This Research in a Nutshell will be focusing on the presence of lymphedema after treatment for breast cancer.

The article mentions what most would consider a surprising statistic, in that “approximately 1 in 6 women treated for breast cancer will develop lymphedema within months to years after diagnosis and treatment.” That’s a considerable number of individuals, especially considering the issue that remains with patients who are at risk to develop or have breast cancer-related lymphedema (BCRL) and the delay in referring to a Certified Lymphedema Therapist (CLT) for proper management and/or prevention.

This article does a good job reviewing the risk factors and mechanisms for onset of BCRL, as well as reviews other research literature available and what it has to say.

Let’s take a look at the basic breakdown of this research.

Article Breakdown

Breast Cancer and Lymphedema Statistics

One of the first things this article describes in detail is some of the statistics associated with breast cancer and BCRL prevalence.

It reports that “in 2018, there were over 2 million new diagnoses of breast cancer worldwide.” While most of us are familiar with the general incidence of breast cancer, this number is still astounding.

Furthermore, the article then connects to the commonality of lymphedema development, as a result of breast cancer. It indicates that multiple studies have shown “~16.6%” of breast cancer survivors will develop lymphedema. Unfortunately, many may not even be aware that this could be a possible long-term side effect from the treatment for their breast cancer.

The most common causes and triggers for BCRL the article discusses involve the removal of lymph nodes (the more lymph nodes removed = a greater chance of lymphedema onset) and radiation therapy.

It’s important to keep in mind though that throughout the entire treatment course for breast cancer, any and all attacks on the lymphatic system in that region can be a trigger for lymphedema. This may include chemotherapy, onset of infections, etc.

Methods Behind the Research

The information in this article is primarily based around a large search among other educational journals, trials and sites. Various professional groups were also included in order to have the most updated research behind the prevalence and management of BCRL.

How the Lymphatic System Works

While we won’t go into a lot of detail regarding the anatomy and physiology of the lymphatic system (the article does an excellent job with explaining this), the fact that this article chose to dive into this topic shows just how detail-oriented it is.

For a basic breakdown, the article reviews how lymphedema occurs because of a failure and onset of congestion within the affected region of the lymphatic system.

As long as the lymphatic system can keep up with its normal workload, swelling will not develop. Once a certain region of the lymphatics has been disrupted, such as with lymph node removal and/or radiation therapy, it has to work harder to keep up with its work load. If it can’t, then fluid will begin accumulating in that region, and lymphedema will develop.

The article does a nice job in detailing the basic description of lymphedema itself, and then its specific application to patients who have had or are currently undergoing treatment for breast cancer.

Potential Causes and Triggers of BCRL

We’ve already reviewed how lymph node removal and radiation therapy are common triggers within a treatment protocol for breast cancer that can tend to cause lymphedema to develop.

The research shows that if fewer lymph nodes are removed, the chances of lymphedema developing are reduced. For this reason, many surgeons will favor a sentinel lymph node biopsy to stage breast cancer versus immediately performing a full axillary (a.k.a. armpit) lymph node dissection. It’s important to note though that sometimes a full dissection is necessary, per the surgeon’s assessment and biopsy results, if the cancer has spread further into the lymph nodes.

Radiation therapy is another common trigger for lymphedema due to the more permanent effects on the targeted lymphatics during this treatment. It all depends, of course, on the specific type of radiation chosen, the size of the area being targeted, the duration and frequency of treatment, as well.

The article discusses mixed opinions regarding the potential of chemotherapy (adjuvant versus neoadjuvant) to cause lymphedema. While some research has shown a correlation, others have not. Clinically speaking, I can attest that I have worked with individuals who have been able to time and track the onset of their lymphedema with the start and progression of their chemotherapy.

Ultimately, with all of these potential risk factors, the most important thing is to understand why they could create potential for lymphedema and to monitor for symptom onset accordingly.

BCRL Presentation and Diagnosis

While it’s important to know the potential triggers for BCRL with regards to treatment for breast cancer itself, it’s just as important to understand how BCRL would present in order to make an official diagnosis.

There is an extensive summary within this article describing the various stages of lymphedema. With each stage is a description of symptoms and changes to look out for in the potential at-risk area.

If there is concern for the presence of lymphedema, it’s important to consult with your oncologist as soon as possible. They will take into consideration the treatment that has been performed so far for your breast cancer, as well as the physical signs and symptoms described by you. This may include visible swelling, with or without pitting (an indentation left in the skin when firm pressure is applied). They will also assess if you have developed any skin changes, such as hardening of the skin, which can commonly occur the longer lymphedema is present without initiating treatment for it. Your oncologist will also ask if you notice any abnormal sensations in the area of concern, such as heaviness or tightness.

With all of these details provided, as well as the possible ordering of imaging to verify the status of your circulation and lymphatic system, your oncologist can make an appropriate diagnosis and referral for management of your lymphedema.

Lymphedema Management

Finally, the article concludes by discussing treatment options for lymphedema.

It goes into detail about the primary conservative form of lymphedema management, Complete Decongestive Therapy (CDT). This involves a combination approach of manual lymphatic drainage, skin care, compression use, and exercise. Additional forms of treatment may also be incorporated, such as the use of vasopneumatic compression pumps.

In addition to discussion of the conservative management of lymphedema, the article also discusses surgical options. Surgery for management of lymphedema is only recommended as a last resort if conservative management has failed, and severe lymphedema remains, which may impact your functional activities and quality of life. While there are various techniques that are being utilized surgically for lymphedema management, it’s important to note that these are not claiming to cure your lymphedema. Only to attempt better management if conservative efforts were not as successful as anticipated.

Key Takeaway

The primary takeaway from this article is that we know the prevalence of BCRL is more pronounced than what we might have previously been aware of.

Knowing the potential risk factors and triggers for BCRL can assist with early prevention and early diagnosis. The sooner any noticeable symptoms are recognized and treated, the better your outcomes will be.

As with anything, proactivity is key!

Research:

1.   Ayre K, Parker C. Lymphedema after treatment of breast cancer: a comprehensive review. Journal of Unexplored Medical Data. 2019;2019(4). doi:https://doi.org/10.20517/2572-8180.2019.02.