Recognizing Lymphedema Is Vital in Assisting Oncology Patients认识淋巴水肿有助于肿瘤患者治疗January 21, 2009 —Oncologists who are alert to the signs and symptoms of cancer and cancer-treatment-related lymphedema can have a large impact on its course, because the chronic condition can be minimized if recognized and treated early, according to a review article on lymphedema published in the January/February issue of CA: A Cancer Journal for Clinicians.依据2009年1月21日发表在《临床癌症杂志》1/2月刊上关于淋巴水肿的一篇回顾性文章，提醒肿瘤专家警惕癌症和癌症治疗相关的淋巴水肿的体征和症状可以影响癌症的进程，因为如果尽早的认识和治疗，这种慢性过程可以最小化。
However, oncologists are generally too busy to oversee the care of lymphedema themselves, and hence should become familiar with resources that can help connect patients with lymphedema-management specialists, said lead author Brian D. Lawenda, MD, clinical director of radiation oncology at the Naval Medical Center, in San Diego, California.这篇文章的第一作者——加利福尼亚圣地亚哥海军医疗中心放疗主任Brian D. Lawenda博士说：“肿瘤专家往往由于过于忙碌而忽视淋巴水肿的治疗，因此应该帮助病人联系处理淋巴水肿的专家。
”"We don't have the time to manage the care for lymphedema. Therefore, my colleagues and I recommend that clinicians be aware of referring specialists in their area who are experts in the diagnosis and management of lymphedema," Dr. Lawenda said in an interview with Medscape Oncology。
Lawenda博士在肿瘤学医学网景的一次采访中说：“我们没有时间去处理淋巴水肿。
因此，我同事和我建议临床医生要意识到向善于诊断和处理淋巴水肿的专家咨询。
”Dr. Lawenda also noted that oncology patients at risk for lymphedema should receive pretreatment evaluation that includes baseline girth and volume measurements of limbs. He emphasized the importance of prevention education, which includes a discussion of risk factors, and arm and leg care guidelines.Lawenda博士同时也提到存在发生淋巴水肿危险的肿瘤患者应该进行包括淋巴的基线长度和测量体积的治疗前评估。
他强调治疗前评估的重要性，包括风险因素的讨论和四肢的护理指导。
Pretreatment patient evaluation and education are not well used by clinicians, suggested Dr. LawendaLawenda博士谈到临床并没有很好的对患者进行治疗前和教育。
"Oncology patients are left with a lot of side effects of treatment. We commonly see lymphedema, but unfortunately it does not get a lot of discussion [by oncologists]. As result, it can be a surprise to patients," he said.他说：“肿瘤患者的治疗会遗留很多副作用。
我们通常会看到淋巴水肿，但不幸的是它未得到肿瘤专家的大量讨论。
因此，对于病人这会成为一个意外。
”Who's Most at Risk?谁是最危险的呢？The most common causes of lymphedema in the United States are surgery and radiation therapy for the treatment of cancer. The most common etiology is the impaired flow of lymph fluid through the draining lymphatic vessels and lymph nodes, write Dr. Lawenda and hiscoauthors, Tammy Mondry, DPT, a physical therapist at New Horizons Physical Therapy, in San Diego, and an expert on managing the condition, and Peter Johnstone, MD, chair of the Department of Radiation Oncology at the Indiana University School of Medicine, in Indianapolis.在美国造成淋巴水肿的最常见的原因是癌症治疗中的外科手术和放疗。
Lawenda博士和其他作者——圣地亚哥新视野物理治疗机构的物理治疗师Tammy Mondry和印第安纳波利斯的印第安纳大学医学院放疗系主任Peter Johnstone博士——认为最常见的病因是淋巴管和淋巴结分泌的淋巴液的通路被损害了。
Lymphedema is most commonly reported after breast cancer treatment, but can result from the treatment of cervical, endometrial, vulvar, head and neck, and prostate cancers, and of sarcomas and melanoma. Lack of standardized definitions and measurement techniques for the disorder make an accurate incidence rate of cancer-treatment-related lymphedema difficult to determine, say the authors.淋巴水肿最常见于胸部肿瘤治疗后，但也可见于颈部、子宫内膜、外阴、头颈和前列腺等部位的癌症以及肉瘤和黑素瘤治疗后。
作者们认为针对这种情况由于缺乏规范定义和处理技术导致癌症治疗后相关的淋巴水肿的精确发生率难以确定。
However, the likelihood of lymphedema by cancer type and related treatment has been established但是，可能导致淋巴水肿的癌症类型和相关治疗已经建立。
For instance, with regard to breast cancer, the frequency of breast edema ranges from 6% to 48% when surgery and radiation therapy are combined. The frequencies tend to be at the higher ends of the range when a lymph node dissection and radiation therapy are performed.例如像胸部肿瘤，如果合并手术和放疗，胸部水肿的概率从6%到48%，如果切除一个淋巴结同时放疗，水肿的发生率将会处于上述范围的高端。
Increased body mass index and tumor location in the upper outer quadrant are other factors that have been reported to significantly increase the risk for breast lymphedema. Also, one study (Lymphat Res Biol. 2005;3:208-217) found that women older than 60 years had a higher likelihood of lymphedema (41.2%) than women younger than 60 years (30.6%). Approximately 15% of patients with a bra cup size of A or B developed breast edema, whereas approximately 48% of patients with a bra cup size of C, D, or DD presented with edema.已报道的可明显增加发生胸部淋巴水肿危险的因素还包括较高的体重指数以及肿瘤的生长位置在外上象限。