• Patient education about lymphedema with one to one, individual instruction
• Three certified therapists — two Vodder certified and one by the Academy of Lymphatic Studies — who treat lymphedema with all components of CDT (complete decongestive therapy)
• CDT is inclusive of MLD (manual lymphatic drainage) massage, compression bandaging, compression garments, skin care, remedial exercises and preventative education. Teaching all of these components to patients with lymphedema.
• Free monthly education classes about lymphedema and education for preventative measures that can be taken to avoid development of lymphedema. Classes offered once a month alternating between Palmetto Health Richland and Palmetto Health Baptist campuses. In addition, monthly classes are offered at South Carolina Oncology Associates, 166 Stoneridge Dr., Columbia, S.C.
• Assistance and direction in obtaining specific compression sleeves and garments.
• Education about the latest products available in lymphedema management.
• Exercises in obtaining normal range of motion following breast cancer surgery with a physician prescription.
• Physician referral (faxed or written) is required

Staff:

• Kel Jansen, OTR/L, CLT-LANA (Vodder and National Board of Lymphology Association of North America certifications)
• Susan Howell Spires, OTR/L, CLT (Vodder certified)
• Lynette Phelps, OTR/L, CLT (Academy of Lymphatic Studies certification)
  

Hours of Operation: 8 a.m. - 4:30 p.m., Monday thru Friday

Location: Rehabilitative Therapies Department in basement of main hospital on the Palmetto Health Baptist campus. The D elevator opens adjacent to the department.

How to Contact: Call 296-3564 or fax prescription referrals to 296-3947.

You are invited to attend one of our free workshops to learn about lymphedema prevention and general tips for post breast cancer surgery exercises.

Conducted by
Lynette Phelps , OTR/L, CLT
Occupational Therapist and Certified Lymphedema Therapist
&
Susan Howell Spires, OTR/L, MLDT
Occupational Therapist and Certified Lymphedema Therapist

Campus: Palmetto Health Baptist, 1501 Sumter St.
• January 3, 2005, Classroom A
• March 1, 2005, Classroom E
• May 2, 2005, Classroom A
• July 5, 2005, Classroom D
• September 6, 2005, Classroom D
• November 1, 2005, Classroom D

OR

Campus: Palmetto Health Richland
Location: South Carolina Cancer Center, Mandanis Classroom
• February 3, 2005
• April 5, 2005
• June 1, 2005
• August 3, 2005
• October 5, 2005
• December 14, 2005

Time: each class starts at 4 p.m. and ends at 5 p.m.

Note: Patients need to attend only one session as the same material is covered at each workshop. Free consultations are available to assess if an individual is getting Lymphedema.

For more information or to register for a workshop or assessment consultation, call (803) 296-3564.

Hyperbaric Oxygen Therapy for Lymphedema Associated with Breast Cancer

September 2001-Researchers from Palmetto Health and the University of South Carolina began the first study in the United States on whether hyperbaric oxygen can help eliminate a painful condition called lymphedema. For more information about this study call 803-434-7812.

Recent studies suggest that hyperbaric oxygen therapy (HBO) does improve lymphedema associated with breast cancer. One study in Germany found that of the 44 patients who had received surgery and radiation for breast cancer about 32 with lymphedema showed improvement after HBO.

MammoSite RTS Brachytherapy
MammoSite RTS treatment is different than conventional breast treatment. With conventional therapy, the patient first must undergo breast surgery, followed by tissue healing and then chemotherapy before being able to be treated with radiation. If a patient is undergoing chemotherapy, it can take six months before radiation treatment can begin. With MammoSite RTS, a catheter is placed in the breast during surgery to prepare for radiation treatment to begin within a few days.

What to expect during a MammoSite Procedure
During the scheduled surgical treatment, a surgeon will remove the breast tumor and take a biopsy of surrounding lymph nodes to which the tumor may have spread. If a pathologist determines the nodes are negative (-), a MammoSite catheter is placed in the cavity where the tumor had been growing. A balloon around the catheter is filled with sterile saline and radiographic dye to fill the cavity. A sterile dressing is applied to the surgical site and the patient is then sent to a recovery room. The following day, the patient is taken to the Radiation Oncology department for the x-rays and catscan needed to prepare the individual treatment planning.

MammoSite treatment usually is started within 48 hours following the treatment planning session and is done on an out-patient basis. A special device, the MammoSite RTS, delivers radiation from inside the cavity twice a day over a course of five days. The device targets the area where tumors are most likely to recur and minimizes radiation exposure to healthy tissue. No source of radiation remains in the patient’s body between treatments or after the final procedure. When the therapy is concluded, the balloon is deflated and the catheter is easily removed.

A Patient and Surgeon’s Perspective
Seventy-nine-year-old Nell Conner likes to keep busy. Whether she’s cutting the grass on her riding mower, tidying up around the house or attending church activities, she stays very active. So, when she had an opportunity to become the first breast cancer patient at the South Carolina Comprehensive Breast Center to be treated with a new procedure and knew that it would reduce her treatment time, she was excited by the prospect.

“Dr. Sweatman explained the procedure to me and said that I was a candidate,” she said. Alden Sweatman is a Columbia surgeon who is one of the participating physicians at the South Carolina Comprehensive Breast Center. Sweatman performed Conner’s previous surgery so she trusted his judgment. “When he explained that one of the benefits of the procedure was having radiation twice a day for five days instead of for six weeks, I was glad to hear it. Because I live in Winnsboro, traveling to Columbia every day for that long is difficult.”

Many breast cancer survivors soon will share Conner’s relief. The new procedure, approved by the Federal Drug Administration in May, is expected to be a shorter but equally effective method of radiation therapy for some women who’ve had lumpectomies (the surgical removal of breast tumors).

Mary Ellen Doyle, administrative director for the South Carolina Cancer Center, said, “Palmetto Health is excited to be among the first in the country to offer this new internal treatment option for breast cancer patients who, at a very stressful time, are confronting difficult choices regarding their. The fact that MammoSite is minimally invasive for patients, coupled with the short treatment time, could make it easier for more women to consider having a lumpectomy.

Sweatman believes the procedure has significant benefits for women. “This type of procedure delivers a more focused radiation dose,” he said. “Instead of delivering radiation to the entire breast and surrounding skin, it’s very targeted. Since it offers women the convenience of shorter radiation times, it makes a big difference for patients who live in rural areas and have to travel to Columbia for treatment.”

Conner had a benign lump removed years ago and lost a sister to breast cancer five years ago. She’s been having yearly mammograms and believes in early detection. “When they found my sister’s cancer, it was out of control,” she said. “Since then, the doctors have been keeping tabs on me. I know that’s why they caught it so early. After a short period of time, I’m back to my regular level of activity. I couldn’t be happier.”

Benefits of MammoSite RTS:

• Reduction in the chances of side effects such as burning, fatigue, scarring, dry cough and heart damage.
• Radiation Treatment can begin immediately; there is no delay by waiting for the completion of chemotherapy and surgical healing.
• MammoSite treatment takes only five days as opposed to seven to eight weeks with conventional radiation treatment.

Who is a Candidate for MammoSite RTS Treatment?
MammoSite treatment is available for breast cancer patients based on the following criteria:

• Age of patient (45 years or older)
• Tumor size (less than 2.5 cm. or 1" in size)
• Type of tumor (must be an invasive ductal tumor)
• Location of tumor
• No positive node involvement

Most insurance companies cover MammoSite RTS treatment. For more information on this procedure call 803-434-3400.

For more information on MammoSite RTS Treatment you may visit Proximatherapeutics online.

Surgery is the most common treatment for breast cancer. An operation to remove the breast is called a mastectomy. Lumpectomies and segmental mastectomies are types of breast-sparing surgeries that remove the cancer but not the breast. Breast-sparing surgeries usually are followed by radiation therapy to destroy cancer cells that may remain. Often, the lymph nodes under that arm also are removed to help determine whether cancer cells have entered the lymph system.

Sentinel Node Biopsy

Our Breast Center performs sentinel node biopsies more often than any other institution in the state. Sentinel node biopsy prevents people from having unnecessary surgeries.

The sentinel node is the first lymph node that filters fluid from the breast. Many cancer experts believe that malignant cells reach the sentinel node first and that this lymph node is more likely to contain cancer cells.

Based on this assumption, the node most likely to contain malignant cells should be removed and analyzed. If the sentinel is free of cancer cells, then it is highly unlikely that the other nodes are positive. This technique, combined with lumpectomy, is easily performed as an outpatient procedure and causes less pain and deformity than an axillary node dissection.

Procedure
After the patient is given general anesthesia in the operating room, a radioactive tracer and blue dye are injected into and around the tumor. Sometimes the tracer injection is given as a preoperative procedure. With a small, hand-held Geiger counter, the surgeon tracks the path the tracer takes as it travels away from the breast and under the arm to the first lymph node. Once located, the sentinel node is removed and sent to the laboratory for diagnosis.

If the results are negative, it is assumed that the cancer has not spread and there is no need for further surgery. If the sentinel node is positive, the surgeon may perform an axillary node dissection to assess how many other lymph nodes are affected.

Advantages
Because sentinel node biopsy removes fewer lymph nodes than axillary lymph node dissection, many patients have no side effects. Pain, nerve damage, and lymphedema are more common when additional lymph nodes are removed with the sentinel node. Most patients spend a day or less in the hospital.

There is no need for a drain, or physical therapy exercises. The recuperation from the procedure is faster. Typically, patients are performing regular activities within a few days. The incision is well healed within a few weeks.

A sentinel lymph node biopsy can lead to a more accurate assessment of whether the cancer has spread to the lymph nodes. In a traditional axillary dissection, the pathologist receives at least ten lymph nodes or more; there is no way of telling which one is the sentinel lymph node. So the pathologist makes one cut in each lymph node and looks for cancer. When the pathologist receives only one, or a few, lymph nodes from a sentinel lymph node procedure, he or she can make many cuts through that lymph node to look for cancer. A negative sentinel lymph node(s) indicates a more than 95 percent chance that the remaining lymph nodes in the axilla also are cancer free. Therefore, there is no need to undergo a full axillary lymph node dissection, or to risk the long term complications and side effects from an axillary dissection.