Upper limb lymphedema related to breast cancer therapy: incidence, risk factors, diagnostic techniques, risk reduction and optimal management

Authors

  • Hatem A. Saleh Department of General Surgery, Faculty of Medicine, Menoufia University, Menoufia, Egypt
  • Tarek M. Rageh Department of General Surgery, Faculty of Medicine, Menoufia University, Menoufia, Egypt
  • Suzan A. Alhassanin Department of Clinical Oncology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
  • Mohamed A. Megahed Department of General Surgery, Damanhour medical national institute, Al Buhayrah, Egypt

DOI:

https://doi.org/10.18203/2349-2902.isj20184636

Keywords:

Breast Cancer, Compression garment, Lymphedema

Abstract

Background: Lymphedema remains to be a great source of morbidity for breast cancer survivors. The aim of this work is to study upper limb lymphedema following breast cancer therapy for breast cancer patients regarding its incidence, risk factors, diagnostic techniques, risk reduction and optimal management.

Methods: This prospective study was done on two hundred breast cancer patients who underwent breast cancer management. The study was done in the period between May 2016 and July 2018. Exclusion criteria were Male patients, Female patients with metastatic breast cancer and who already had upper limb lymphedema before breast cancer management. All patients underwent follow up for incidence, risk factors, diagnostic techniques and management of lymphedema. Statistical analysis used: The collected data were organized, tabulated and statistically analyzed using SPSS software

Results: The incidence of lymphedema was (18 %) distributed as follow: grade I = 55.6%, grade II = 33.3%, grade III = 11.1 % and grade IV = 0 %. The most relevant risk factors for development of lymphedema were: age between 41 and 50 years and diabetes mellitus. Higher incidence of pain (66.7%) and restricted motion (61.1%) were observed in lymphedema cases.

Conclusions: Old (41:50 years) and diabetic patients are at the highest risk for developing lymphedema. Breast cancer patients of stage IIIB who had undergone modified radical mastectomy or who developed postoperative seroma are at higher risk for developing lymphedema. Physical exercises and compression garment are important part of treatment plan.

References

Ban KA, Godella CV. Epidemiology of Breast Cancer. Surg Oncol Clin N Am. 2014;23:409-22.

Ibrahim AS, Khaled HM, Mikhail NN, Baraka H, Kamel H. Cancer incidence in Egypt: Results of the national population-based cancer registry program. J Cancer Epidemiol. 2014.

Rebegea L, Firescu D, Dumitru M, Anghel R. The incidence and risk factors for occurrence of arm lymphedema after treatment of breast cancer chirurgia. 2015;110:33-7.

Handley WS. Lymphangioplasty: a new method for the relief of the brawny arm of breast-cancer and for similar conditions of lymphatic oedema J. The Lancet. 1908;171(4411):783-5.

Halsted W. The swelling of the arm after operations for cancer of the breast - elephantiasis chirurgica - its cause and prevention. Bull John Hopkins Hosp. 1921;32:309-13.

Ahmed RL, Prizment A, Lazovich D, Schmitz KH, Folsom AR. Lymphedema and quality of life in breast cancer survivors: the Iowa Women’s Health Study. J Clin Oncol. 2008;5689-96.

Taghian NR, Miller CL, Jammallo LS, O’Toole J, Skolny MN. Lymphedema following breast cancer treatment and impact on quality of life: a review. Critical Reviews in Oncol/Hematol. 2014;1;92:227-34.

Soran A, D’Angelo G, Begovic M, Ardic F, Harlak A, Samuel Wieand H. Breast cancer‐related lymphedema–what are the significant predictors and how they affect the severity of lymphedema? Breast J. 2006;12(6):536-43.

Shah C, Arthur D, Riutta J, Whitworth P, Vicini FA. Breast cancer related lymphedema: a review of procedure-specific incidence rates, clinical assessment aids, treatment paradigms, and risk reduction. Breast J. 2012;18:357-61.

Shahpar H, Atieh A, Maryam A, Fatemeh HS, Massoome N, Mandana E. Risk Factors of Lymph Edema in Breast Cancer Patients. Int J Breast Cancer. 2013.

Pillai PR, Sharma S, Ahmed SZ, Vijaykumar DK. Study of Incidence of Lymphedema in Indian patients undergoing axillary dissection for breast cancer. Indian J Surg Oncol. 2010;1(3):263-9.

Warren LE, Miller CL, Horick N, Skolny MN, Jammallo LS, Sadek BT. The impact of radiation therapy on the risk of lymphedema after treatment for breast cancer: a prospective cohort study. Int J Radiation Oncol* Biol* Physics. 2014;88(3):565-71.

Erickson VS, Pearson ML, Ganz PA, Adams J, Kahn KL. Arm edema in breast cancer patients. J National Cancer Institute. 2001;17;93(2):96-111.

Bani HA, Fasching PA, Lux MM, Rauh C, Willner M, Eder I. Lymphedema in breast cancer survivors: assessment and information provision in a specialized breast unit. Patient Education Counseling. 2007;1;66(3):311-8.

DiSipio T, Rye S, Newman B, Hayes S. Incidence of unilateral arm lymphoedema after breast cancer: a systematic review and meta-analysis. J. The Lancet Oncol. 2013;1;14(6):500-15.

Larson D, Weinstein M, Goldberg I, Silver B, Recht A, Cady B. Edema of the arm as a function of the extent of axillary surgery in patients with stage I–II carcinoma of the breast treated with primary radiotherapy. Int J Radiation Oncol Biol Physics. 1986;12(9):1575-82.

Ozaslan C, Kuru B. Lymphedema after treatment of breast cancer. Am J Surg. 187,2004;69-72.

Kiel KD, Rademacker AW. Early-stage breast cancer: arm edema after wide excision and breast irradiation. Radiol. 1996;198:279-83.

Edwards TL. Prevalence and etiology of lymphedema after breast cancer treatment in Southern Tasmania. Aust NZ J Surg. 2000;70:412-8.

Clark R, Wasilewska T, Carter J. Lymphoedema: a study of Otago women treated for breast cancer. Nursing Praxis in New Zealand Inc. 1997;12(2):4-15.

Paskett ED, Stark N. Lymphedema: knowledge, treatment, and impact among breast cancer survivors. Breast J. 2000;6(6):373-8.

Moffatt CJ, Franks PJ, Doherty DC, Williams AF, Badger C, Jeffs E. Lymphedema: an underestimated health problem. QJM. 2003;1;96(10):731-8.

Sparaco A, Fentiman IS. Arm lymphoedema following breast cancer treatment. Int J Clin Pract. 2002;56:107-10.

İrdesel. Effectiveness of exercise and compression garments in the treatment of breast cancer related lymphedema. Turkish J Phys Med Rehabilitation/Turkiye Fiziksel Tip ve Rehabilitasyon Dergisi. 2007;53:1.

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Published

2018-10-26

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Original Research Articles