Lymphedema care for the breast cancer patient: an integrative approach.

Lymphedema is a serious complication that involves the accumulation of protein-rich fluid in the interstitial space. Lymphedema is common after treatment for breast cancer, especially for those patients receiving axillary lymph node dissection. Severe lymphedema is associated with serious morbidities such as swelling, fibrosis, decreased function, reduced range of motion, infection, and pain.

Breast-cancer related lymphedema: a review of procedure-specific incidence rates, clinical assessment AIDS, treatment paradigms, and risk reduction.

With improved outcomes following treatment of breast cancer, chronic toxicities including breast cancer related lymphedema (BCRL), gain increased significance with limited evidence-based guidelines present. This review attempts to summarize data addressing these concerns and provides recommendations based on currently published data. Substantial differences exist in rates of BCRL reported in the literature ranging from less than 5% to 65% based on locoregional therapy.

Comparison of lymphedema in patients with axillary lymph node dissections to those with sentinel lymph node biopsy followed by immediate and delayed ALND.

Purpose: The purpose of the study was to show that delayed axillary lymph node dissection (ALND) has higher rates of lymphedema compared with immediate ALND, using data from NSABP-B32 at Beaumont Hospital.

Method: NSABP B-32 at Beaumont had 207 patients with follow-up data on 199 patients, randomizing clinically negative axilla to sentinel lymph node biopsy (SLNB)+ALND (GrA N=98), and SLNB+cytology±ALND (GrB N=101). All patients had preoperative volumetric arm measurements and only node negatives had routine postoperative measurements assessing lymphedema for 36 months.

Factors associated with the development of breast cancer-related lymphedema after whole-breast irradiation.

Purpose: To determine the rates of breast cancer-related lymphedema (BCRL) in patients undergoing whole-breast irradiation as part of breast-conserving therapy (BCT) and to identify clinical, pathologic, and treatment factors associated with its development.

Methods And Materials: A total of 1,861 patients with breast cancer were treated at William Beaumont Hospital with whole-breast irradiation as part of their BCT from January 1980 to February 2006, with 1,497 patients available for analysis. Determination of BCRL was based on clinical assessment.

Paucity of muscle metastasis in otherwise widely disseminated cancer: a conundrum.

Despite widespread dissemination of cancer to multiple organs, muscle metastasis remains a rare occurrence. Limiting factors in this regard include, among others, repetitive muscle contraction, increased lactic acid, and decreased pH as well as protease metabolism. With the approval of hospital's research committee, a 10-yr review of histopathologic and imaging studies of patients diagnosed as having muscle metastasis was attempted.

SVC syndrome with a patent SVC: treatment of internal jugular venous occlusion after surgical and radiation therapy of esophageal cancer.

A patient is described in whom recanalization and stent placement in an occluded internal jugular vein was performed for the treatment of refractory facial edema initially thought to be lymphedema. The authors describe the combination of venous obstructions leading to this clinical presentation, which they term "SVC syndrome with a patent SVC."

"Occult" roentgenographic osteoblastoma of the cervical spine.

A 33-yr-old man presented with a 4-yr history of neck pain. Previous work-ups, including planar radiographs and magnetic resonance imaging, were determined as "normal" by six previous consultants. In a subsequent in-office evaluation by a physiatrist, a vertebral osteoid osteoma or carotid artery angiitis was clinically suspected.