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December 1, 2008

Lymphedema After Breast Cancer Treatment
Robert A. Wascher, MD, FACS



Arm lymphedema, or chronic swelling of the arm, occurs in 10 to 30 percent of women following treatment for breast cancer. When the lymphatic drainage network in the arm has been disrupted by the surgical removal of armpit lymph nodes by the surgeon, or by radiation therapy to the armpit area (or, sometimes, following both types of treatment), the delicate network of lymphatic vessels that return excess tissue fluid back to the heart can become obstructed. This lymphatic obstruction can result in chronic swelling of the hand and arm. Patients with significant lymphedema of the arm, following breast cancer treatment, may experience considerable swelling (edema), heaviness, stiffness and discomfort of the affected hand and arm.

A newly published study in the journal Breast Cancer Treatment & Research has taken a new look at factors associated with arm lymphedema following breast cancer treatment. This study was performed by researchers at the University of Southern California, the City of Hope in California, the National Cancer Institute in Bethesda, the Fred Hutchinson Cancer Center in Seattle, and the University of Louisville in Kentucky.

In this study, nearly 500 women who had been diagnosed with preinvasive or invasive breast cancer completed an initial interview with study researchers. A follow-up interview was then performed, on average, about 4 years later. The researchers then analyzed the resulting data from these two sets of interviews.

This study confirmed the findings of numerous prior studies that have linked the surgical removal of armpit lymph nodes, obesity, and high blood pressure with chronic arm lymphedema. In this study, women with high blood pressure were found to have almost two-and-a-half times the risk of developing lymphedema following breast cancer treatment when compared to women who did not have hypertension. Moreover, this hypertension-associated risk of lymphedema was essentially equivalent to the level of risk associated with the surgical removal of armpit lymph nodes and with obesity, which is a much higher level of risk than has been reported by most prior studies.

Taken together, the results of this study confirm several previously established risk factors for arm lymphedema following breast cancer therapy, but also suggest that high blood pressure may, by itself, be a more significant risk factor for lymphedema than has been previously appreciated.

The good news is that there are strategies available to most women that can address these lymphedema risk factors. Recently, a relatively new surgical technique has been developed, and allows surgeons to remove only one or a couple of lymph nodes (sentinel lymph node biopsy) in the 60 to 70 percent of breast cancer patients whose breast cancer has not yet spread to lymph nodes in the armpit area. Sentinel lymph node biopsy has been shown to reduce the risk of lymphedema to one-tenth the risk associated with the more radical complete axillary lymph node dissection that was formerly performed on all breast cancer patients. Likewise, losing excess weight may also reduce the incidence of obesity-associated lymphedema. The findings of this study also suggest that achieving good control of hypertension may reduce the volume of edema fluid generated in the arms of patients who have undergone breast cancer therapy, and may further reduce the risk of chronic lymphedema.

For additional information on the subject of chronic lymphedema following breast cancer therapy and sentinel lymph node biopsy for breast cancer, please see the following links:
http://www.cancersupportivecare.com/Abstracts/asbdpbtps.html

http://meeting.ascopubs.org/cgi/content/abstract/23/16_suppl/8185

http://www.www.annsurgoncol.org/cgi/content/abstract/15/7/1996

http://www.cancerlynx.com/sln.html

Reprinted by permission
doctorwascher.com
Of Interest:
Exercise If At Lymphedema Risk
A Restorative Yoga Therapy for Breast Health and Breast Cancer
Three Keys to Manage Breast Cancer-Related Lymphedema



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