Radiation can be combined with other forms of treatment to produce cure rates which are greater than when any one treatment is used on its own. The radiation may be to the primary site or to likely or definite secondary sites. Ependymoma, and low grade astrocytoma are examples of  cancers which are more likely to be cured by a combination of surgery and radiation, both to the primary site, than by either [ surgery or radiation alone. These two examples are both brain  cancers which, because of their location, are difficult to remove completely. Radiation given after surgery increases the cure rate by killing any cells which have not been removed. As we will see in the next section, pre- or post-operative radiation to the primary site usually makes a difference only to the chance of local recurrence and not to the chance of complete cure. These cancers are I exceptions to this rule because they rarely spread outside of the central nervous system. Effective local treatment therefore has a good chance of curing them completely.  Some cancers which have spread can be cured by removing the primary cancer surgically and irradiating the secondary deposits. The main examples are seminoma (a type of testicular cancer) and dysgerminoma (a rare type of ovarian cancer). The primary cancer is removed mainly in order to make a definite and exact diagnosis. These types of cancer are so sensitive to radiation that even quite large secondary deposits can be destroyed completely К using safe doses of radiation. These cancers are also very sensitive to chemotherapy treatment. The chance of cure is greater with chemotherapy than with radiation if the disease is very extensive. However, chemotherapy has more side effects. If you have one of these types of cancer you will have to find out what figures apply in your particular case and exactly what each treatment would involve in order to make the best decision for you.*275/40/1*
Cancer

Although lymphoedema cannot be cured once it has developed, the arm-raising exercises can help to reduce the swelling and to prevent it getting worse. It may be controlled by a combination of regular, gentle exercise, massage (which you will have to be taught), general skin care and, when appropriate, by the wearing of an elastic compression sleeve. Although you can carry out most of the measures to control lymphoedema yourself, you must ask your doctor’s advice before starting any form of treatment.

*      Skin care. Germs can enter the body through dry, cracked skin, and you should therefore use a simple moisturizer after every bath. If your skin has become very rough, your doctor will be able to prescribe a special cream to treat it.

You should always protect the hand and arm on your affected side from injury and possible infection, for example by wearing gloves while you are gardening or using strong cleansing agents, and a thimble when sewing. If your hand or arm is cut or grazed, however small the injury, make sure it is thoroughly cleaned, treated with antiseptic, and covered with a clean dressing. If persistent inflammation or swelling follows an injury of this sort, ask your doctor’s advice as soon as possible.

Blood pressure measurement, blood tests and injections should be done on the other arm whenever possible.

*     Movement and exercise. Gravity tends to cause the lymph to pool, and its effect can be counteracted by raising the arm whenever possible. This can be done by resting your affected arm on a cushion – on the arm of a chair when sitting, and beside you when you are in bed – so that it is above the level of your heart.

Although too much exercise will cause the swelling to increase, gentle regular movement of the arm helps the lymphatic fluid to drain away. The exercises described above should be done gently at least once a day, while wearing a compression sleeve if you have one.

*     Massage. Massage of the affected arm and armpit, as well as of the lymph glands in the neck (and of the chest if fluid has started to accumulate here), will help lymphatic drainage away from the arm. A nurse or physiotherapist should be able to advise you about this, as specific lymph drainage massage must be done to ensure that it is effective. Massage clears the way ahead of the swelling so that fluid can drain from the swollen area. It should be gentle but firm, just enough to move the skin.

*     Compression sleeves. In some cases of lymphoedema, an elastic compression sleeve may be worn which prevents fluid building up in the arm and provides support to the muscles. These sleeves can be obtained from a hospital appliance officer, to whom you must be referred by your consultant or breast care nurse.

Compression sleeves should be put on in the morning when the swelling is least, and can be removed at night. Moist skin makes them more difficult to apply, and it is therefore best not to have a bath immediately before fitting your sleeve. Once the sleeve is on, it should be smooth and creaseless. It should never be rolled back as it will act as a tourniquet. The elastic gradually loses its strength and the sleeve will need to be replaced every 3 to 4 months.

It is important that you wear your elastic sleeve in hot weather, even though it may be uncomfortable, as this is a time when your arm is likely to swell.

*     Compression pumps. The use of a compression pump is not always suitable in every case; your doctor will be able to advise you about this. The pump is attached by a small tube to an inflatable cuff, and is powered from the mains electricity. Air is pumped in to inflate the cuff and is then gradually sucked out to deflate it again. The effect is a gentle squeezing of the arm which assists the drainage of lymph away from it. Compression pumps are normally used at regular intervals throughout the day to help reduce swelling.

Your pump should not be used if you have an infection in your arm, swelling in your chest, or if it causes pain.

If you are attending a lymphoedema clinic, your progress will be regularly monitored and you will be given advice about all the measures you can take to help control the condition.

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