Lymphedema management
Section snippets
Modifications of primary cancer therapy
Breast cancer can be used as a model to show how early detection and treatment modification can assist in the prevention of lymphedema. Advanced nodal disease at diagnosis is a known risk factor for lymphedema because of the need for extensive axillary surgery, increased chemotherapy, and additional radiation therapy to the axilla.4, 5, 6
Arm edema is associated with the degree of axillary dissection and the use of axillary radiation therapy.7, 8 The incidence of lymphedema increases with more
Manual lymphatic drainage
Manual lymphatic drainage (MLD) is a highly specialized massage technique designed to enhance the sequestration and transport of lymph. Specific stroke duration, orientation, pressure, and sequence characterize MLD. Through gentle, rhythmic skin distension, congested lymph is directed through residual functioning lymphatics into intact nodal basins. MLD permits elimination of congested truncal lymph by shifting it to lymphotomes (anatomic regions drained by a specific lymph node bed) with
Surgical procedures for lymphedema
Many operations have been used over the past century to improve the status of the lymphedematous upper limb. The list of the diverse operations attempted for this disabling condition in the past decades suggests that none are successful. Philosophically these can be loosely grouped as (1) recreation or imitation of lymphatic channels, (2) bridging the lymphedematous area to normal lymphatic areas, and (3) resections or debulking of lymphedematous tissue.
The most biologically based operation,
Medications
Diuretics are routinely initiated to treat lymphedema. Although many patients experience an acute reduction in swelling with diuretics, they are not recommended in the long-term management of lymphedema.82 These medications exert their therapeutic influence by reducing blood capillary pressure. This alters the interplay of forces that dictate net fluid movement across the endothelium, reducing ultrafiltration. Unfortunately, although use of diuretics may curtail the accumulation of lymph fluid,
Future directions
Increasing investigative attention is being paid to the development of novel lymphedema treatment approaches. The identification of vascular endothelial growth factor receptor as the defective gene in several families afflicted with congenital lymphedema has paved the way for gene therapy trials.105, 106 These are currently in the incipient stages. Hyperbaric oxygen therapy has also received attention as a means of curbing radiation-induced fibrosis of lymphatics and thereby preserving drainage.
Conclusion
Lymphedema remains a significant, long-term problem for many cancer survivors. Although numerous surgical and pharmacological interventions have been scrutinized, none offer unequivocal benefit and many are plagued by deleterious side effects. At present, multimodal manual therapy is the standard of care. The combination of MLD, remedial exercises, skin care, and compressive bandaging, referred to as complete decongestive physiotherapy, has been shown to be effective in numerous large case
References (107)
- et al.
The effects of adjuvant chemotherapy on cosmesis and complications in patients with breast cancer treated by definitive irradiation
Int J Radiat Oncol Biol Phys
(1983) - et al.
Arm morbidity after sector resection and axillary dissection with or without postoperative radiotherapy in breast cancer stage IResults from a randomised trial. Uppsala-Orebro Breast Cancer Study Group
Eur J Cancer
(1997) - et al.
Management of the axilla in conservatively treated breast cancer592 patients treated at Institut Gustave-Roussy
Int J Radiat Oncol Biol Phys
(1987) - et al.
Sentinel-node biopsy to avoid axillary dissection in breast cancer with negative lymph nodes
Lancet
(1997) Lymphedema following the surgical treatment of breast cancerA review of pathophysiology and treatment
J Pain Symp Manage
(1992)- et al.
Complex physical therapy for the lymphoedematous arm
Br J Hand Surg
(1992) Lymphangioplasty
Lancet
(1908)- et al.
Liposuction in the treatment of lymphoedemaA preliminary report
Br J Plast Surg
(1989) - et al.
Complications associated with mastectomy
Surg Clin North Am
(1983) - et al.
Primary lymphedema
The diagnosis and treatment of peripheral lymphedemaDraft revision of the 1995 Consensus Document of the International Society of Lymphology Executive Committee for discussion at the September 3–7, 2001, XVIII International Congress of Lymphology in Genoa, Italy. International Society of Lymphology Executive
Lymphology
LymphedemaClassification, diagnosis and therapy
Vasc Med
Risk of lymphoedema following the treatment of breast cancer
Br J Surg
Lymphoedema of the arm after treatment of cancer of the breastA study of 5868 cases
Detsch Med Wschr
Sequalae of axillary dissection vs. axillary sampling with or without irradiation for breast cancerA randomized trial
Acta Chir Scand
Primary breast cancerComplications of axillary management
Acta Radiol Oncol
Early-stage breast cancerArm edema after wide excision and breast irradiation
Radiology
Arm edema in conservatively managed breast cancerObesity is a major predictive factor
Radiology
Breast radiotherapy and lymphedema
Cancer
Sentinel lymphadenectomy in breast cancer
J Clin Oncol
Morbidity following sentinel lymph node versus axillary lymph node dissection for patients with breast carcinoma
Cancer
Handbuch der allgemeinen Pathologie, 3, Band 6
The pathophysiology of lymphedema
Verbesserte forderleistung der wadenmuskelpumpe unter kompressionstrumpfen bei Varizen und venoser Insuffizienz
Phlebol Proktol
Do we need firm compression stocking exerting high pressure?
VASA
Compression treatment of the lower extremities particularly with compression stockings
Dermotologist
Modern Treatment of Lymphoedema
The use of three compression sleeves in complete decongestive therapya comparison study of clinical effectiveness
Lymphlink
Sequential and graded intermitties pneumatic compression device for treatment of swollen limbs
Biomedizinische Technik
Lymphatic clearance during compressive loading
Lymphology
Lymphatic clearance of radioactive sulfur colloid
Lymphology
Lymphatic reabsorbtion of proteins and pressotherapies
Fluid translocation measurementA method to study pneumatic compression treatment of postmastectomy lymphoedema
Scand J Rehab Med
Factorial analysis in radionuclide lymphography assessment of the effects of sequential pneumatic compression
Lymphology
Evaluation of the results of three different methods of post mastectomy lymphedema treatment
J Surg Oncol
A comparison of intermittent compression of single and multiple chamber systems for treatment of secondary arm lymphedema after mastectomy lymphology
Z Lymphol
Effects of treatment with elastic sleeve an intermittent pneumatic compression in post-mastectomy patients with lymphoedema of the arm
Scand J Rehab Med
Postmastectomy lymphedema treated with the Wright linear pump
Can J Surg
Lymphedema treated with linear pumpPediatric case report
Arch Phys Med Rehab
Treatment of adult low-extremity lymphedema with the Wright linear pumpStatistic analysis of a clinical trial
Arch Phys Med Rehab
The “lympha-press” intermittent sequential pneumatic device for the treatment of lymphedemaFive years of clinical experience
J Cardiovasc Surg
Sequential pneumatic compression for lymphedema
Arch Surg
Clinical experiences using pneumatic massage therapy for edematous limbs over the last 10 years
Angiology
Vasomotoric function of lymphatics and lymph transport in limbs during massage and with elastic support
Dynamic pressure variation under bandages with different stiffness
BandagesScintigraphic demonstration of its efficacy on colloidal protein reabsorption during muscular activity
Physiology (fundamentals)
Therapeutic exercise
Treatment for lymphedema of the arm-the Casley-Smith method
Cancer
Die chirurgischen krankheiten der haut und des zellgewebes. Billroth Chr, Deutsche Chirurgie, Lieferung 23
Cited by (135)
Genetics of Skin Disease in Horses
2020, Veterinary Clinics of North America - Equine PracticeComparison of Spinal Alignment and Mobility in Women With and Without Post Modified Radical Mastectomy Unilateral Lymphoedema
2020, Clinical Breast CancerCitation Excerpt :Post modified radical mastectomy lymphoedema is associated with chronic or recurring swelling of the affected side. Although the arm is the most common site, the chest and the upper back are also often involved.5,6 Women commonly state symptoms such as pain, stiffness, heaviness, loss of sensation, limitation of movements, and weakness of the upper limb owing to the swelling.7-9
The effectiveness of lymphedema self-management in the prevention of breast cancer-related lymphedema and quality of life: A randomized controlled trial
2019, European Journal of Oncology Nursing