Limfedem pri bolnikih z melanomom Lymphoedema in melanoma patients

Abstract

Po zdravljenju malignomov je eden izmed najpogostejših zapletov pojav sekundarnega limfedema. Pogostnost pojavljanja je odvisna od mesta rakavega obolenja in terapevtskih ukrepov. Pojavlja se pri eni tretjini vseh rakavih obolenj, ali zaradi samega obolenja oziroma razrasta metastaz, ki moti odtok limfne tekočine, ali zaradi limfadenektomije, ter operativne odstranitve primarnega tumorja, kjer operacija poškoduje limfne poti, ali kot posledica fibrozno spremenjenega tkiva po radioterapiji, kjer je prav tako moten limfni odtok. Pojavnost limfedema pri zdravljenju melanoma je pogosta, vendar pri nas še vedno neprepoznana. Nezdravljen limfedem pogosto vodi v ponovitve erizipelov in v enormno povečanje določenega predela telesa. Zato sta izredno pomembna preventiva in hitro prepoznavanje limfedema z napotitvijo na ustrezno zdravljenje. Da bi preprečili zapoznelo diagnozo in zdravljenje limfedema po zdravljenju raka ter posledične zaplete, mora zdravnik v času spremljanja bolnika aktivno iskati znake in simptome limfedema ter bolnike s težavami takoj zdraviti ali napotiti. Še pomembneje pa je, da bolnik že ob zdravljenju osnovne bolezni dobi ustrezne informacije o možnosti nastanka lifedema ter sam zazna že zgodnje otekanje in na to opozori svojega terapevta, ki nato bolnika napoti na čim prejšnje ustrezno zdravljenje limfedema. Zdravljenje se sestoji iz faze dekongestije, kjer z različnimi metodami, najpogosteje kompresijsko terapijo s kratkoelastičnimi povoji, evakuiramo edem. Tej fazi sledi vzdrževalna faza, kjer z medicinskimi kompresijskimi pripomočki vzdržujemo needematozno stanje.

Abstract (Eng)

Secondary lymphoedema is one of the most common complications after the surgical treatment of malignancies. The incidence rate depends on the cancer site and therapeutic measures. It occurs in one third of all cancers, either due to the disease itself or because of the growth of metastases interfering with the lymphatic fluid drainage, due to lymphadenectomy or surgical removal of the primary tumour, where the surgical procedure can damage the lymphatic pathways, or as a result of fibrous changes to the tissue after radiotherapy, which also interferes with lymphatic fluid drainage. The incidence of lymphoedema is common in the treatment of melanoma, yet still unrecognised in Slovenia. If left untreated, lymphoedema often leads to recurrences of erysipelas and an enormous enlargement of a specific body part. Therefore, prevention and early detection of lymphoedema with referral for appropriate treatment are of utmost importance. To prevent late diagnosis and treatment of lymphoedema after cancer treatment and subsequent complications, the physician must actively look for signs and symptoms of lymphoedema during patient follow-up and immediately treat such patients or refer them for further treatment. To continue, it is even more important that the patient gets the information about the possibility of developing lymphoedema already during treatment of the primary disease, and that the patient detects the swelling early enough and reports it to his/her therapist who must then refer the patient for immediate lymphoedema treatment. The treatment consists of a decongestion phase, where the oedema is evacuated using different methods, most often compression therapy with short-stretch bandages, and a maintenance phase, where we maintain the non-oedematous state using medical compression aids.