Giving Patients Back What Cancer Took Away
Plastic surgeon Dr. Josh Vorstenbosch, Director of the McGill University Health Centre (MUHC)’s Surgical Lymphedema Program, wants to “give patients back what cancer took away,” he says. “Our job as oncologic reconstructive surgeons is to do what we can to restore that patient’s quality of life, to bring them as close as we can to how they were before having cancer.”
With the support of Dr. Mirko Gilardino, Chief, Division of Plastic Surgery (MUHC) in “helping to push the program forward,” Dr. Vorstenbosch is ready to perform innovative surgical lymphedema procedures that promise to improve the quality of life of cancer survivors suffering from lymphedema. Simply put, lymphedema is a chronic inflammatory condition involving swelling of one or more limbs. It can occur when the lymphatic system is not working properly and doesn’t circulate fluid the way it’s supposed to, which can happen following cancer treatment.
“Think about things you do to care for yourself,” Dr. Vorstenbosch says. “We spend 30 or 60 seconds in the morning and night brushing our teeth, and there’s all the other little things we do. Well, another thing lymphedema patients need to do is use compressive wraps, or they may need to wear a sleeve. Some will spend three hours a day doing this. As you can imagine, this has a major impact on their quality of life. Lymphedema patients face this every single day. If we can improve that with a surgical option, it will have profound impact on their lives.”
Specialized Equipment for “Supermicrosurgeries”
One of these surgical options is, essentially, a lymph node transfer. “You can think of this as replacing the lymph node that’s been removed with another one from somewhere else in the body,” Dr. Vorstenbosch explains. The second surgery uses “stitches finer than a human hair to divide the lymphatic channel before it’s blocked, then bypass it into a vein.”
Dr. Vorstenbosch has already performed a few successful lymph node transfers and patients are doing well. However, without the specialized equipment they need, “we just don’t have the capacity to meet the demand that’s out there.”
New state-of-the-art equipment is required in order to offer these groundbreaking surgeries through the MUHC’s Surgical Lymphedema Program, an initiative supported by our Together Against Cancer campaign (a unique collaboration between the Montreal General Hospital Foundation and the Cedars Cancer Foundation).
What is Lymphedema?
Many cancer survivors who undergo surgery or radiation involving the lymph nodes — while thankfully cured of cancer — go on to suffer from lymphedema. “For example, about 25% of patients who have radiation to their lymph nodes would develop lymphedema, while [in] a subset of patients who have many lymph nodes removed from their armpit, and then have radiation, it can be up to 40%,” he says.
He also notes that patients with urological cancers or sarcomas have a high risk of lymphedema. Dr. Vorstenbosch’s data indicates this debilitating condition affects approximately 25% of patients with gynecologic cancers or patients who undergo lymph node dissection for melanoma, and 20 to 25% of breast cancer patients.
“Bringing it back to breast cancer, if somebody has lymph nodes removed from their axilla (their armpit), then have radiation there, there’s a very high chance they’ll develop lymphedema. When you consider that one in eight women will be affected by breast cancer, then you compound it, this is not an insignificant number. This is a real number of women.”
“In the context of cancer-related lymphedema, it almost uniformly occurs when the lymphatic channels are cut or blocked due to scarring from radiation,” Dr. Vorstenbosch explains. “We’ve all had times where our hand or foot was swollen, then over time that fluid disappears because it’s brought back into circulation through the lymphatic channels.” The access point is the lymph nodes, he continues, noting these nodes are located in the groin, armpit, and other parts of the body. But often, that’s where cancer will go.
“In cancer treatments, the nodes will be removed, or a targeted node will be removed, or there will be radiation. If you remove the node, then you cut off the transit of that fluid and it gets stuck in the limb. So our goal is to find a way for that fluid to get back to the body.”
The Future of Lymphedema Surgery
Certainly, beyond physical discomfort and psychological impacts, this swelling can greatly affect a person’s range of motion in the affected limb, and their ability to perform basic tasks most of us take for granted — much less go to work or care for their children. The disease also comes with a risk of dangerous bacterial infection. And managing lymphedema with therapies such as compression and bandages can consume several hours a day, with no end in sight as there is no cure.
“The Lymphedema Clinic, led by Dr. Anna Towers, already has a well-established patient outcomes research program and is excited to work with surgeons and surgical lymphedema patients. This collaboration uniquely positions the MUHC Surgical Lymphedema Program as the only one in the country with the ability to study outcomes and evaluate certain patient and surgical parameters to adjust surgical procedures,” says Dr. Vorstenbosch, expressing gratitude to MUHC President and Executive Director Dr. Lucie Opatrny and its Surgeon-in-Chief Dr. Liane Feldman for championing this project as part of Dr. Feldman’s transformative Future of Surgery initiative. The Cedars Cancer Centre and MUHC Cancer Care Mission Chief Dr. Armen Aprikian have also been helpful sources of support for the program, he notes.
“We know enough about screening patients that we can say patients will probably be better. Some will get a little bit better; some will get a lot better, but we have enough data to say that this is going to have a positive impact on the patient’s life. To be one of few people offering this in the country, and drive this surgical treatment forward, is really humbling.”
Together Against Cancer is a unique collaboration between the Cedars Cancer Foundation and the Montreal General Hospital Foundation. Our goal is to raise $100 million to support transformative projects that will improve the experience, quality of life, and outcomes of cancer patients. Join us and give the best you can. Togetheragainstcancer.ca
