Breast cancer is a malignant tumor with high incidence in women. In 2020, its incidence surpassed that of lung cancer and became the highest incidence of cancer in the world. There are a large number of morbidity of breast cancer among Chinese women every year. Surgery is the main treatment for breast cancer. Although axillary lymph node dissection can improve the survival rate of patients, it also brings a series of problems, among which lymphedema is one of the common complications after breast cancer surgery.
Under normal circumstances, human lymph is in a state of balanced circulation. The lymph of the upper limb flows through the lymphatic vessels to the venous angle of the neck, and the axilla is the only way. In breast cancer patients, axillary lymphatic vessels are damaged by surgery and radiotherapy, resulting in obstruction of upper limb lymph reflux, retention in the interstitial space, and limb swelling. Because lymphatic circulation cannot repair itself, women undergoing breast cancer surgery are at risk of lifelong lymphedema, which can occur in up to 40% of the postoperative population.
Lymphedema can occur anywhere from immediately to 20 or 30 years after surgery. Early limb swelling is not obvious, easy to be ignored, with the development of the disease, the limb will gradually “fat” up, and appear heavy, tight, sore and other symptoms. Lymph that accumulates in the arm is a good culture medium that increases the likelihood of infections in the affected limb, such as cellulitis and lymphangitis, which can aggravate edema. In addition, the limb with long-term lymphedema may develop into malignant tumors such as lymphangiosarcoma, and the prognosis is very poor.
Lymphedema can usually be identified by history and physical examination, and measurement of limb circumference is a common method of assessment. Radionuclide lymphoscintigraphy is an important examination for definite diagnosis, with a sensitivity of 96% and a specificity of 100%.
The treatment
of lymphedema includes conservative treatment and surgical treatment. Conservative treatment is often combined detumescence therapy (CDT), such as the use of elastic bandages, manual lymphatic drainage, functional exercise and skin care. Elastic bandage can adjust the pressure to help reduce the volume of the affected limb; manual lymphatic drainage can promote lymphatic absorption; proper exercise can increase venous return and lymphatic absorption; skin care is also important. Surgical treatment includes liposuction, lymphatic-venous anastomosis and lymph node metastasis. Liposuction reduces the volume of the arm, but requires lifelong use of a pressure suit; lymphatic-venous anastomosis creates new pathways for lymph fluid; and lymph node transfer improves lymphatic drainage by transplanting healthy lymph nodes.
In order to prevent lymphedema, patients should observe whether there are abnormal symptoms in the ipsilateral upper limb after operation, avoid lifting heavy objects and repetitive movements, keep the skin of the affected limb clean and dry, avoid therapeutic operation and trauma in the affected limb, avoid compression and high temperature stimulation of the affected limb, take appropriate exercises, wear elastic sleeves, etc.
Breast cancer-related lymphedema is a chronic disease that has adverse physical and psychological effects on patients. Understanding the relevant knowledge is very important for patients with breast cancer after surgery, which is helpful to improve the quality of life and reduce the harm of complications.
References:
[1] Zhu Yan. Breast cancer postoperative challenge: lymphedema, need to be vigilant [J]. Healthy Life, 2024, (10): 23-24.
Breast cancer
