Axillary Web Syndrome in Breast Cancer: A Prevalent But Under-Recognized Postoperative Complication

Abstract

The purpose of this review is to define axillary web syndrome (AWS) and describe its diagnosis and management. The following databases were searched through July 2017: PubMed, EMBASE (OvidSP), Cumulative Index for Nursing and Allied Health Literature, Physiotherapy Evidence Database, and Cochrane Database of Systematic Reviews. Search terms included ‘axillary web syndrome', ‘axillary cording', and ‘lymphatic cording'. 49 articles were identified; 8 did not relate to breast cancer, and 3 were not in English. Of the remaining articles, the majority were case reports, case series, or descriptive reviews. 2 systematic reviews were located as well as 1 randomized trial, 6 prospective cohort studies, and 2 retrospective cohort studies. Although a common sequela after axillary surgery for breast cancer staging, AWS has been poorly described in the medical literature as to the underlying pathophysiology, diagnosis, and management. Interventions range from patient education and simple reassurance that the syndrome will resolve spontaneously to active physical or manual therapies to maintain upper extremity range-of-motion, especially adequate motion for undergoing radiation therapy. Oncologists, breast surgeons, family physicians, and oncology nurse practitioners that work with patients with breast cancer should educate them about this prevalent complication and inform them preoperatively about what to anticipate.

Long‐Term Effects of Breast Cancer Surgery, Treatment, and Survivor Care

“…Axillary web syndrome is also referred to as axillary or lymphatic cording . Current literature characterizes this syndrome as the presence of overriding axillary tissue that impedes arm or shoulder range of motion .…”

“…Current literature characterizes this syndrome as the presence of overriding axillary tissue that impedes arm or shoulder range of motion . Axillary web syndrome is described as 2 or 3 tense, nonerythematous cords that are palpable or visible under the skin, originating at the axilla, tracking down the medial arm to the antecubital fossa, and ending at the thumb's base . Prevalence varies from 10% to 85.4% depending on the definition used and the timing of diagnosis .…”

“…41,44,45 Axillary web syndrome is described as 2 or 3 tense, nonerythematous cords that are palpable or visible under the skin, originating at the axilla, tracking down the medial arm to the antecubital fossa, and ending at the thumb's base. 44,45 Prevalence varies from 10% to 85.4% depending on the definition used and the timing of diagnosis. 44 Common risk factors for developing axillary web syndrome are younger age, lymph node involvement, healing complications, the degree of surgery, and low BMI.…”

“…44,45 Prevalence varies from 10% to 85.4% depending on the definition used and the timing of diagnosis. 44 Common risk factors for developing axillary web syndrome are younger age, lymph node involvement, healing complications, the degree of surgery, and low BMI. 44,45 It may be present as frequently in women with higher BMI but not be apparent because of increased adipose tissue.…”

Cording: a treatable complication of breast cancer surgery

“…Second, there seems to be no connection between cording and lymphoedema, and cording does not lead to lymphoedema. 3,4 Lymphoedema, a condition where the removal of lymph nodes causes swelling in the body's tissues, is regularly discussed with patients undergoing surgery and an information leaflet given, yet cording is hardly ever mentioned.…”