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Stanford Report, February 2, 2000

Lymphedema clinic joins Stanford

BY MITCH LESLIE

Stanford is expanding its clinical services to treat the common circulatory disorder known as lymphedema by combining the functions of the former Stanford Lymphedema Center and the privately run Aurora Lymphedema Clinic.

The Aurora clinic, formerly located in San Francisco, was one of the oldest and best known lymphedema clinics in North America. The clinic was founded by Saskia Thiadens, who also directs the National Lymphedema Network, the primary organization for lymphedema education and patient advocacy. Thiadens has decided to donate the clinic to Stanford. Stanley Rockson, MD, associate professor of medicine at Stanford University School of Medicine, will serve as the director of the combined centers.

Lymphedema is an accumulation of fluid in tissues that results from a damaged or diseased lymphatic system. This "alternate" circulatory system, which extends throughout the body, normally collects fluids and proteins that have escaped into the tissues and returns them to the bloodstream. Several diseases can obliterate lymphatic vessels, but the most common cause of lymphedema in the United States is cancer surgery. When lymph nodes are removed to limit the spread of cancerous cells, the lymphatic circulation to surrounding tissues can be disrupted.

According to Rockson's estimates, about six to 20 percent of women who have breast cancer surgery will develop lymphedema. It also often develops after operations for pelvic or abdominal tumors. In addition, lymphedema can arise from other forms of trauma and infection, or it can be inherited.

The resulting fluid buildup can lead to swelling that interferes with the function of the affected arm or leg. Over the long term, the composition of the skin can change, compromising its structural integrity and increasing the risk of infections.

Lymphedema is underdiagnosed and undertreated because both doctors and patients are ill-informed about the disorder, Rockson said. However, specific diagnostic procedures and effective therapies are available. One example is a treatment called decongestive lymphatic therapy that is among a variety of treatments offered at Stanford. It comprises specific massage techniques, multilayer bandaging, skin care, exercise and the use of compressive garments.

With the donation of the Aurora Clinic to Stanford, the San Francisco facility will close. The merged clinic will be known as the Stanford Aurora Center for Lymphatic and Venous Disorders and will be located within the Stanford Medical Center complex. The center will promote intensive diagnostic, therapeutic, educational and research efforts for lymphedema and allied disorders. SR