Web seminar 120 min // October 22, 2022

Cancer related lymphedema – prophylaxis and management

Lipoedema is a chronic disease of high unmet need. Challenges include lack of diagnostic tools and animal models, ignorance and prejudice, as well as getting international consensus due to limited research in this field. At the current global medical online hub MOH Talks“Latest insights in the lipoedema pathophysiology and potential new therapeutic pathways” on August 27, 2022, Drs Ramin Shayan, Tara Karnezis, and Stanley Rockson shared their cutting-edge research on this topic and discussed paradoxes and future perspectives associated with the disease.  

Lipoedema, a chronic lymphatic microvascular disease with pathological accumulation of subcutaneous adipose tissue, is often misdiagnosed as obesity or lymphedema. “There is no group more desperate than patients with lipoedema”, moderator Dr Christine Moffatt, clinical professor of skin integrity and emeritus at Nottingham University Hospital in the UK opened the 8th online event of the global MOH series, which was co-moderated by Dr Sylvain Gaillard, corporate medical affairs manager at Sigvaris Group in Switzerland. The first speaker, Dr Ramin Shayan, specialist plastic and reconstructive surgeon and director of O’Brien Institute Department at St Vincent’s Institute in Fitzroy, Victoria, Australia, shared his view on lipoedema from the plastic surgeon’s perspective.

While current treatments are limited and non-curative, one of the aims of reconstructive surgery is to help heal the body. The overall goal is to enhance patient’s quality of life by treating stigmatisation, fat-shaming, self-esteem problems, emotional distress and depression. However, surgical methods are costly, time-consuming and not feasible for all patients. The key to unravelling lipoedema are biomarkers and a molecular mechanism that can be targeted. The research group employed a comprehensive ‘omics’ platform to analyse tissue across modalities in order to find the stem cells driving the disease.

Dr Tara Karnezis, lead of lipoedema Lab presented latest findings on the identification of Bub1, a mitotic checkpoint protein involved in unregulated cell growth, as a potential therapeutic avenue to target cancer stem cells. “Bub1 is critical for lipoedema stem cell growth, which in turn is more sensitive to Bub1 inhibition than normal fat,” Dr Karnezis summarised the rationale for focussing on Bub1. Future plans include validation of Bub1 as a biomarkerto design a novel Bub1 inhibitor and to expand this knowledge into obesity and other metabolic diseases.

In the second presentation Dr Stanley Rockson, cardiologist at Stanford University School of Medicine, unravelled the clinical problem of lipoedema and presented perspectives on how to move forward. The diagnosis is currently based on clinical grounds, although diagnostic evaluation may be necessary to distinguish from other systemic disorders with overlapping phenotypes. Treatment is directed toward relief of symptoms. Efficacy of treatment interventions has not been fully evaluated and is therefore not evidence-based. In the setting of unsuccessful conservative management, lymph-sparing liposuction for symptom palliation can be considered, however, evidence-based assessment of long-term efficacy is needed. Dr Rockson’s research group identified platelet factor 4 (PF4/CXCL4) as a biomarker that could be used to diagnose lymphatic vasculature dysfunction. Furthermore, they determined that PF4 levels in circulating blood plasma exosomes were also elevated in patients with lipoedema, supporting current claims arguing that at least some of the underlying attributes of this disease are also the consequence of lymphatic defects.

During the lively discussion, joined by panellists Drs Asmaa Alderaa (Saudi-Arabia), the experts stressed the need for biomarkers for the distinction of lipoedema from obesity in order to be able to reimburse patients. Furthermore, expectation management in the context of surgery is important and adjustable compression garments after surgery are recommended.

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The importance of prevention of lymphedema in breast cancer-related lymphedema: How and when?

Pinar Borman

Pinar Borman, TUR

Professor of Physical Medicine and Rehabilitation & Algologyand founder member and chair of Turkish Lymphedema Association. She has also formed Hacettepe University Lymphedema Research and Practice Center and was head of this organization until 2020. Dr Borman is the representative of Turkey in International Lymphedema Framework (ILF) International Board and founder member of International Lipoedema Association (ILA). She is a member of the Cancer Rehabilitation Special Interest group of ISPRM. She is currently working academically in the University of Health Sciences Medical Faculty and Ankara City Hospital Department of Physical Medicine and Rehabilitation. She is the author of more than 200 international and national papers.

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Prophylactic Use of Compression Sleeves Reduces the Incidence of Arm Swelling

Vincent Paramanandam

Vincent Paramanandam, AUS

Onco-Physiotherapist; Cancer survivorship researcher; Exercise in Oncology, Lymphoedema and Fatigue; completed his Doctor of Philosophy degree at The University of Sydney in 2021. His thesis title was Effectiveness of compression sleeve in preventing breast cancer-related lymphoedema. He has completed MSc in Cancer Care with Distinction from Oxford Brookes University, UK. He has an MSc degree in Psychology and a bachelor's degree in Physiotherapy. He has 20 years of experience in cancer physiotherapy. He has conducted Lymphoedema certification programs, been an organizing secretary for Cancer Rehabilitation workshops multiple times, Scientific committee member for the CanRehab conference (2017) and taught in the Onco-physiotherapy program at Tata Memorial Hospital, Mumbai, India.

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Orsi Kokai

Orsi Kokai, AUS (Linkedin)

Oncology Physiotherapist and Practice Owner
Experienced physiotherapist and leading specialist in cancer care and lymphoedema management with over 20 years' clinical experience in Australia and Germany. Established in private practice in Sydney since 2011, practice owner at Oncology Recovery Services Inc.
Higher degree in research, investigating lymphoedema and compression.


Nouf Aldhwayab

Nouf Aldhwayan, KSA (Twitter)

Outpatient Supervisor of the Physical Therapy Department, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia; Clinically oversee patient care for Lymphedema and breast cancer patients. On a broader scale, also oversee the training and competency development of Lymphedema Therapists.


Margaret McNeely

Margaret McNeely, CA (LinkedIn)

Professor in the Department of Physical Therapy at the University of Alberta, in a jointly funded position with the Department of Oncology, Cancer Care Alberta. She is also the Director of the Cancer Rehabilitation Research Clinic at the University of Alberta. Her research explores the benefit of cancer rehabilitation and exercise interventions for cancer related impairments of pain, fatigue and lymphedema.



Dr Christine Moffatt, UK  (Profile)

CBE, FRCN, PhD, MA, RGN, DNClinical professor of skin integrity and Emeritus at Nottingham University Hospital, Nottingham, UK and visiting professor at the Copenhagen Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark. She is the chair of the board of directors of the International Lymphoedema Framework (ILF). She has been involved in wound healing research and practice for 25 years and Lymphoedema for 15 years and has undertaken extensive research in this field using mixed research methods including running national and international clinical trials.


Sylvain Gaillard

Sylvain Gaillard, CH (LinkedIn)

Head of Corporate Medical Marketing of SIGVARIS GROUP and an experienced clinical / medical expert in pharmaceutical industry

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