CLT Post-Surgical & Oncology Lymphedema Care 1 — Questions and Answers
Question 1: The sentinel lymph node biopsy (SLNB) was developed to:
- Replace MLD as a diagnostic tool
- Reduce lymph node removal by identifying the first draining node from a tumor (Correct answer)
- Increase lymph node removal accuracy
- Detect lymph node metastasis after chemotherapy
Correct answer: Reduce lymph node removal by identifying the first draining node from a tumor
SLNB identifies the first lymph node receiving drainage from a tumor site, allowing surgeons to remove only that node initially and spare others if it is cancer-free.
Question 2: Axillary web syndrome (cording) is characterized by:
- Infection of axillary lymph nodes
- Palpable cord-like structures under the skin causing restricted arm movement (Correct answer)
- Excessive scar tissue in the axillary incision
- Seroma formation after surgery
Correct answer: Palpable cord-like structures under the skin causing restricted arm movement
Axillary web syndrome presents as tight, cord-like structures of thrombosed lymphatic vessels extending from the axilla down the arm, limiting shoulder abduction.
Question 3: The recommended time to begin post-operative MLD after axillary lymph node dissection is generally:
- Immediately in the operating room
- Within 24–48 hours, as soon as incisions are stable (Correct answer)
- Only after all swelling resolves spontaneously
- 6 months post-operatively to allow full healing
Correct answer: Within 24–48 hours, as soon as incisions are stable
Early MLD can begin within 24–48 hours post-operatively once surgical drains are removed and incisions are stable to prevent early fluid accumulation.
Question 4: Which cancer treatment besides surgery carries the highest risk of secondary lymphedema?
- Systemic chemotherapy
- Radiation therapy to regional lymph nodes (Correct answer)
- Targeted therapy (trastuzumab)
- Hormonal therapy (tamoxifen)
Correct answer: Radiation therapy to regional lymph nodes
Radiation to regional lymph nodes causes fibrosis and scarring of lymphatic vessels and nodes, significantly increasing lymphedema risk, especially combined with surgery.
Question 5: A CLT treating a patient with active cancer should coordinate care with the oncologist primarily because:
- MLD can interfere with chemotherapy drug distribution
- CDT timing must align with treatment phases, and certain conditions alter contraindications (Correct answer)
- Insurance requires physician co-signature for billing
- Patients with cancer cannot tolerate exercise
Correct answer: CDT timing must align with treatment phases, and certain conditions alter contraindications
Active cancer treatment creates changing clinical situations where standard CDT contraindications and precautions may need to be modified based on current treatment status.
Question 6: Seroma formation after breast cancer surgery is relevant to lymphedema care because:
- Seroma is a type of lymphedema
- Repeated seroma aspiration can further damage lymphatic vessels and increase lymphedema risk (Correct answer)
- Seromas prevent MLD from being effective
- Seroma fluid must be redirected using MLD techniques
Correct answer: Repeated seroma aspiration can further damage lymphatic vessels and increase lymphedema risk
Repeated surgical aspiration of seromas can damage remaining lymphatic vessels and scar tissue pathways, potentially increasing the risk of subsequent lymphedema.
CLT Post-Surgical & Oncology Lymphedema Care 1
The sentinel lymph node biopsy (SLNB) was developed to: