Lenfödem
Özet
Lenfatik sistem, dolaşım sisteminin hayati bir parçası olup, sıvı dengesini sağlama, bağışıklık hücrelerinin taşınması ve hareketini kolaylaştırma, inflamatuar yanıtları düzenleme ve diyetle alınan yağların emilimine yardımcı olma gibi önemli roller oynar. Lenfatik damarlar, kör uçlu lenfatik kapillerlerle başlayarak interstisyel sıvıyı tek yönlü bir akışla kalbe taşır. Lenfatik sistemin kronik parazitik enfeksiyonlar, kanser tedavileri, travma veya genetik mutasyonlar nedeniyle bozulması, protein açısından zengin interstisyel sıvının birikmesine ve sürekli inflamasyona yol açabilir. Zamanla, bu patolojik değişiklikler lenfödem adı verilen, doku fibrozisi ve yağ birikimi ile karakterize bir duruma dönüşebilir. Lenfödem, yaşam kalitesinde önemli düşüşe, tekrarlayan enfeksiyonlara ve nadir durumlarda ölümcül olabilen sekonder tümörlerin gelişimine neden olabilir.
The lymphatic system is a vital part of the circulatory system, playing key roles in maintaining fluid balance, facilitating immune cell transport and migration, regulating inflammatory responses, and assisting in dietary fat absorption. Lymphatic vessels form a network that begins with blind-ended lymphatic capillaries, which transport interstitial fluid in a one-way flow back to the heart. When the lymphatic system is disrupted—whether due to chronic parasitic infections, cancer treatments, trauma, or genetic mutations—it can lead to the accumulation of protein-rich interstitial fluid and persistent inflammation. Over time, these pathological changes progress into lymphedema, a condition marked by tissue fibrosis and fat deposition. Lymphedema is associated with a significant reduction in quality of life, recurrent infections, and, in rare cases, the development of life-threatening secondary tumors.
Referanslar
Loscalzo, J., et al., Preface, in Harrison's Principles of Internal Medicine, 21e. 2022, McGraw-Hill Education: New York, NY. p. 2115-2117.
Norrmén, C., et al., Biological Basis of Therapeutic Lymphangiogenesis. Circulation, 2011. 123(12): p. 1335-1351.
Levine, S.M., Lymphedema: Complete Medical and Surgical Management. Plastic and Reconstructive Surgery, 2017. 139(3): p. 4.
Kanter, M.A., The lymphatic system: an historical perspective. Plast Reconstr Surg, 1987. 79(1): p. 131-9.
Mortimer, P.S. and S.G. Rockson, New developments in clinical aspects of lymphatic disease. J Clin Invest, 2014. 124(3): p. 915-921.
Nonne M. Vier Fälle von elephantiasis congenita hereditaria. Virchows Arch. 1891;125:189–96.
Milroy W. An undescribed variety of hereditary oedema. NY Med J. 1892;56:505–8.
Brice, G., et al., Milroy disease and the VEGFR-3 mutation phenotype. J Med Genet, 2005. 42(2): p. 98-102.
Falls, H.F. and E.D. Kertesz, A NEW SYNDROME COMBINING PTERYGIUM COLLI WITH DEVELOPMENTAL ANOMALIES OF THE EYELIDS AND LYMPHATICS OF THE LOWER EXTREMITIES. Trans Am Ophthalmol Soc, 1964. 62: p. 248-75.
Witte, M.H., et al., Structure function relationships in the lymphatic system and implications for cancer biology. Cancer Metastasis Rev, 2006. 25(2): p. 159-84.
van der Putte, S.C., The development of the lymphatic system in man. Adv Anat Embryol Cell Biol, 1975. 51(1): p. 3-60.
Suami, H., et al., The lymphatic anatomy of the breast and its implications for sentinel lymph node biopsy: a human cadaver study. Ann Surg Oncol, 2008. 15(3): p. 863-71.
Wenzel-Hora, B.I., et al., Scanning electron microscopy of the initial lymphatics of the skin after use of the indirect application technique with glutaraldehyde and MERCOX as compared to clinical findings. Lymphology, 1987. 20(3): p. 126-44.
Mislin H. Structural and functional relations of the mesenteric lymph vessels. New trends in basic lymphology; proceedings of a symposium held at Charleroi, Belgium; July 11-13, 1966. Experientia Suppl. 1966;14:87–96.
Gashev, A.A. and D.C. Zawieja, Physiology of human lymphatic contractility: a historical perspective. Lymphology, 2001. 34(3): p. 124-34.
Bernas, M.J., C.L. Witte, and M.H. Witte, The diagnosis and treatment of peripheral lymphedema: draft revision of the 1995 Consensus Document of the International Society of Lymphology Executive Committee for discussion at the September 3-7, 2001, XVIII International Congress of Lymphology in Genoa, Italy. Lymphology, 2001. 34(2): p. 84-91.
Graham, P., et al., Supraclavicular radiotherapy must be limited laterally by the coracoid to avoid significant adjuvant breast nodal radiotherapy lymphoedema risk. Australas Radiol, 2006. 50(6): p. 578-82.
Meek, A.G., Breast radiotherapy and lymphedema. Cancer, 1998. 83(12 Suppl American): p. 2788-97.
Rönkä, R.H., et al., Breast lymphedema after breast conserving treatment. Acta Oncol, 2004. 43(6): p. 551-7.
Goffman, T.E., et al., Lymphedema of the arm and breast in irradiated breast cancer patients: risks in an era of dramatically changing axillary surgery. Breast J, 2004. 10(5): p. 405-11.
Chatani, M., et al., Adjuvant radiotherapy after radical hysterectomy of the cervical cancer. Prognostic factors and complications. Strahlenther Onkol, 1998. 174(10): p. 504-9.
Gerdin, E., S. Cnattingius, and P. Johnson, Complications after radiotherapy and radical hysterectomy in early-stage cervical carcinoma. Acta Obstet Gynecol Scand, 1995. 74(7): p. 554-61.
Hong, J.H., et al., Postoperative low-pelvic irradiation for stage I-IIA cervical cancer patients with risk factors other than pelvic lymph node metastasis. Int J Radiat Oncol Biol Phys, 2002. 53(5): p. 1284-90.
Nunns, D., et al., The morbidity of surgery and adjuvant radiotherapy in the management of endometrial carcinoma. Int J Gynecol Cancer, 2000. 10(3): p. 233-238.
Petereit, D.G., et al., A retrospective review of nodal treatment for vulvar cancer. Am J Clin Oncol, 1993. 16(1): p. 38-42.
Pilepich, M.V., et al., Surgical staging in carcinoma of the prostate: the RTOG experience. Radiation Therapy Oncology Group. Prostate, 1984. 5(5): p. 471-6.
Wrone, D.A., et al., Lymphedema after sentinel lymph node biopsy for cutaneous melanoma: a report of 5 cases. Arch Dermatol, 2000. 136(4): p. 511-4.
Starritt, E.C., et al., Lymphedema after complete axillary node dissection for melanoma: assessment using a new, objective definition. Ann Surg, 2004. 240(5): p. 866-74.
Sabel, M.S., et al., Inguinal node dissection for melanoma in the era of sentinel lymph node biopsy. Surgery, 2007. 141(6): p. 728-35.
Armer, J.M., et al., Predicting breast cancer-related lymphedema using self-reported symptoms. Nurs Res, 2003. 52(6): p. 370-9.
Lawenda, B.D., T.E. Mondry, and P.A. Johnstone, Lymphedema: a primer on the identification and management of a chronic condition in oncologic treatment. CA: a cancer journal for clinicians, 2009. 59(1): p. 8-24.
Brennan, M.J. and J. Weitz, Lymphedema 30 years after radical mastectomy. Am J Phys Med Rehabil, 1992. 71(1): p. 12-4.
Swedborg, I., Effects of treatment with an elastic sleeve and intermittent pneumatic compression in post-mastectomy patients with lymphoedema of the arm. Scand J Rehabil Med, 1984. 16(1): p. 35-41.
Deltombe, T., et al., Reliability and limits of agreement of circumferential, water displacement, and optoelectronic volumetry in the measurement of upper limb lymphedema. Lymphology, 2007. 40(1): p. 26-34.
Clarke, D., et al., Breast edema following staging axillary node dissection in patients with breast carcinoma treated by radical radiotherapy. Cancer, 1982. 49(11): p. 2295-9.
Wollina, U. and B. Heinig, [Differential diagnostics of lipedema and lymphedema : A practical guideline]. Z Rheumatol, 2018. 77(9): p. 799-807.
Szuba, A., M. Razavi, and S.G. Rockson, Diagnosis and treatment of concomitant venous obstruction in patients with secondary lymphedema. J Vasc Interv Radiol, 2002. 13(8): p. 799-803.
Bae, J.S., et al., Evaluation of lymphedema in upper extremities by MR lymphangiography: Comparison with lymphoscintigraphy. Magn Reson Imaging, 2018. 49: p. 63-70.
Mihara, M., et al., Indocyanine green (ICG) lymphography is superior to lymphoscintigraphy for diagnostic imaging of early lymphedema of the upper limbs. PLoS One, 2012. 7(6): p. e38182.
The diagnosis and treatment of peripheral lymphedema: 2013 Consensus Document of the International Society of Lymphology. Lymphology, 2013. 46(1): p. 1-11.
Helyer, L.K., et al., Obesity is a risk factor for developing postoperative lymphedema in breast cancer patients. Breast J, 2010. 16(1): p. 48-54.
Showalter, S.L., et al., Lifestyle risk factors associated with arm swelling among women with breast cancer. Ann Surg Oncol, 2013. 20(3): p. 842-9.
Cemal, Y., A. Pusic, and B.J. Mehrara, Preventative measures for lymphedema: separating fact from fiction. J Am Coll Surg, 2011. 213(4): p. 543-51.
Schmitz, K.H., et al., Weight lifting for women at risk for breast cancer-related lymphedema: a randomized trial. Jama, 2010. 304(24): p. 2699-705.
Schmitz, K.H., et al., Weight lifting in women with breast-cancer-related lymphedema. N Engl J Med, 2009. 361(7): p. 664-73.
Ezzo, J., et al., Manual lymphatic drainage for lymphedema following breast cancer treatment. Cochrane Database Syst Rev, 2015. 2015(5): p. Cd003475.
Pritschow, H. and A. Vollmer, Lymphedema management and complete physical decongestive therapy ; a manual for treatment. 2. , completely rev. and expanded ed. 2010, Köln: Viavital-Verl.
Zuther JE, Norton S, editors. Lymphedema Management: The Comprehensive Guide for Practitioners. 3rd ed. Sttuttgard: ThiemeVerlag KG; 2013. p. 165-342.
Granzow, J.W., Lymphedema surgery: the current state of the art. Clin Exp Metastasis, 2018. 35(5-6): p. 553-558.
Blumberg, S.N., et al., Pneumatic Compression Improves Quality of Life in Patients with Lower-Extremity Lymphedema. Ann Vasc Surg, 2016. 30: p. 40-4.
Woo, J.H., et al., The effect of lumbar sympathetic ganglion block on gynecologic cancer-related lymphedema. Pain Physician, 2013. 16(4): p. 345-52.
Gott, F.H., et al., Negative pressure therapy in the management of lymphoedema. Journal of Lymphoedema, 2018. 13(1).
Gatt, M., S. Willis, and S. Leuschner, A meta-analysis of the effectiveness and safety of kinesiology taping in the management of cancer-related lymphoedema. Eur J Cancer Care (Engl), 2017. 26(5).
Roberson, M.L., et al., Financial Burden of Lymphedema Hospitalizations in the United States. JAMA Oncol, 2021. 7(4): p. 630-632.
McDuff, S.G.R., et al., Timing of Lymphedema After Treatment for Breast Cancer: When Are Patients Most At Risk? Int J Radiat Oncol Biol Phys, 2019. 103(1): p. 62-70.
Ancukiewicz, M., et al., Standardized method for quantification of developing lymphedema in patients treated for breast cancer. Int J Radiat Oncol Biol Phys, 2011. 79(5): p. 1436-43.
