Beware of lymphoedema after breast cancer treatment

About 1 in 5 women who survive breast cancer develops secondary lymphoedema. Unlike primary lymphoedema that is congenital, secondary lymphoedema develops due to an injury. Lymphoedema is a swelling that occurs because excess lymph fluid is no longer properly drained and, therefore, accumulates. In survivors, lymphoedema mainly occurs around the hand, arm, shoulder, chest and torso. It can occur immediately after surgery or treatment, but it also regularly pops up years later. Prevention and early detection are very important because the painful condition can be cured or at least curbed at an early stage.

Possible symptoms:
- swelling of the arm
- burning pain
- sense of heaviness
- loss of gross and fine motor skills
- disturbance in the sensation
- paralysis

Chronic lymphoedema also causes patients to suffer from poor wound healing, benign tumours (papillomas), cellulite, erysipelas, inflammation of the lymphatic vessels and, in exceptional cases, a rare malignant tumour that develops from the wall of a lymphatic vessel (lymphangiosarcoma). Moreover, as the disease progresses, medical costs also rise.

Risk factors and prevention
Scientific studies show that axillary lymph node clearance, high BMI and/or high weight and a greater number of removed lymph nodes are important risk factors for developing lymphoedema. Radio and chemotherapy can also entail extra risk. Physical activity, sports and early compression therapy are said to have a protective effect.

Axillary lymph node clearance
In the past, axillary lymph node clearance was standard procedure to see how far breast cancer had spread and to prevent further spread. These days, sentinel lymph node biopsy is increasingly being performed. During this procedure, a small piece of tissue is taken from the sentinel lymph node. This is the lymph node that first catches the lymph flow with possible metastases. If there are metastases, this lymph node will be affected first. After that, the metastases spread to the lymph nodes that are further downstream. If the biopsy gives a positive result, radiotherapy is started. This approach reduces the risk of secondary lymphoedema. If an axillary lymph node clearance is necessary, it is important to carefully and regularly monitor the patient after surgery because prevention and early detection of lymphoedema are so important. Research also shows that the risk of lymphoedema increases as the number of removed lymph nodes increases.

High BMI and/or high body weight
For about 70 years, scientific studies have been showing that heavier people are much more at risk of developing lymphoedema. Obesity supposedly compromises the proper functioning of the lymphatic system. Weight loss after surgery and a more active lifestyle can reduce the risk of lymphoedema.

Taxanes
Chemo with taxanes causes a temporary and not clearly defined oedema in the extremities (ankles, legs and arms). This oedema is treated with a corticosteroid treatment - a treatment with adrenal cortex hormones. There is only moderate evidence that treatment with taxanes also entails higher risks of lymphoedema in the longer term. Nevertheless, it is advisable to remain vigilant for swellings.

Compression therapy
Early compression therapy (applying back pressure to the edema area by bandaging or wearing a therapeutic elastic stocking or a non-elastic bandage) could prevent the development of secondary lymphoedema.

Multidisciplinary consultation on the consequences of chemotherapy with taxanes and radiotherapy is important. That is why Think Pink always recommends survivors to be treated in an accredited breast clinic.

Source: Verstraeten, L., Thomis, S., Bechter-Hugl, B., & Fourneau, I. (2020). Risicofactoren voor het ontwikkelen van lymfoedeem na een borstkankerbehandeling: een systematische review. Tijdschrift voor Geneeskunde, 76 (1-2), pp. 19-37.