Ätiologie sekundärer Lymphödeme onkologischer Genese^[*]

 

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Zusammenfassung

Neoplasien stellen eine wichtige Ursache für sekundäre Lymphödeme dar. Dabei kann der Tumor selbst (malignes Lymphödem) oder seine Therapie das Lymphödem auslösen. Die wichtigsten Neoplasien im Hinblick auf Lymphödeme betreffen – in absteigender absoluter Lymphödem-Inzidenz – die Mamma, die Prostata, die Haut (Melanom), das Ovar und die Harnblase. Jedoch können auch zahlreiche andere Tumore direkt oder indirekt ein sekundäres Lymphödem auslösen. Ganz klar erkennbar ist, dass mit der Radikalität der Therapien die Inzidenz von Lymphödemen zunimmt; Daten für einen Zusammenhang mit dem Schweregrad fehlen jedoch. Bei zunehmenden Überlebensraten steigt daher die Prävalenz von Patentinnen und Patienten mit einem Lymphödem mit physischen und/oder psychischen Beschwerden und Einschränkungen im Erwerbsund/oder Privatleben.

Summary

Malignancies are among the major reasons for secondary lymphoedema. On the one side, the tumour itself can induce the lymphoedema or, on the other side, the applied therapy. The most important malignancies – in descending order of the absolute incidence of lymphoedema – are tumours of the (female) breast, the prostate, the skin (melanoma), the ovaries and the bladder. Of course, several other malignancies can also induce lymphoedema, either directly or indirectly. It is evident that the incidence is directly coupled with the radicalism of the therapy applied; nevertheless, data dealing with the relation of the severity of the lymphoedema and the therapy are missing. With increasing survival rates the prevalence of lymphoedema-patients with physical and/or psychical complains and restrictions within their professional and even their private life is rising.

Résumé

Les tumeurs malignes sont les premières causes de lymphoedèmes secondaires. D’une part, la tumeur elle-même peut provoquer un lymphoedème et d’autre part celui-ci peut être induit par le traitement de la tumeur. Les tumeurs malignes les plus fréquentes – en ordre décroissant pour l’apparition d’un lymphoedème – concernent le sein (chez la femme), la prostate, la peau (mélanome), l’ovaire et la vessie. Il est évident que beaucoup d’autres tumeurs malignes peuvent induire un lymphoedème, de manière directe ou indirecte. Le degré d’agressivité d’un traitement est également en relation directe avec l’apparition d’un lymphoedème ; néanmoins, on manque de données pour établir une relation entre la gravité d’un lymphoedème et la thérapie. On peut souligner que l’augmentation de la survie après traitement montre un parallèle avec l’accroissement des plaintes des patients sur le plan physique ou psychique concernant les restrictions de leur vie privée et professionnelle.

^* Die gegenständliche Arbeit entstand aus dem ersten Teil einer Dissertationsarbeit, die an der Division für klinisch-funktionelle Anatomie, Department für Anatomie, Histologie und Embryologie, der Medizinischen Universität Innsbruck erstellt wurde (85).

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