This review paper is just out, and is available open source. I will be posting articles for many months to thoughtfully discuss all the information contained in the paper about lymphatic structure and function, lymphatic imaging, the impact of cancer and cancer treatment on the lymphatics, lymphatics and venous disease, and how to use imaging to direct clinical treatment. Just as an aside, I will also discuss some “myths” the paper debunks about lymphatic function and manual lymphatic drainage (MLD) – spoiler alert, the MLD therapists were right about everything they told me. This is the definitive paper about lymphatic function and I am proud to have my  name on it, summarizing almost two decades of work. Stay tuned.

The Development and Treatment of Lymphatic Dysfunction in Cancer Patients and Survivors
by Melissa B. Aldrich ,John C. Rasmussen ,Caroline E. Fife, Simona F. Shaitelman, and Eva M. Sevick-Muraca

In this review, we describe how cancer metastasis, lymph node dissection, and radiation therapy alter lymphatic function, as visualized by near-infrared fluorescence (NIRF) lymphatic imaging. Using custom gallium arsenide (GaAs)-intensified systems capable of detecting trace amounts of indocyanine green administered repeatedly as lymphatic contrast for longitudinal clinical imaging, we show that lymphatic dysfunction occurs with cancer progression and treatment and is an early, sub-clinical indicator of cancer-acquired lymphedema. We show that early treatment of lymphedema can restore lymphatic function in breast cancer and head and neck cancer patients and survivors. The compilation of these studies provides insights to the critical role that the lymphatics and the immune system play in the etiology of lymphedema and associated co-morbidities.