Lymphedema after treatment of breast cancer: a comprehensive review

Abstract

Lymphedema is a chronic and morbid complication that can result from breast cancer treatment involving surgery and/or radiation therapy. Breast cancer related lymphedema (BCRL) can result in functional and psychological problems that can affect a patient's quality of life. Lymphedema is a pathologic condition of the lymphatic system in which protein-containing fluid accumulates in the interstitial tissue leading to tissue inflammation, fibrosis, and adipose hypertrophy. Clinical manifestations of lymphedema include swelling, induration, skin changes, and decreased functionality of the affected limb. A common risk factor associated with BCRL is the management of the axilla. Advances in research have shown sentinel lymph biopsy to be equally effective as axillary lymph node dissection in staging the axilla, in appropriate cases. In addition, with breast-conserving therapy it has been shown that radiation therapy also increases the risk of BCRL. Overall, approximately 1 in 6 women treated for breast cancer will develop lymphedema within months to years after diagnosis and treatment. Lymphedema is a progressive disease with a subclinical phase that can last for years before becoming clinically evident. While management of breast cancer has improved, it is important that we develop a coordinated and standardized approach to better diagnose, assess, and manage BCRL. This includes patient education, a thorough physical examination, access to confirmatory testing when necessary, a conservative multimodality treatment plan that includes compression and decongestive therapy, and being able to offer operative management when conservative management is ineffective. METHODSWe performed PubMed/MEDLINE and Cochrane searches of the English-language literature. Studies of all dates were included to provide adequate background as well as to capture new studies that have emerged in the past 5 years. General keywords used for this search were lymphedema, breast-cancer related lymphedema, decongestive lymphatic

Relationship between Viscoelastic Properties of Tissues and Bioimpedance Spectroscopy in Breast-Cancer-Related Lymphedema

“…However, a significant correlation between the L-Dex index and BMI and fat in group L was found, whereas there were no significant correlations between these parameters in group C. This suggests that a high BMI and high content of body fat promote the development of BCRL. Similar conclusions were presented by Johansson et al [25] and Ayre and Parker [26], who stated that a higher BMI before and after operation increases the lymphedema risk. However, it should be noted that the clinical manifestations of lymphedema are secondary to an inflammatory response to the chronic accumulation of protein-containing interstitial fluid and adipose tissue.…”

Platinum Chemotherapy Induces Lymphangiogenesis in Cancerous and Healthy Tissues That Can be Prevented With Adjuvant Anti-VEGFR3 Therapy

“…Other therapeutics, such as doxorubicin, delivered to lymphatics result in reduced lymphatic flows through reduced function of smooth muscle cells ( 52 ). We did not specifically examine the function of the platinum-treated lymphatics here, though this would be an interesting future study to determine effects on not only metastatic spread, but also lymphedema, which is a common clinical sequelae of treatment and can be enhanced with lymphangiogenesis ( 53 – 55 ). Ultimately, we see across multiple dosing schemes in multiple contexts ( in vitro , ex vivo , in vivo , and clinic) indications of lymphangiogenesis in healthy and diseased tissues with platinum agents.…”

Prevalence and determinants of lymphedema in newly diagnosed Nigerian breast cancer patients using bioimpedance estimations

“…Breast cancer-related lymphedema (BCRL) is a common complication of breast cancer treatment characterised by an abnormal collection of protein-rich fluid in the interstitial space. Lymphedema can occur following the disruption of the lymphatic drainage from the ipsilateral arm during axillary lymph node staging/resection [1][2][3]. There is significant heterogeneity in the reported incidence of lymphedema (2%-65%), which is largely attributable to highly variable diagnostic criteria.…”