Jinekolojik Kanser Hastalarında Alt Ekstremite Lenfödemi
Özet
Lenfödem, lenf sıvısının dokularda birikmesiyle oluşan, jinekolojik kanser tedavileri sonrasında %20-45 oranında görülen kronik bir komplikasyondur. Bölgesel lenfadenektomi ve adjuvan radyoterapi jinekolojik kanserlerde en önemli risk faktörleridir. Erken evre serviks ve endometrium kanserlerinde sentinel lenf nodu (SLN) haritalaması, lenfödem gelişme riskini %10'un altına düşürmektedir. Over kanserinde tümör yayılım riski nedeniyle SLN kullanılamazken, vulva kanseri tedavisi %25-75 ile en yüksek lenfödem insidansına sahiptir. Tanıda öykü, fizik muayene, Stemmer belirtisi ve biyoempedans spektroskopi gibi yöntemler kullanılır. Uluslararası Lenfoloji Derneği lenfödemi Evre 0'dan 3'e kadar sınıflandırır. Bu hastalık hastaların yaşam kalitesini, uyku düzenini ve günlük aktivitelerini olumsuz etkiler. Sağkalım sürelerinin uzamasıyla artan bu komplikasyon için hastaların tedavi öncesi ve sonrasında bilgilendirilmesi ve takibi büyük önem taşır.
Lymphedema is a chronic complication resulting from the accumulation of lymph fluid in tissues, occurring at a rate of 20-45% following gynecological cancer treatments. Regional lymphadenectomy and adjuvant radiotherapy are the most significant risk factors in gynecological cancers. In early-stage cervical and endometrial cancers, sentinel lymph node (SLN) mapping reduces the risk of lymphedema development below 10%. While SLN cannot be used in ovarian cancer due to the risk of tumor dissemination, vulvar cancer treatment carries the highest incidence of lymphedema at 25-75%. Diagnosis utilizes history, physical examination, Stemmer's sign, and bioimpedance spectroscopy. The International Society of Lymphology classifies lymphedema from Stage 0 to 3. This condition negatively impacts patients' quality of life, sleep patterns, and daily activities. With prolonged survival times increasing this complication, informing and monitoring patients before and after treatment is of paramount importance.
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