Lymphedema in Head and Neck Cancer

The readers of Lymphatic Research and Biology are certainly well-acquainted with the paradoxical coexistence of high prevalence and low recognition in the association of acquired lymphedema and the treatment of cancer. This phenomenon is compellingly evident in the setting of head and neck cancer, where the survivors are particularly prone to early and late onset of lymphedema in relationship to therapeutic interventions. It is estimated that oropharyngeal cancer is diagnosed in 45,000 individuals annually in the United States, ¹ a figure that is anticipated to grow substantially under the influence of papilloma virus infection.^2,3

It is likely that the lymphedema of the head and neck that ensues following treatment of these cancers remains under-recognized and undertreated by clinicians. In the current issue of Lymphatic Research and Biology, Ridner and colleagues seek to explore this problem by attempting to prospectively define the prevalence and nature of late-effect internal, external, and combined lymphedema and fibrosis in patients with head and neck cancer. ⁴

The authors undertook a four-year, prospective, longitudinal, descriptive study in which they documented the rates and severity external, internal and combined lymphedema and fibrosis that ensued in the enrolled head and neck cancer survivors. Surprisingly, the authors documented an arresting degree of pre-treatment lymphedema; furthermore, approximately 75% had moderate-to-severe external or internal lymphedema as a late complication of treatment, while some 47% had moderate-to-severe fibrosis.

This well-executed prospective investigation underscores the magnitude and severity of the problem of lymphedema in association with head and neck cancer. The authors' observations merit both further study and translation into the realm of clinical awareness and practice.