Lymphedema in survivors of breast cancer

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/m²), 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.

Keywords: breast cancer; lymphedema; swelling.

Figure 1.

Early stage of breast cancer-related lymphedema. (A) Swollen hand; (B) swollen arm.

Figure 2.

Advanced stage of breast cancer-related lymphedema and peau dorange appearance of the affected limb. (A) Advanced stage of disease; (B) peau dorange appearance of the affected limb.

Figure 3.

Pathogenesis for lymphedema. Schematic representing the pathogenesis of lymphedema. VEGF-C, vascular endothelial growth factor C; VEGFR, vascular endothelial growth factor receptor; VE, vascular endothelial; VB, vascular bed; IFV, interstitial fluid volume; IP, interstitial pressure; HP imbalance, the imbalance of hydrostatic pressure difference; E-RVs, existing resistance vessels.