Question

1. Oftentimes, when individuals have cancerous tissue removed (such as breast tissue), lymphatic tissue is removed as well. What condition would you expect to result after this lymphatic tissue is removed. Why?  

2. Gold medalist Chris Mears is a diver who suffered from a ruptured spleen several years ago. He almost died from this injury. When an individual suffers from a ruptured spleen, what would you guess is the most immediate danger?  

Answer 1

Oftentimes, when individuals have cancerous tissue removed (such as breast tissue), lymphatic tissue is removed as well. What condition would you expect to result after this lymphatic tissue is removed. Why?  

Patients diagnosed with cancer may have involvement of adjacent lymph nodes draining the area as well as there may be metastasis to distant organs. So during staging the cancer, patient is evaluated for involvement of lymph nodes and distant metastasis. If they are involved treatment is planned accordingly.

If a patient has involvement of lymph nodes, they may have lymph nodes removed as a part of surgical treatment or can be damaged due to other treatments like radiation therapy. In some patients they are removed to reduce the risk of recurrence. Sometimes lymph nodes are blocked by cancer.

A build-up of lymph fluid in an area of area drained by those lymph nodes/ channels. This causes swelling in the area called lymphoedema.

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It is a long-term (chronic) condition. It can’t be cured, but it can usually be well controlled.

Not everyone who has cancer or cancer treatment develops lymphoedema, it is more common in some cancers like cancer of breast, vulval, cervical, penile cancer etc. Some other risk factors can increase risk of lymphoedema are obesity, varicose veins or other blood vessel problems in the area, skin infection., inactivity,

Exercise and movement can help to lower the risk of developing lymphoedema. Early physiotherapy after breast cancer surgery, exercise programme including weight lifting, swimming and water-based exercise, aerobics and yoga are very helpful. Initially one need help of a physiotherapist to teach them. Other than this take care to prevent trauma, keeping the area moisturized, wearing insect repellent to avoid bites and stings, avoid extremes of temperature, both hot and cold, avoid injections and blood pressure measurement in affected area and wearing a compression garment is helpful.

Contact immediately if the area becomes swollen, sore, red and hot because it indicate complication.

Another long-term effect after axillary lymph node dissection in women with breast cancer is cording or banding or axillary web syndrome. Here the connective tissues in the armpit get inflamed, which forms one or more tight bands feeling something like a guitar string. It can extend down the arm past the elbow, possibly as far as the wrist or thumb This usually happens within the first few weeks or months after the operation.

Cording is harmless but can be painful and can limit arm movement. Regularly massaging the area and stretching exercises are helpful.

Gold medalist Chris Mears is a diver who suffered from a ruptured spleen several years ago. He almost died from this injury. When an individual suffers from a ruptured spleen, what would you guess is the most immediate danger?

Blunt abdominal trauma usually from road traffic accidents, sports injuries and physical assault may result in spleen injury or rupture.

A ruptured spleen is a medical emergency and may result in death from massive internal haemorrhage and the problems that result from excessive haemorrhage that is hypovolemic shock and death.

Emergency doctors should suspect a ruptured spleen in any person involved in an accident that might have caused injury to their left-lower chest or left-upper abdomen. The patient may also have associated rib fractures, pelvic fracture, and spinal cord injury

Evaluation must be carried out very fast without any delay to prevent complications. Main symptoms are pain in the upper-left part of the abdomen. Referred pain may occur in the left shoulder and chest wall as a result of may irritation of the phrenic nerve, known as Ker’s sign. Pain increases in severity when the individual breathes in.

Continuous monitoring of heart rate and blood pressure is must. Internal bleeding is confirmed by low blood pressure, a high heart rate, and a positive FAST ultrasound scan.

In the emergency trauma setting, an ultrasound scan is performed while other monitoring and management continue uninterrupted. This scan is done according to the focused assessment with sonography for trauma (FAST) protocol, which forms part of the advanced trauma life support (ATLS) protocol.

Treatment protocol is almost exclusive surgical management in hemodynamically unstable clients and selective use of nonsurgical management in hemodynamically stable patients.

If the bleeding is not severe and the person is stable, they will need to be monitored in the hospital for a while. Even if surgery is not needed, patient may still have active bleeding and may require blood transfusions. Further interventions may be needed to manage the bleeding of a ruptured spleen. One technique is splenic angioembolization which is an embolization procedure of splenic artery carried out through the femoral artery to stop the bleeding.

Emergency surgical interventions may be required in hemodynamically unstable client to find out source of bleeding and repair it. A laparoscopy requires only small incisions and a laparoscope to visualize the spleen. Laparotomy is done when a larger incision is made to open up the abdomen. Depending on the extent of the injury and bleeding, the doctor may perform a selenography (repair spleen by suturing ) or splenectomy (removal of spleen).