Prevention and management of arm lymphedema in the patient with breast cancer

Abstract

Arm lymphedema develops in 10%-35% of patients who undergo axillary dissection and/or nodal radiation therapy for breast cancer. Lymphedema that occurs in the first 18 months after surgery or radiation is described as acute lymphedema, and can be managed with conservative measures such as elevation of the arm and mild compression. Chronic lymphedema, the more serious form, has a progressive and generally irreversible course. Risk factors associated with the development of lymphedema include greater extent of axillary surgery; more positive axillary nodes; a postoperative axillary hematoma, seroma, or infection; and use of nodal radiation. The most common method of lymphedema measurement is the circumference 10 cm above and below the olecranon process, although most clinicians do not take measurements in the preoperative setting for comparison.Treatment strategies include elevation, complete decongestive physiotherapy, pneumatic pumps, and, after failure of all other methods, surgery. Lymphangiosarcoma is a rare and late complication of longstanding extremity lymphedema. The advent of sentinel lymph node biopsy as an alternative to axillary dissection should decrease the rate of lymphedema. The increasing number of breast cancer survivors and the high prevalence of the disease will continue to make lymphedema a significant consequence of breast cancer treatment.