Mentioned previously, surgery, so when we
resect tumors and then resect lymph nodes,
we can get lymphedema.
Shown on the left hand side, if
you look at the woman's left leg,
it is about 50%, larger overall than the right leg.
That's edema fluid, there's
not adequate drainage out.
That can cause stasis ulcers.
That can cause, make that leg more prone to
infections and can make it more prone to tumors,
secondary tumors, such as limb angiosarcomas.
Similarly, the woman on the right is demonstrating
that she has lymphedema in her right arm,
and there is marked swelling, this is
woman who underwent breast cancer surgery
with a mastectomy and axillary node dissection,
and so there's no drainage out of that tissue.
It has secondary consequences.
If we are treating, for example, breast
cancer, or lung cancer with radiation,
in many cases, depending on where the
tumor is, we are going to have significant
effects on the heart because the heart is in
the way as I'm shooting in radiation beams
that are going to affect a breast cancer or
lung cancer, especially on the left hand side.
The heart itself doesn't turn over.
The myocytes are terminally differentiated
cells, so they're not proliferating.
That's not the problem.
The inflammation that is elicited by the
radiation and the subsequent scarring
elicited by that radiation can lead
to a restrictive cardiomyopathy.
And what is being shown with what the arrows are
pointing to is the pericardium around this heart
has become fibrotic and thickened.
It's that brighter, white line all the
way around the heart on the right side.
Now this heart will squeeze perfectly
well, but it won't be able to relax.
So because of the radiation, because of our treatment,
this patient has a restrictive cardiomyopathy
and will have a significant degree of heart failure.
Radiation isn't just affecting the pericardium.
It's also affecting the vessels that are
around the pericardium, and you can get
extensive, aggressive accelerated
atherosclerosis following radiation treatment
so you can get macro vascular
disease, that's the coronary artery.
You can also get micro vascular disease.
It's showing a small microscopic infarct,
again due to damage to the endothelium,
to the smooth muscle cells within the small
penetrating arteries within the myocardium.