DAVID GREENE, HOST:
All right, now more on a disease that maybe you've never heard of. It's called lymphedema. It can occur whenever lymph nodes are removed to stop the spread of cancer, and it's most common among breast cancer patients. NPR's Patti Neighmond reports on two procedures that can treat and maybe even prevent the problem.
PATTI NEIGHMOND, BYLINE: At Memorial Sloan Kettering Cancer Center in New York City, surgeon Joseph Dayan says every week, he sees patients who've survived breast cancer but break down in tears in his office.
JOSEPH DAYAN: And they're crying not only because they struggle with lymphedema but because many people, including some doctors, do not recognize this as a debilitating condition.
NEIGHMOND: When lymph nodes are removed as part of some cancer treatments, the normal function of the body's lymph node system is damaged, raising the risk of infection.
DAYAN: It really acts as the sewage system of the body.
NEIGHMOND: And when the system's compromised, fluid can build up in areas where lymph nodes used to be.
DAYAN: It's a disease that is permanent, that's marked by permanent swelling, the need for wrapping and compressing the limb, and daily care that has a tremendous impact and burden on a patient's quality of life.
NEIGHMOND: Three years ago when Virginia Harrod had a double mastectomy, surgeons also removed 16 lymph nodes. A county prosecutor in Kentucky, Harrod returned to work just 10 days after her surgery. Everything seemed fine for nearly a year, until suddenly, one day...
VIRGINIA HARROD: I thought I had the hives. My right arm started itching terribly, and these bizarre, little red blisters were forming that I thought were hives. Fortunately, I was at the oncologist for a follow-up, and that's when the oncologist told me I had cellulitis.
NEIGHMOND: A bacterial infection that could be life-threatening. Harrod was then diagnosed with lymphedema. She didn't have the painful, swollen arm that often comes with the condition, but her infection-fighting system was impaired. She ended up in the hospital two more times with dangerous infections. So when she heard Dr. Joseph Dayan was transplanting healthy lymph nodes into areas where they'd been removed...
HARROD: I'm in. Yes.
NEIGHMOND: She traveled to New York to Memorial Sloan Kettering, where Dr. Dayan transplanted two clusters of nodes from her abdomen into her armpit and forearm.
HARROD: It has been amazing. It's like I'd never, ever had a problem with lymphedema.
NEIGHMOND: Lymph node transplants aren't new, but Dayan says advances in imaging now help him pinpoint which nodes are best to transplant.
DAYAN: You can actually see the lymphatic system itself. It's a delicate, beautiful network of vessels, and it's like an angiogram for the heart. You can see any disease, any scarring of the lymphatics.
NEIGHMOND: And the new imaging can show a damaged system in patients like Virginia Harrod who don't have obvious symptoms.
SHELDON MARC FELDMAN: This is what you have to be super careful about...
NEIGHMOND: At Montefiore Health System in New York, surgeon Sheldon Marc Feldman is performing another type of surgery. This one's aimed at preventing lymphedema in the first place.
FELDMAN: Good. Good news.
NEIGHMOND: When Feldman removes the nodes, instead of tying off the lymphatic blood vessels, he reconnects them to a vein in the arm to preserve as much of the body's natural drainage system as possible.
FELDMAN: So their risk of lymphedema is dramatically reduced. It's - you know, it doesn't make it zero, but it definitely dramatically reduces it. So in my study, you know, there was a 4 percent incidence of lymphedema as opposed to 30-40 percent in the group that didn't have it.
NEIGHMOND: Forty-nine-year-old Luana DeAngelis is a breast cancer survivor who runs a foundation helping others. She'd worked with Feldman and knew about his study, so when her cancer recurred, she knew what to do.
LUANA DEANGELIS: I knew if he was going in to remove a lot more lymph nodes, I had a very high risk of lymphedema. And I said to him, please, if you need to go in and take a lot out, let's talk about this lymphovenous bypass.
NEIGHMOND: DeAngelis had 22 lymph nodes removed and, so far, no trace of lymphedema. Feldman says in the future, removing any lymph nodes may not be necessary. Science has evolved so that now a needle biopsy can tell doctors just how aggressive the cancer is and whether it's likely to spread. Both procedures - the transplant and the bypass - are only performed at a handful of medical centers, and insurance may not cover the cost. But Feldman hopes that one day, they'll be more available, dramatically reducing a cancer patient's risk of lymphedema. Patti Neighmond, NPR News.
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