Advances in medicine have increased the number of breast cancer survivors. Now, physicians like Lisa Spiguel, M.D., are turning their attention toward what happens after beating cancer—aka, the rest of your life.
“Systemic therapy and advances in technique have permitted us to cure breast cancer patients,” said Spiguel, an associate professor with the University of Florida department of surgery in the division of general surgery’s surgical oncology service. “Now, it’s our responsibility to also focus on quality of life after treatment—and address barriers that can prevent cancer survivors from thriving.”
Breast cancer-related lymphedema (BCRL) is a source of postoperative morbidity for survivors of breast cancer, negatively impacting their recovery and day-to-day. Common symptoms of pain, heaviness, and tightness of the arm, as well as practical limitations in range of motion and fine motor skills, prevent patients from getting back to living their lives.
“There’s an added financial burden in having to manage BCRL, and patients can experience high rates of anxiety and depression,” Spiguel said.
Although there is no cure and patients rely on physical therapy techniques for symptom management, Spiguel and her team have identified ways of preventing BCRL by incorporating a microsurgical preventive healing approach, or LYMPHA.
In short, the technique relies on the creation of a lymphatic-venous anastomosis at the time of axillary node dissection for BCRL prevention, and can reduce lymphedema risk as much as 50%. Spiguel is one of the few breast cancer surgeons who have been trained in the art of preventing lymphedema at the time of lymph node surgery.
“The procedure’s intention is to preserve healthy lymphatic channels by identifying which have been disrupted during lymph node removal and re-creating a pathway for lymph drainage,” she explained. “Using a dye injected into the arm, we can identify lymphatic channels of the arm and re-route them into a vein to preserve flow.”
Part of the procedure’s success rate hinges on identifying candidates who are predisposed to developing BCRL early on, Spiguel said. Consequently, she and her team began a surveillance program in 2014.
“Our screening surveillance program begins with pretreatment evaluation, so we can recognize and evaluate their risk of BCRL prior to treatment and watch them closely after treatment,” Spiguel said.
Preventing severity is one bulwark for a disease that lacks a standardized care. BCRL can present differently in each individual—it can be fluid, fatty, or scarred. Accordingly, Spiguel’s program is risk-stratified, adjusting patient surveillance based on their likelihood of developing lymphedema.
Certain factors can make some patients more prone to developing BCRL than others, Spiguel explained. Common ones include the extent of treatment, lymph node surgery, and radiation a patient has received, as well as the patient’s body composition.. Her program evaluates each patient’s body composition, assessing fat, muscle mass, and water, and testing lymphatic system functions before any treatment is prescribed.
“Timing is everything,” Spiguel said. “In many cases, there is a certain degree of inevitability with those predisposed to lymphedema. But if we can detect their risk early, we can actually make the symptoms much better and bring down the stage, severity of the BCRL.”
Eventually, Spiguel hopes to expand her team’s ability to offer LYMPHA by hiring more specialized plastic microsurgeons to assist with not only preventative techniques but also potential surgical techniques for treatment of established lymphedema.
“It’s very rewarding to be able to offer a procedure that can minimize the risk something many of our patients are afraid of,” Spiguel said. “It’s providing access to a better quality of life—and hope that they can maintain that.”