidney and liver disease, thyroid disorders, blood clots, certain medications, and poor nutrition.
Etiology and the disease process: Cancer-related edema is caused directly by the cancer or is a result of treatment. In some cases, cancer cells may build up in the neighboring lymph nodes, blocking the flow of the lymphatic fluid. Cancer patients may also have poor nutritional intake, in part because of loss of appetite and metabolic disorders, and their bodies may not have sufficient amounts of protein to function normally. If the kidneys are impaired, they cannot properly rid the body of salt through the urine. This leads to an increased amount of salt in the body, causing water to be retained and leading to edema.
Edema can also be the result of the drugs that cancer patients receive. Chemotherapy drugs associated with an increased risk of edema include cyclosporine, docetaxel, gemcitabine, imatinib, and thalidomide. Additional anticancer agents known to cause edema include corticosteroids, anabolic steroids, progestins, and nonsteroidal anti-inflammatory agents. In addition, some treatments may directly affect the lymphatic system. For example, in breast cancer patients, the neighboring axillary lymph nodes may be affected either by targeted radiation therapy or surgical removal (known as node dissection). Disrupting the lymphatic system is a cause of lymphedema.
Incidence: Edema in the arm is a common side effect in breast cancer patients, especially if they have received radiation therapy or had a lymph node removed. The reported incidence depends on the type of breast cancer therapy administered and the time since treatment. Based on an analysis of multiple studies in which women received a variety of surgical procedures and adjuvant therapies, it is estimated that 20 percent of women may develop arm breast cancer-related edema after treatment for breast cancer. Moreover, the frequency of lymphedema rises over time since treatment.
Symptoms: The symptom of edema is swelling of the limbs.
Screening and diagnosis: Edema may be diagnosed by measuring limbs; a difference of more than 2 centimeters between the circumference of the normal and affected limbs would indicate edema. Bioelectrical impedance (to quantify the fluid accumulation) and lymphoscintigraphy (to visualize the lymphatic system) may also be used.
Treatment and therapy: Treatment for edema can be broken down into three categories: diet, supportive therapy, and pharmacological therapy.
Reducing the amount of dietary salt consumed may help to manage edema. Patients should avoid foods that are high in salt or sodium, including canned soups, canned or processed meats, prepared mixes and foods (including frozen dinners and fast foods), snack foods (pretzels, potato chips, olives, cheeses, pickles), and high-salt seasonings (bouillon cubes, seasoned salts, soy sauce, Worcestershire sauce, and premixed spice packets).
Supportive therapies are also important in treating edema. Elevating affected limbs above the heart may help reduce swelling. Other strategies include wearing elastic compression stockings or sleeves, which help to return the excess fluid into the circulation. Massage, compression pumps, and specialized physical therapy and exercise regimens may also be effective. Less frequently used methods include electrically stimulated lymphatic drainage (such as uniform or sequential compression with either pneumatic or hydrostatic pressure devices) and surgery (such as surgical excision of the affected area, insertion of a lymphatic-venous shunt, or liposuction).
Diuretics are a commonly prescribed medication to reduce edema since they inhibit the ability of the kidneys to reabsorb and retain salt, leading to the elimination of more salt and water in the urine. Loop diuretics, named because they target the loop of Henle within the kidney tubules, include furosemide (Lasix), torsemide (Demedex), and butethamide (Bumex). Thiazide diuretics may also be used, but they may cause potassium to be excreted in the urine. Potassium-sparing diuretics include spironolactone (Aldactone), triamterene (Dyrenium), and amiloride (Midamor).
In the twenty-first century, surgical advances have emerged as an effective treatment for edema related to cancer. Lymphovenous bypass creates new pathways for the flow of lymph fluid. Vascularized lymph node transfer replaces damaged lymph nodes with healthy ones from other areas of the body. Liposuction can remove large areas of fat that develop in areas of lymphedema, alleviating some symptoms. Decongestive lymphatic therapy is a non-invasive treatment for lymphedema that integrates various treatment options, such as massage, compression, exercise, and skin care.
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