Lymphedema and Radiation Heart Disease

by Richard Mitchell, MD

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    00:01 Mentioned previously, surgery, so when we resect tumors and then resect lymph nodes, we can get lymphedema.

    00:10 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.

    00:21 That's edema fluid, there's not adequate drainage out.

    00:25 That can cause stasis ulcers.

    00:27 That can cause, make that leg more prone to infections and can make it more prone to tumors, secondary tumors, such as limb angiosarcomas.

    00:40 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.

    00:59 It has secondary consequences.

    01:03 Radiation.

    01:07 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.

    01:28 The heart itself doesn't turn over.

    01:30 The myocytes are terminally differentiated cells, so they're not proliferating.

    01:34 That's not the problem.

    01:36 The inflammation that is elicited by the radiation and the subsequent scarring elicited by that radiation can lead to a restrictive cardiomyopathy.

    01:45 And what is being shown with what the arrows are pointing to is the pericardium around this heart has become fibrotic and thickened.

    01:54 It's that brighter, white line all the way around the heart on the right side.

    02:00 Now this heart will squeeze perfectly well, but it won't be able to relax.

    02:06 So because of the radiation, because of our treatment, this patient has a restrictive cardiomyopathy and will have a significant degree of heart failure.

    02:16 Radiation isn't just affecting the pericardium.

    02:19 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.

    02:32 You can also get micro vascular disease.

    02:35 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.

    About the Lecture

    The lecture Lymphedema and Radiation Heart Disease by Richard Mitchell, MD is from the course Cancer Morbidity and Mortality.

    Included Quiz Questions

    1. Disruption of the lymphatics by a lymph node resection
    2. Blockage of lymph drainage by metastatic tumor
    3. Hypoproteinemia caused by tumor metabolism
    4. Local limb vascular hypertension associated with tumor
    5. Generalized edema associated with tumor

    Author of lecture Lymphedema and Radiation Heart Disease

     Richard Mitchell, MD

    Richard Mitchell, MD

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