Diagnosis of an early (latent) stage of
secondary lymphedema of the arm - a necessary condition for its
successful treatment
Wald M.1, Køížová H.2. Diagnosis of an early
(latent) stage of secondary lymphedema of the arm - a necessary
condition for its successful treatment. Przeglad lekarski 2000, Vol.
57 Suppl.5/2000, pøednáška 56,
pp. 116 - ISSN 0033-2240. 510 KA (19-13-3)-(2-12-2)
1 Department of Surgery, 2nd Medical School, Charles University,
Prague, Czech Republic; 2 Department of Nuclear Medicine, 2nd
Medical School, Charles University, Prague, Czech Republic
4th Annual Meeting of European Society of Surgery, Krakow, Dec.3-6,
2000.
Secondary lymphedema development as a
consequence of complex therapy for breast cancer occurs in up to 40%
patients, often appearing after many years. More than 10% of
lymphedemas appear 3 years after surgery or radiotherapy. It is
rather common, that once a surgical wound is healed, the patient is
not subject to the follow up by surgeon anymore. Although an
oncologist permanently dispensarizes the patient, with respect to
the severity of a primary disease he usually does not pay special
attention to the complaints signaling already a latent form of
lymphedema with the threat of its future progression. Thus, we often
deal with advanced stages of secondary lymphedema which are
therapeutically difficult to treat. The authors consider a
lymphoscintigraphy a simple noninvasive method of objectivization of
the homolateral upper limb lymphatic system transporting capacity.
This method is able to reveal even clinically silent (latent)
lymphedema stages.
An early lymphedema pharmacotherapy with perorally administered
proteases enables a normalization of the transporting capacity of
lymphatic system. Perorally administered proteases (hydrolases)
which act systemically, i.e. in the whole organism, brought a
significant change into the lymphedema pharmacotherapy. Such
preparations are combinations of plant and animal proteases: papain,
bromelain, trypsin, chymotrypsin, and pancreatin combined with
amylase, lipase, and rutosid (Wobenzym® tbl. and
Phlogenzym® tbl.).Although later stages with lymph
congestion and protein precipitation in the interstitium can also be
well pharmacologically treated, the function of lymphatic system
remains irreversibly impaired.