There are three primary methods for treating cancer.  These are surgery, chemotherapy (“chemo” for short) & radiation.  Sometimes these methods may be combined.  Depending on the type of cancer, additional treatment options might include bone marrow transplant, hormone therapy, molecular-targeted therapy, clinical trials & unconventional methods.

Surgery – Tumors may be removed or shrunk through surgery (often followed by chemo &/or radiation to treat any cells that may have spread).  This surgery is localized to the tumor site & might be done with the old-fashioned surgical knife.  However, there are also less extensive surgeries such as sentinel node biopsy, minimally invasive (like laparoscopy or thoracoscopy) & organ-preserving (e.g. lumpectomy). Newer approaches to destroy tumor tissue include focused sound waves (i.e. ultrasound), cold (cryotherapy), radiowaves (radiofrequency ablation) & light (phototherapy).

Chemotherapy – A drug or combination of drugs primarily administered orally, through injection or through a vein (via a catheter such as a PICC line or a port (i.e. a device placed under your skin on the chest).  Chemo is a systemic treatment, meaning it affects the whole body.  It targets fast-growing cells which include not only cancer cells but other fast-growing cells like skin, hair, bone marrow (including white or red blood cells & platelets) & cells that line your digestive tract (such as stomach & mouth).  Fortunately, the side effects from damage to healthy cells (such as nausea or diarrhea) can often be managed during treatment & other side effects (such as hair loss, dry skin or skin rash) usually go away.

Radiation – High-energy radiation is delivered to the tumor(s) by a machine via an external beam (i.e. X-Ray or gamma ray) or internally (via radioactive material placed in the body near the tumor or via systemic administration called brachytherapy).  The purpose of radiation is to shrink or kill the cancer cells by damaging their DNA. Unfortunately, normal cells can also be damaged leading to long-term effects such as fibrosis & lymphedema. However, doctors have an idea of how much radiation normal tissue can receive & take this into consideration when planning your treatment course.

 

References
www.cancer.org
Coleman, Norman, MD (2006). Understanding Cancer, p. 85-106. Baltimore: The John Hopkins University Press.

In March’s blog, we discussed what cancer is.  We said,

“When a cell is told to multiply, it begins a multi-step process which has “checkpoints.”  These checkpoints inspect the cell, ensure it is progressing normally & allow it to continue its development.  If a cell is found defective (i.e. several genes have changed or mutated), it will usually self-destruct or it will be removed by other cells (thanks to our immune system).  This process is programmed so there is a balance between the cells that multiply & those that die.   In cancer, however, this process is defective.  Instead of self-destructing or being removed, the defective cell passes through the checkpoints & multiplies at-will.”

This describes one reason people get cancer: Cells malfunction (usually as a result of age or genetic predisposition).  However, environmental factors may also contribute.  For example, chemicals found in pesticides or in cigarettes (or other forms of tobacco use).  UV radiation from too much sun exposure or sunburns has been linked to cancer development.  Behavioral factors may also increase risk.  For example, an unhealthy diet & sedentary lifestyle can lead to obesity* which increases the risk of developing cancer.  Smoking, heavy/regular alcohol consumption, chronic stress & hormones (such as menopausal therapy or oral contraceptives) do as well.

*Obesity & other conditions that cause chronic inflammation (such as chronic inflammatory bowel diseases – e.g. Crohn’s Disease – or even untreated lymphedema) has been linked to cancer.  The longer chronic inflammation persists, the greater the risk of cancer development.

References
http://www.cancer.gov/about-cancer/understanding/what-is-cancer
http://www.cancer.gov/about-cancer/causes-prevention
https://www.mdanderson.org/publications/focused-on-health/december-2014/how-stress-affects-cancer-risk.html.html

If you or someone you know has been given a diagnosis of breast cancer, you may have heard unfamiliar terms like “in situ,” “ductal,” “invasive,” “lobular,” “inflammatory” & “carcinoma.”  What do these words mean?

When the breast creates milk, it begins in a lobule.  Once the lobule develops milk, the liquid flows through the milk ducts & exits through the nipple.  When cancer cells develop in one of these areas, the cells may stay within that site or they may invade other parts of the breast tissue.  “In situ” & “invasive” describe what the cancer cells have done.  If the cancer has not spread to surrounding breast tissue, it is said to be “in situ” (i.e. in its original site).  If the cancer has spread beyond the borders of its original location & invaded surrounding breast tissue, it is said to be “invasive.”  The words describing the involved breast area & what the cancer cells have done are combined to form the name of a particular type of breast cancer:

• Ductal – refers to the milk ducts of the breast
  • ductal carcinoma in situ (or DCIS for short) means the tumor (or cancer mass) is contained within the milk ducts
  • invasive ductal carcinoma (or IDC for short) means the tumor growth has broken through the duct wall & spread to the surrounding breast tissue
• Lobular – refers to the lobule milk glands
  • lobular carcinoma in situ (or LCIS for short) means cells that look like cancer are growing in the milk glands; this type isn’t considered cancer yet – it is, however, a condition that needs to be watched
  • invasive lobular carcinoma (or ILC for short; also called “infiltrating lobular carcinoma”) means the tumor growth has broken through the lobule wall & spread to the surrounding breast tissue

For a diagram of the breast anatomy & above types of cancer, click: http://www.breastcancer.org/pictures/types

More terms

• carcinoma – refers to any cancer that begins in the skin or other tissue that cover organs
• inflammatory – refers to the description of inflammatory symptoms accompanying this type of cancer (tenderness, warmth, redness, swelling, &/or an orange-peel appearance to the skin).
  • inflammatory breast cancer (or IBC for short) means an inflammatory response within the breast tissue caused by cancer cells blocking the flow of lymph fluid.  Note: While an antibiotic should improve symptoms caused by an infection or mastitis, it will not help this condition. Be sure to notify your doctor if you’ve been prescribed an antibiotic but your symptoms haven’t gone away.

It’s worth noting there are other types of breast cancer not mentioned.  A comprehensive list includes:

ductal carcinoma in situ
invasive ductal carcinoma
lobular carcinoma in situ
invasive lobular carcinoma
inflammatory
medullary
mucinous or colloid
Paget’s disease

and even less common:
tubular
cribiform
papillary
micropapillary
apocrine
adenocystic
carcinosarcoma
squamous
sarcoma

References
Kneece, Judy, RN, OCN (2012). Breast Cancer Treatment Handbook (8^th ed), p 20-21, 66. South Carolina: EduCare
www.cancer.org
www.breastcancer.org

In our last blog, we described what cancer is.  In this blog, we’ll outline the different types of cancer (listed below).  A starting point to understanding the different types of cancer is to understand how a particular type of cancer gets its name.  Cancers are named based on their appearance & what part of the body they originate in.  For example, breast cancer is named “breast cancer” because the cancer is located in breast tissue.  Lung cancer is named “lung cancer” because the cancer is located in lung tissue & so on.  It’s important to note, however, that even if the cancer progresses (i.e. metastasizes) to other body parts, it is still named based on its original location.  For example, breast cancer which has metastases that go to the lung(s) isn’t called “lung cancer,” it’s called “metastatic breast cancer.”

 

Breast Cancer – the number one cause of lymphedema in the United States

• Ductal carcinoma in situ
• Lobular carcinoma in situ
• Invasive ductal carcinoma
• Invasive lobular carcinoma
• Inflammatory breast cancer

Lung Cancer

• Small-cell lung cancer
• Non-small-cell lung cancer

Skin Cancer

• Melanoma
• Basal cell carcinoma
• Squamous cell carcinoma
• Neuroendocrine carcinoma

Gastrointestinal Cancer

• Esophageal
• Stomach
• Liver
• Pancreas
• Colon & Rectum

Genitourinary Cancers (cancer of sexual organs & urinary organs)

• Prostate
• Cervix
• Bladder
• Kidney

Hematological Cancers (cancer of the blood & stem cells)

• Leukemia
• Lymphoma
• Multiple Myeloma

Head & Neck Cancers

• Oral cavity
• Nasal cavity
• Thyroid gland
• Pharynx

Sarcomas (cancerous tumors of soft tissue & bone anywhere in the body)

• Osteosarcomas (primary bone sarcomas)
• Soft tissue sarcoma (such as tumors arising from fat tissue, muscles, nerves, blood vessels, etc.)

Brain & Spinal Cord Tumors

• Glioma (tumors that start in glial cells)
• Meningioma (tumors that start in the outer lining of the brain)
• Acoustic Neuromas & Schwannomas (tumors that develop from Schwann cells – which line the cranial & peripheral nerves)
• Medulloblastoma (which arise from fetal cells in the cerebellum; more commonly found in children but they can be found in adults)

 

http://www.cancer.org/cancer/showallcancertypes/index
Smith-Gabai, Helene (2011).  Occupational Therapy in Acute Care, p. 416-426.  Maryland: The American Occupational Therapy Association, Inc.
Coleman, Norman, MD (2006). Understanding Cancer, p. 43-45. Baltimore: The John Hopkins University Press.

National Cancer Institute

American Cancer Society

National Comprehensive Cancer Network

PDQ system

p. 85 Understanding Cancer book

Science has come a long way in treating cancer, but cancer is a word that still causes anxiety for most who receive (or have loved ones who receive) the diagnosis.  That anxiety is complicated by several unknowns – starting with understanding what cancer is (in user-friendly terms). Cancer (specifically, breast cancer) is the number one cause of lymphedema in the United States & so finds its way on our blog.  This series will address cancer, what it is, how it may be developed, treatments & other related topics.

So, what exactly is cancer?  The simple answer is cells multiplying (i.e. dividing themselves) out of control.  For a deeper insight, let’s take a look at what happens on a biological level.

Our bodies are made up of cells, many different types of cells which have different functions.  For example, there are muscle cells, bone cells, blood cells, skin cells, defense cells, etc.  Some cells continue to multiply throughout their life (like blood & skin cells) while others stop multiplying when their type is complete (cells in our nervous system).  Normal cells only multiply when they are told to do so by

1. hormones
2. growth factors (usually a protein or hormone) &
3. cytokines (“messenger” proteins)

When a cell is told to multiply, it begins a multi-step process which has “checkpoints.”  These checkpoints inspect the cell, ensure it is progressing normally & allow it to continue its development.  If a cell is found defective (i.e. several genes have changed or mutated), it will usually self-destruct or it will be removed by other cells (thanks to our immune system).  This process is programmed so there is a balance between the cells that multiply & those that die.   In cancer, however, this process is defective.  Instead of self-destructing or being removed, the defective cell passes through the checkpoints & multiplies at-will.  Amazingly & thankfully, this breakdown doesn’t happen very often.

 

http://www.cancer.org/cancer/cancerbasics/what-is-cancer
Kumar, V., Abbas, A., Aster, J. (2013).  Robbins Basic Pathology (9^th ed.), location 1644ff.  Pennsylvania: Elsevier Saunders.
Coleman, Norman, MD (2006). Understanding Cancer, p. 28ff. Baltimore: The John Hopkins University Press.
Smith-Gabai, Helene (2011).  Occupational Therapy in Acute Care, p. 410.  Maryland: The American Occupational Therapy Association, Inc.

The Women’s Health & Cancer Rights Act (established in 1998) requires most group health insurance plans which cover mastectomies to also cover breast reconstruction & associated treatment costs (such as lymphedema).  But changes still need to be made.  Medicare does not cover compression for lymphedema (& consequently many other insurance providers do not cover compression). As a result, the compression supplies needed during & after treatment are often not available for patients who require them but cannot afford them. Consequently, mobility becomes more difficult & self-care independence is reduced while lymphedema becomes worse with chronic infections, tissue changes & repeated hospitalizations. However, you have an opportunity to make a difference!  Please contact your congressmen.  We’ve made it easy for you below (simply click on the link).

Contact your congressmen by visiting: http://www.capwiz.com/lymphedematreatmentact/issues/alert/?alertid=68841626&type=CO
Find out more about the Lymphedema Treatment Act by visiting: http://lymphedematreatmentact.org/about-the-bill/

References
http://lymphedematreatmentact.org/
http://www.cancer.org/treatment/findingandpayingfortreatment/understandinghealthinsurance/womens-health-and-cancer-rights-act

Sigvaris began as a Swiss dress & fabric shop in 1877 by a family called Ganzoni. One of the family sons (Werner Ganzoni) headed up the Swiss business while a brother (Paul) opened a shop in France. In 1924, they opened their own production company in Saint Louis (a European town bordering Germany & Switzerland) & in 1926 they reinvented themselves with finer rubber yarns & wider elastic fabrics. This latter transition yielded belts, suspenders, socks, stockings & stocking suspenders. In 1928, Ganzoni purchased a stitching company in St. Gallen, Switzerland. After several uncertain years due to WW I & II, in 1947 a son (Peter), took over business. In 1961, the first medical compression stocking based on latex was introduced under the name “Sigvaris.” The elastic band-weaving portion of business was sold & a concentrated effort was placed on medical compression stockings in order to stay afloat. Medical compression proved to be their best asset, & they have continued to expand not only in Europe but overseas as well.

Sigvaris manufacturers four categories of compression which include medical, well-being, sports & arm sleeves. Their focus is primarily on venous disorders but venous disorders can develop into lymphedema, so their compression can be beneficial for some lymphedema patients. Their products are ready-made & come in ready-made compression grades. For more information regarding Sigvaris & their products, visit: http://www.sigvaris.com/usa/en-us.

LympheDIVAS is a family-owned company based in Massachusetts with a unique start-up story.  The founder was a woman named Rachel who was diagnosed with Stage 3, triple negative breast cancer just before her 35th birthday.  She had no family history of cancer aside from her 98-year-old grandmother who developed ovarian cancer late in life.  Because of the nature of triple negative cancer, her treatment options were limited.  19 lymph nodes had been removed from her axilla during the diagnosis phase, & she went through chemo & radiation.  After her first radiation treatment, she developed lymphedema & went to see her physician who prescribed a compression sleeve.  Rachel was dismayed that the sleeve looked like a boring, beige medical garment & was just as uncomfortable with the heavy, hot, thick fabric.  Her doctor challenged her to make a better sleeve &, so, she set out to do just that.  Unfortunately, Rachel passed away at the age of 37 but her family has maintained her legacy by continuing & growing her business focused on providing a compression sleeve that was a medical, gradient compression yet more fashionable & comfortable with the lighter, breathable, moisture-wicking fabric.

LympheDIVAS has three primary garments:  A sleeve, a gauntlet & they recently came out with a glove.  Each of these are latex & silicone-free with a silky-feel to them – more like sports compression than medical compression.  They come in Class 1 (20-30 mmHg) & Class 2 (30-40 mmHg) compression, are circular-knit & come in 5 colors with over 100 different print patterns to choose from.  Additionally, they contain aloe vera for a moisturizing-effect.

To find out more, visit www.lymphedivas.com.

BiaCare is a medical compression company based in Michigan. They were founded approximately 10 years ago with a mission to create high quality garments that are affordable. One way they achieve more affordability is by not having sales reps on staff. Because of that, they may not be as well-known as some of their competitors, but they still compete with their selection of lymphedema & wound/vascular compression as well as their own bandaging products. We’ll overview a few of their products in this blog.

LYMPHEDEMA PRODUCTS
1. ChipSleeve with OverSleeve: A non-compressive, channeled chipped-foam liner (which can also be used under bandaging) increases compression to an arm, full leg or foot to knee length with the added OverSleeve for a total of 15-20 mmHg compression. This is suited for mild edema & is a ready made item but they will sell a custom option in 2016.
2. CompreSleeve: A substitute for bandaging, this sleeve has Velcro closure with a removable loop at the top for easier donning & comes in lengths for a full arm & foot to knee length. Compression given is 20-30 mmHg.
3. MedaFit: A sleeve for the arm, full leg or foot to knee length, this is the most durable fabric & highest compression garment provided at 30-40 mmHg. As with the CompreSleeve, this is a Velcro-closure compression with a removable Velcro attachment at the top for easier donning. Another helpful feature to this garment is a removable foam liner (made of a moisture-wicking fabric) which can be taken out to be washed. This garment may be paired with the MedaHand or MedaGlove with an OverSleeve. They also have a unique Dorsal Pocket Glove which contains a pocket on the back of the hand for foam inserts to prevent fluid refilling or break up fibrosis (15-20 mmHg).

SPECIAL “NITCHE” PRODUCTS
1. Biker shorts & capris with an optional length extending into the trunk & abdomen. 10-15 mmHg. Sizing goes up to 5x or custom-shorts can be made.
2. ChipPads for head/face, neck, breast/chest & genital areas.
3. Cotton liners or liners made with anti-microbial silver (silver liners contain 10-15 mmHg).
4. TheraBra (comparable to the Bellisse post-mastectomy bra) which has a foam-insert pocket each side or a drain tube option. This front-closure bra also has Velcro shoulder straps for easy removal & wide, soft elastic band to prevent it from sliding up while also providing 20 mmHg compression.

WOUND CARE / VENOUS PRODUCTS
1. CompreFit: Inelastic/non-stretch, 2 or 4-piece Velcro garment (knee-high or thigh-high) which provides 30-40 mmHg in the leg & 20-30 mmHg in the foot. A strap extender option allows an additional 10 cm of circumference compression, for a total of 75 cm around the calf. This garment has been Medicare-approved for those with a venous ulcer using code A6545-AW & is latex-free.
2. CompreFlex Lite: Low-stretch, 2 or 4-piece Velcro garment (knee-high or thigh-high) which provides 30-40 mmHg. A best-seller, this garment has also been Medicare-approved & is latex-free.
3. CompreBoot: Velcro foot piece which can be paired with the above items & has 20-30 mmHg compression.
4. CompreBoot-Lite: Velcro Foot piece which can be paired with the above items & has 10-15 mmHg compression.  Because of the thin material, it fits easily into most shoes.

BANDAGE SUPPLIES
BiaCare carries their own line of bandages which are manufactured in Germany (like their competitors Lohmann & Rauscher or BSN Medical). Their lines are called BiaForm & IsoForm. They also sell liners, tubular compression (BiaGrip), elastic gauze, tape & foams.

In conclusion, BiaCare is a small company with big potential. All their lymphedema & venous compression products can be machine-laundered & dried & come with a 6-month warranty. You can learn more by visiting BiaCare.com.