Lymphedema in survivors of breast cancer (Review)

Abstract

The tremendous improvement of survival in patients with breast cancer can be attributed to several treatment strategies, but these strategies also lead to the occurrence of breast cancer-related lymphedema (BCRL). BRCL is regularly associated with factors such as axillary lymph node dissection and local lymph node radiotherapy and manifests as an increase of >10% in the volume of affected limbs. Being overweight or having obesity (body mass index ≥25 kg/m 2 ), an excessive number of positive lymph nodes (>8) and capsular invasion by a tumor are additional risk factors for lymphedema. It is worth assessing the risk before surgery as this can prevent the occurrence of BCRL at the initial stage of breast cancer management. The clinical utility of many diagnostic tools and lymphedema surveillance allows early stage and even subclinical BCRL to be diagnosed, and allows real-time monitoring of the disease. The early diagnosis of BRCL allows treatment at an early stage, which is beneficial to the reduction of excess limb volume and the improvement of quality of life. At present, the major therapeutic methods of BCRL include complex decongestive therapy, pneumatic compression devices, participating in exercise, microsurgery and liposuction, each of which alleviates lymphedema effectively. No medications for treatment of BRCL have yet been developed. However, the recent findings on the success of molecular therapy in animal models may remedy this deficiency. Furthermore, the volume reduction of swollen limbs without swelling rebound by transplanting autologous stem cells has been successfully reported in some pilot studies, which may provide a new technique for treating BCRL. This review aimed to discuss the pathogenesis, clinical manifestation, risk factors, advantages and disadvantages of diagnostic tools, lymphedema surveillance and the characteristics of traditional and newly emerging BCRL treatments.

The effect of therapeutic exercise in the prevention of lymphoedema secondary to breast cancer: a systematic review

“…In the field of lymphoedema treatment in female breast cancer survivors, there are several research works in which the benefits of exercise treatment in reducing lymphoedema have been collected [36][37][38][39]. In the studies of DiSipo et al [9] and Baumann et al [25] subjective improvements in the quality of life of the patients, anxiety (as occurs in other pathologies that alter the quality of life [40,41]), the decrease in lymphoedema (evaluated with volumetry) and, equally important, the non-appearance of adverse effects in the study population, are revealed.…”

“…Nine RCTs published between 2006 and 2019 were included, with a total of 1147 patients distributed in groups of 21-104 women. The selected articles evaluated the effect of therapeutic strength [2,7,8,[31][32][33][34] or aerobic [2,30,34,36] exercise on the swelling of the affected upper limb in women who had been surgically intervened for breast cancer; three of these articles also included stretching exercises in their intervention programmes [31,33,34]. Strength training was understood as exercises with weights, dumbbells, variable-resistance machines, and thera-bands, whereas aerobic training was understood as activities such as walking; on the other hand, exercises with hand crank ergometers were considered as combined strength and aerobic training.…”

Assessment of Potential Risk Factors and Skin Ultrasound Presentation Associated with Breast Cancer-Related Lymphedema in Long-Term Breast Cancer Survivors

“…The initial signs of BCRL are swelling and discomfort in the forearm area that disappears when lifting the affected area or by external compression [12,21]. Moderate to severe stages of BCRL consist of changes of the skin structure or appearance of peau d'orange (skin texture that resembles orange peel) that becomes bigger and is no longer relieved by lifting or external pressure [22]. The continuous expansion of fibrotic tissue and fat deposition affects the thickness of the skin and subcutaneous tissue, leading to the hardening of the skin.…”

Changes of lymphatic flow caused by core needle biopsy of axillary sentinel lymph node in a rabbit model

“…However, lymphedema still occurs in 7% of patients undergoing SLNB (2). Lymphedema severely affects the quality of life of BC patients due to the lifestyle and occupational alternations, change in the functional status, as well as changes in the psychosocial and economic aspects (3). The clinical signs vary with the duration and severity of lymphedema, from vague…”