Breast Cancer-Related Lymphedema: From Description to Management

Breast cancer-related lymphedema (BCRL) stands as a potentially debilitating consequence of breast cancer treatment, often irreversible in nature. It arises from either a diminished drainage capacity or an overload on the lymphatic system, wherein the interstitial fluid volume surpasses the lymphatic system’s transport capacity in the arm and affected areas due to the mechanical limitations of the lymphatic system. Research has shed light on the intricate pathogenesis of BCRL, revealing a complex interplay of inflammatory processes, disrupted lymphatic remodeling, and impaired lymphatic angiogenesis, compounded by various risk factors. These risk factors include the body mass index at diagnosis, subclinical edema, and cellulitis on the affected side. Treatment-related independent risk factors encompass the type of surgical procedure, the extent of lymph node removal, radiation to regional lymph nodes, and chemotherapy. BCRL can manifest at different intervals post-surgery, with the majority of cases surfacing within the initial 2 years, although it is noteworthy that BCRL can emerge even years after the conclusion of initial treatment, underscoring the necessity for prolonged monitoring and support for breast cancer survivors. Hence, early identification and timely interventions play pivotal roles in BCRL prevention. Diagnosis hinges on a comprehensive assessment of risk factors, associated symptoms, clinical signs, and physical examination. The literature offers an array of non-invasive techniques for evaluating secondary arm lymphedema. Complex decongestive therapy (CDT) stands as the widely endorsed therapeutic approach for BCRL patients, comprising manual lymphatic drainage, skin care, compression, and decongestive exercises. To improve patient outcomes and enhance their quality of life, healthcare professionals should utilize evidence-based techniques such as CDT for risk reduction, prevention, and adaptation. It is essential to address all components of CDT proactively from the outset. In addition to employing exercises and compression as preventive measures, comprehensive CDT encompasses various domains aimed at addressing BCRL. Further research is needed to determine whether CDT is more effective as a risk reduction behavior compared to its role as a management and treatment strategy.