REVIEWBreast Cancer-Related Lymphedema
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ANATOMY OF THE LYMPHATIC SYSTEM AND PATHOPHYSIOLOGY OF LYMPHEDEMA
The lymphatic system is composed of superficial and deep lymphatic vessels that collect lymph from the skin, subcutaneous tissue, muscle, bone, and other structures. Lymph fluid consists of water, protein, cellular debris, toxins, and other macromolecules. The lymphatic system is designed to drain this fluid and return it to the intravascular circulation. Lymph fluid enters the interstitium, which increases oncotic pressure, thereby drawing water into the interstitium. When this drainage is
BREAST CANCER AND LYMPHEDEMA
Sentinel lymph node (SLN) mapping studies have confirmed the presence of 3 interconnecting lymphatic systems in the breast8,9—the dermal, subcutaneous, and parenchymal lymphatics, which travel along the routes of the breast's blood supply to the regional lymphatics. The primary drainage is to the axilla, with only a small proportion of the lymph draining to extra-axillary sites (internal mammary, infraclavicular, and supraclavicular lymph nodes). Metastatic spread to the axilla occurs in
SYMPTOMS AND DIAGNOSIS OF LYMPHEDEMA
Patients with breast cancer and lymphedema may report symptoms such as a sensation of arm fullness and mild discomfort, which are seen in the early stages of the condition. Joint immobility, pain, and skin changes are noted frequently in the later stages of lymphedema. Patients also may be predisposed to infections involving the affected extremity.
Diagnosis of lymphedema requires a detailed medical history and physical examination. Changes may include pitting of tissues, increased thickness of
STAGING OF LYMPHEDEMA
A staging system has been developed for lymphedema (Table 1). Many clinicians have defined clinically significant lymphedema as a difference in circumference of greater than 2 cm between the extremities.21,36,48,49 However, most clinical trials have used volume-based rating scales to assess edema. Other parameters that have been used to determine the stage of lymphedema include limb circumference, tissue texture, dermal changes, subjective sensations, and tissue responses to gravity or pressure.
TREATMENT
The treatment of lymphedema associated with breast cancer can include combined modality approaches, compression therapy, therapeutic exercises, and pharmacotherapy.
SUMMARY
Lymphedema is a chronic and debilitating disease that can arise from breast cancer treatment. It generally is under-reported and undertreated. The effects of lymphedema on a patient's quality of life are substantial and can be devastating. Further education and better clinical trials are needed to address the importance of early recognition and treatment of lymphedema after breast cancer.
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2019, Surgery (United States)Citation Excerpt :In addition, the required treatments for the management of BCRL becomes more complex with severe disease. Breast care clinicians should familiarize themselves with practices to provide best care and appropriate counseling to aid patients in reducing their risk and improving their awareness and management13–15. LE within the first year after surgery is acute LE, which may improve with treatment as lymphatic channels reform.
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