Over the past decade, the incidence of cancer treatment-related diseases such as secondary lymphedema has risen due to improved cancer survival rates. Secondary lymphedema is a life-long, debilitating disease that affects patients treated for various types of cancers including breast cancer, urologic cancer and sarcomas. Almost one-third of patients who undergo lymph node dissection surgery during breast cancer treatment develop secondary lymphedema. In the USA alone more than 6 million people are affected by cancer-related lymphedema, resulting in a significant medical burden. Although conservative options such as compression devices and massage therapies have shown some clinical benefit, lymphedema continues to have a profound impact on the quality of life in this patient population.
Despite the millions of patients who suffer from lymphedema, the pathophysiology of this disease is still not completely understood. Initially, lymphedema was considered to be a disease of lymphatic insufficiency. However, research over the past decade has led to notable advances in our understanding of the pathology of lymphedema. Recent evidence has shown that it is initiated by lymphatic damage and insufficiency propagated by chronic inflammation. This results in a connective tissue disorder involving chronic tissue fibrosis and adipose deposition. Current research is aimed at treating the disease from several directions, including the targeting of pro-lymphangiogenic, anti-inflammatory and anti-fibrotic pathways.
Additionally, advanced surgical therapies such as lympho-venous bypass and lymph node transplantation have proven to be somewhat effective in alleviating the pathology of lymphedema. This two-pronged approach involving basic research and clinical therapies is likely to be the best way forward in developing effective therapies to treat this condition. Since lymphedema only arises in some patients who undergo cancer therapies, emphasis should also be given to identifying susceptible individuals who are more prone to develop lymphedema through the use of accurate biomarkers.
The intent of this special issue is to shed light on new findings relating to lymphedema pathology, clinical therapies and prognostic approaches. In addition, this issue will summarize our current understanding of lymphedema pathology and the existing therapies used to treat this disease.
Dr. Raghu P. Kataru
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