- Following treatment for breast cancer:
- The onset of lymphedema is insidious:
- It is typically characterized by slowly progressive swelling of the upper extremity ipsilateral to the axillary node dissection or radiation treatments
- The onset of lymphedema is insidious:
- The main risk factors for breast cancer-associated lymphedema include:
- Dissection / disruption of axillary lymph nodes
- Radiation therapy
- Local infection
- Obesity
- Other factors may also contribute
- There is no known link between smoking and lymphedema
- The American College of Surgeons Oncology Group (ACOSOG) Z1071 study:
- Demonstrated that 40% of women with proven involved axillary nodes who underwent neoadjuvant chemotherapy:
- Obtain a pathologic complete response in the previously involved nodes
- Although the study demonstrated an overall false-negative rate of sentinel lymph node biopsy (SLNB) in this setting to be 12%:
- The authors stratified these results and found that if more than two sentinel lymph nodes (SLNs) were removed in patients with dual tracer mapping (blue dye and radioisotope):
- The false-negative rate of SLNB then dropped below 10% (6.8%)
- The authors stratified these results and found that if more than two sentinel lymph nodes (SLNs) were removed in patients with dual tracer mapping (blue dye and radioisotope):
- Demonstrated that 40% of women with proven involved axillary nodes who underwent neoadjuvant chemotherapy:
- With these guidelines, if SLNB is negative after neoadjuvant chemotherapy:
- Consideration can be given to SLNB alone
- The risk of lymphedema is significantly reduced with SLNB than with a level I / II axillary node dissection:
- Odds ratio (OR) 0.33 based on Cochrane Review of three studies comparing SLNB to axillary dissection
- Manual lymphatic drainage:
- May offer some additional benefit to help with swelling reduction in patients with mild to moderate lymphedema:
- But not all studies have found a benefit for this technique
- May offer some additional benefit to help with swelling reduction in patients with mild to moderate lymphedema:
- Data are conflicting with regard to the prophylactic use of compression sleeves, prophylactic manual lymphatic drainage, or timing of arm mobilization following surgery
- References
- Hayes SC, Janda M, Cornish B, Battistutta D, Newman B. Lymphedema after breast cancer: incidence, risk factors, and effect on upper body function. J Clin Oncol.2008;26(21):3536-3342.
- Boughey JC, Suman VJ, Mittendorf EA, et al. Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer: the ACOSOG Z1071 (Alliance) clinical trial. JAMA. 2013;310(14):1455-1461.
- Bromham N, Schmidt-Hansen M, Astin M, Hasler E, Reed MW. Axillary treatment for operable primary breast cancer. Cochrane Database Syst Rev. 2017;1:CD004561.
- Patricolo GE, Armstrong K, Riutta J, Lanni T. Lymphedema care for the breast cancer patient: an integrative approach. Breast. 2015;24(1):82-85.
- Stuiver MM, ten Tusscher MR, Agasi-Idenburg CS, Lucas C, Aaronson NK, Bossuyt PM. Conservative interventions for preventing clinically detectable upper-limb lymphoedema in patients who are at risk of developing lymphoedema after breast cancer therapy. Cochrane Database Syst Rev. 2015;2:CD009765.
- Brennan MJ, Miller LT. Overview of treatment options and review of the current role and use of compression garments, intermittent pumps, and exercise in the management of lymphedema. Cancer 1998; 83(12 Suppl American):2821-2827.
Rodrigo Arrangoiz MS, MD, FACS, FSSO 