Read the transcript of Dr. Martinez’ talk about lymphedema on Health Matters radio or listen here.
Brought to you by Integrated Rehabilitation Group Physical & Hand Therapy Clinics throughout the Puget Sound Area, where you receive excellent care with exceptional results. Now, your hosts, Maury Eskenazi and Shannon O'Kelley.
Maury Eskenazi: Hi. Welcome to Health Matters. Maury Eskenazi, Shannon O'Kelley, a beautiful day.
Maury Eskenazi: I want to welcome too Dr. Steve Martinez, surgeon from The Everett Clinic. Thanks for coming on with us. Dr. Steve Martinez, he is a surgeon from The Everett Clinic and he specializes in breast, endocrine, and general surgical oncology issues.
Dr. Martinez: Well, lymphedema is a huge issue. It is a huge concern of patients who are treated for breast cancer. Other cancers as well, but, in particular, when we do a lot of our breast surgery we also have to do surgery on the lymph node areas to find out if those are involved, and some of the lymph nodes may be removed, and, thankfully, not as often, we have to remove all of the lymph nodes in the underarm area.
Maury Eskenazi: I have a quick question. What, what do lymph nodes do?
Dr. Martinez: It's a two-part system -- your lymphatic system is part of your immune system, so lymph nodes will contain immune cells, lymphocytes, and they are going to help perform surveillance and filter the blood and fluids for things like bacteria, perform surveillance for things like cancer. But, also, your lymph system, you can think of it as a basic part of your plumbing. Your lymph system helps your veins bring fluid back to your heart, so the lymphatics in the underarm help your veins bring fluid back from your hand, your forearm, and your upper arm back to your heart. If we remove, essentially, a piece of that plumbing, the fluid can get backed up, and that's what lymphedema is, the arm swelling.
Shannon O'Kelley: Those lymph nodes happen to be in certain areas of your body, and, particularly, they are in your armpits and down in your groin area.
Dr. Martinez: Those are some main areas. Also, in the neck, but we have also large numbers of lymph nodes in our chest, sort of in between where our lungs are, and in our abdomen, sort of in the blood supply to our intestines. We have lymph nodes everywhere, but these particular areas where they are accessible to surgery, that's where we check them.
Shannon O'Kelley: And when you're assessing cancer and the cancer grade, as you start to go through this diagnostic process a lot of times you hear where they biopsied the patient's lymph nodes. Is that lymph node or the area of the lymph nodes kind of where those cancer cells will get captured and that's why you're looking at the lymph nodes to assess how much involvement the cancer is?
Dr. Martinez: That's right. So, the cancer will frequently spread from the primary site, where it started, to the nearest lymph node basin. In the case of breast surgery that is going to be the underarm or axillary lymphatics. It could be one that is involved or it could be more than one that is involved. The more that are involved, the more the stage will change and the more advanced we would consider the cancer. The fact that cancer has spread to the lymph nodes, it means to us, logically, that it increases the likelihood that that cancer could spread somewhere else.
Shannon O'Kelley: Because the lymph system, you described it as kind of a plumbing, so that's an easy avenue for that cancer cell to be kind of spread through the body.
Dr. Martinez: It's a sign to us that this cancer has learned how to spread from the primary site to someplace else, and, if it's done that, we have to be sure that it has not done so elsewhere.
Maury Eskenazi: So, because of that you get rid of the lymph node...
Dr. Martinez: Well, you know, that's one thing that is sort of changing. These days, we do oftentimes less invasive surgery. What we want to find out: Has this cancer spread to the lymph nodes? Yes or no. Frequently we can do that by just testing one-three lymph nodes in this procedure called a sentinel node biopsy. It's a technique that we can detect the first lymph node that the cancer would spread to. Only more rarely do we have to remove all of the lymph nodes. Even now there has been a new study that came out within the last year that says we get really similar effects from performing radiation on some lymph nodes, rather than doing surgery. The same rates, essentially, of recurrence, and, actually, decreased risk of lymphedema, or arm swelling.
Shannon O'Kelley: So, the ultimate goal is, as you determine a treatment approach, to save that lymphatic system to prevent that lymphedema or that drainage problem postoperative, post-treatment.
Dr. Martinez: That's right. Anytime we remove a lymph node, whether it is one or 31, we put the patient at risk for lymphedema. Now, when, when we do surgery and remove all the lymph nodes in that area the risk of lymphedema is about 20-40 percent…if we can remove one to three, we decrease that…6-8 percent. So, it's much more beneficial to the patient.
Maury Eskenazi: Dr. Martinez, I am sure that you're educating your patients regarding outcomes and post care, because, sometimes the cancer treatment itself can almost cause a lot of problems.
Dr. Martinez: Right.
Maury Eskenazi: I mean, from fatigue and muscle wasting and lack of exercise. So once we treat the cancer and we are in the kind of return-to-quality-of-life-type situation, we have to look at the person's whole body. How do you have that conversation with your patients? How long after treatment does this happen?
Dr. Martinez: It's an ongoing process, really. Some of the changes you describe happen during treatment, and can even be brought on by treatment. Things like endocrine therapy for breast cancer to block the effect of hormones can change mood, and sleep patterns, sex drive, and these are things that people find very important in their lives, and rightly so. We counsel people as best we can when those treatments are ongoing. After the treatments are over there can even be some lingering side effects. We talked about lymphedema, or arm swelling, but there can be other results from surgical therapy. Chronic pain would be one of them. A lot of people do not realize that after a lumpectomy or a mastectomy people can have really chronic pain issues for greater than three years. In studies that have been done, primarily in Europe, about half of patients will still complain of some element of chronic pain three years after treatment.
Dr. Martinez: The focus has changed quite a bit. A surgeon's focus now is not just getting the patient through the operation and the very short postoperative period. Following my patients now, it's important to me that my patient has good function, not just four days after surgery, but 40 years after surgery. We want to be sure that those people are living their life to the fullest.
Shannon O'Kelley: You have to think about the consequences and the effect of the quality of life of the patient 10-15 years down the road.
Dr. Martinez: That's right. And, you know, and now, as I was saying, we have more options. More options could be surgery, a small surgery, it could be a larger surgery, it could be radiation. It's nice to have those increasing options.
Maury Eskenazi: Alright. And, Dr. Steve Martinez. What a good guy this is. Dr. Steve Martinez. You can see him for yourself. Go to everettclinic.com. You probably can make an appointment to see him.