Lymphedema

This NYT article talks about a recent study on cancer treatment. Specifically, the research found that, for a significant portion of women with breast cancer, having surgery to remove cancerous lymph nodes is not necessary.

Let me back up and explain for just a second. When it comes to cancer, there are three main types of treatment: radiation, chemotherapy and surgery. Radiation is radiation, chemotherapy is drugs, and surgery can include both removing the tumor (such as through a lumpectomy or a mastectomy) and removing the cancerous lymph nodes.

But let’s back up even more. The lymph system is often thought of as the body’s sewage system – it filters out cellular debris, foreign particles and other waste. Most of the action happens at lymph nodes, which are spread throughout the body but are also found in clusters at the neck, axillary (armpit), and inguinal area. In cases such as breast cancer or head and neck cancer, where the cancer cells are close to one of these clusters, the lymph nodes themselves sometimes become cancerous.

Cancerous tumors, cancerous lymph nodes. Logic would say that the best thing to do is to surgically remove this infected tissue – that’s the surefire way to get rid of as much of the cancer as possible. And indeed, that’s the widely accepted treatment. But this new study says that for a significant portion of early breast cancer patients, removing cancerous lymph nodes (along with the typical radiation and chemotherapy treatment) is no more effective than just undergoing radiation and chemo. Why? Because these procedures wipe out the cancer in the lymph nodes all on their own. No surgery needed.

Well, that’s great, but what on earth does it have to do with massage?

Lymph nodes are important. They filter out waste, clean our bodies. One risk of having lymph nodes removed is that the lymph system will get backed up, with too much fluid to filter and not enough nodes to do the filtering. The limb (for breast cancer patients, this would be the arm on the affected side) will swell up with lymph fluid. Proteins molecules in the lymph might cause nearby tissue to harden, and the stagnant fluid will increase the risk of infection. This is called lymphedema, and it’s a chronic, sometimes debilitating, condition that requires lifelong management.

Damaged lymph nodes will put you at risk for lymphedema, but what actually causes it? That depends. First of all, there’s no real logic behind who gets lymphedema or when. There’s no window of risk that closes after a certain time post-surgery; someone with damaged or removed lymph nodes will always have an increased risk. Any sort of high stress – especially the physical kind – that causes inflammation in the muscle tissues could potentially upset the lymph balance and overload the system.

And here’s where we come to massage: Most massage styles cause inflammation or hyperemia, which is an increase of blood to a certain area. You know how your skin turns red after applying pressure? That’s what I mean. Because of this, massaging limbs at risk for lymphedema requires extra care.

This doesn’t mean that a massage therapist isn’t allowed to work on these parts of the body at all; it just means they have to be smart about it. First of all, when working with the cancer population it’s extra important to get a client’s complete and accurate history, so that the therapist will know who is at risk. And when working on these affected limbs, massage techniques should be limited to light strokes and gentle holds.

With the results of this study, though, the medical field will be able to limit the number of lymph node surgeries performed (a procedure that has been ingrained in cancer treatment for decades). Less surgery means less people at risk for lymphedema, which is great news for everyone.

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