Lymphology Association of North America (LANA) Practice Exam

Edema in a patient with metastatic disease of the liver, after treatment for ovarian cancer, may be a result of:

1. Lymphatic decompensation

2. High output failure of the lymphatic system

3. Hypoproteinemia

4. All are true

The correct answer is: All are true

In the context of a patient with metastatic disease of the liver following treatment for ovarian cancer, edema could indeed result from multiple factors, as reflected in the correct response. Lymphatic decompensation occurs when the lymphatic system fails to adequately manage the excess fluid in the tissues, which can happen due to obstruction or damage to the lymphatic pathways caused by cancer metastasis or previous surgical interventions. In patients with metastatic disease, the lymphatic system may become overwhelmed, contributing to the development of edema. High output failure of the lymphatic system can occur when there’s a significant increase in fluid production, surpassing the lymphatic system's ability to transport the excess fluid away. This can happen in metastatic conditions, where the volume of interstitial fluid is increased due to various mechanisms, including inflammation and tumor burden. Hypoproteinemia refers to a lower-than-normal level of protein in the blood, which can reduce oncotic pressure and lead to fluid leaking into the interstitial spaces, thereby causing edema. Patients with cancer might experience this due to malnutrition, liver dysfunction affecting protein synthesis, or increased protein loss from the body. Each of these factors contributes to the overall clinical picture of edema in such patients, evidencing that the presence of metastatic liver disease