Consultant – Orthopaedic Surgeon
Speciality interests include:
Lower extremity: trauma, sports surgery, knee, patella dislocation, tendon problems, foot and ankle surgery, and the management of degenerative joint disease in younger patients.
Visiting on Sep 21-22, 2019Request an Appointment
Breast cancer is the most common type of cancer in women and one of the well-known complications of its treatment is the swelling of the arm and chest, which we call breast cancer-related lymphedema (BCRL). We see that more than one in five women with breast cancer will develop BCRL.
What is BCRL?
Breast cancer-related lymphedema (also called secondary lymphedema), is an abnormal accumulation of protein-rich lymph fluid in the tissues. This is due to the insufficient capacity of the lymphatic system.The fluid accumulation is present on the affected side of the body following breast cancer treatment and can lead to persistent swelling on this side.BCRL can affect the arm, hand, fingers, wrist, elbow, shoulder, neck, breast, chest or any combination of these areas. Arm swelling is the most widely studied. The amount of swelling is always compared to the other arm. A common arm classification is mild (< 20% more volume compared to the other side), moderate (20% to 40% more volume) and severe (> 40% more volume). Lymphedema is not a life-threatening disorder, but in addition to the swelling symptoms, this chronic condition can also cause pain, altered sensations such as discomfort and heaviness, difficulties with physical mobility, physiological distress, recurrent infections and social isolation. It might have a negative effect on the quality of life.
What is the cause of BRCL?
Among breast cancer survivors, the most common causes of BCRL are lymphatic vessel/node removal and radiation treatment:
Breast cancer surgery can cause lymphedema through several mechanisms: surgical removal of lymphatic structures such as nodes and vessels can impair lymph carrying capacity. Surgical scarring can diminish lymph transport by occlusion of lymph vessels and/or loss of elasticity in lymph vessels. Surgical removal or damage of muscle tissue can diminish the pumping effect of the muscle on the lymph vessels.
Radiation therapy can also cause BCRL through several mechanisms, including direct tissue damage, node damage, and/or scarring and fibrosis, which can all reduce the lymph carrying capacity.
The risk of Incidence of developing of swelling varies according to the type of breast cancer treatment received. Although recent changes in early diagnosis and improvement in the treatment of breast cancer (such as sentinel node biopsy, changes in radiation therapy, and less invasive surgical techniques due to earlier diagnosis) have reduced the risk of BCRL, BCRL remains a major problem for women with breast cancer. With the increased use of multimodality therapy (including such as surgery, local-regional radiation therapy, and certain systemic chemotherapeutic agents), the number of cases of BCRL may continue to increase.
What are the risk factors for BCRL?
Different risk factors can influence the incidence of lymphedema such as: the level of lymph node dissection, the number of nodes removed, the number of involved nodes, the size and grade of the primary tumor, chemotherapy, radiation therapy, experience of the surgeon, dominant limb, poorer performance status, obesity and certain genes. The development of the lymphedema can present with an onset ranging from early in the postoperative period to beyond 30 years’ post-treatment.