Lymphedema following axillary lymph node dissection for breast cancer

Abstract

In general, the treatment for breast cancer consists of surgery with or without radiation and with or without systemic therapy. Whether the disease was identified by physical examination, axillary ultrasound, or SLN biopsy, ALN dissection remains the standard of care for patients with known involvement of the ALNs.

Patients undergoing axillary surgery - either SLN biopsy or ALN dissection - may experience short-term or long- term complications. Most common are seroma formation , numbness and paresthesias of the upper arm, , and the most common complication -and the most feared- is lymphedema.

Breast cancer survivors are at lifetime risk for developing lymphedema, a chronic condition that occurs in up to 40% of them. Lymphedema involves the accumulation of protein- rich fluid that affects physical, functional, and psychosocial health and well-being. Second only to breast cancer recurrence, lymphedema is the most dreaded outcome of breast cancer treatment.

Early diagnosis of breast cancer-related lymphedema remains a clinical challenge. It includes Health history and physical examination, Measures of limb volume and Lymph vessel imaging. Symptom assessment is essential since very often observable swelling and measurable volume changes are absent during the initial development of lymphedema, but patients may report such symptoms as heaviness, tightness, firmness, pain, or numbness.

Measuring circumference is the most widely used diagnostic method. A flexible non-stretch tape measure for circumferences is usually used to assure consistent tension over soft tissue, muscle, and bony prominences. Healthcare professionals should use a cost-effective measuring method (such as circumferential arm measurement) and a time- and energy-saving measuring method (such as infra-red perometry) to monitor LVC in breast cancer survivors.

Treatment of lymphedema has been and continues to be a major healthcare challenge. Lymphedema treatment refers to therapies applied to help to slow the disease progression by reducing or maintaining swelling and relieving symptoms. Lymphedema therapy includes complete decongestive physiotherapy (CDT), pneumatic compression therapy (PCT), therapeutic exercises, surgery, and pharmacological therapy.

Surgical treatment for breast cancer-related lymphedema is rarely performed except in severe and refractory cases to reduce the weight of the lymphedematous region, minimize the frequency of infectious and inflammatory episodes, and improve cosmoses and function.

Pharmacological interventions to treat lymphedema include antibiotics for treatment of infections, benzopyrones, flavonoids, diuretics, hyaluronidase, pantothenic acid, and selenium.

Breast cancer-related lymphedema is often under- diagnosed and undertreated. The complexity and variability of individual lymphatic system and the unpredictability of risk factors makes it difficult to predict which patients will ultimately develop lymphedema. For decades, to reduce the risk of

lymphedema after breast cancer treatment, the focus has been on improving surgical treatment.

Patient education is vital for implementing risk reduction behaviors targeting on such personal risk and triggering factors. In practice, many women treated for breast cancer have not received any information about lymphedema and risk reduction strategies.