Rockson SG, Keeley V, Kilbreath S, Szuba A, Towers A, et al.
Nature reviews. Disease primers. Date of publication 2019 Mar 28;volume 5(1):22.
1. Nat Rev Dis Primers. 2019 Mar 28;5(1):22. doi: 10.1038/s41572-019-0072-5.
Cancer-associated secondary lymphoedema.
Rockson SG(1), Keeley V(2)(3), Kilbreath S(4), Szuba A(5), Towers A(6).
Author information:
(1)Stanford Center for Lymphatic and Venous Disorders, Stanford University School
of Medicine, Stanford, CA, USA. rockson@stanford.edu.
(2)University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK.
(3)Medical School, University of Nottingham, Nottingham, UK.
(4)Faculty of Health Sciences, University of Sydney, Sydney, Australia.
(5)Division of Angiology, Wroclaw Medical University, Wroclaw, Poland.
(6)Department of Oncology, McGill University, Montreal, Canada.
Lymphoedema is an oedematous condition with a specific and complex tissue
biology. In the clinical context of cancer, the pathogenesis of lymphoedema
ensues most typically from the modalities employed to stage and treat the cancer
(in particular, surgery and radiotherapy). Despite advances in cancer treatment,
lifelong lymphoedema (limb swelling and the accompanying chronic inflammatory
processes) affects approximately one in seven individuals treated for cancer,
although estimates of lymphoedema prevalence following cancer treatment vary
widely depending upon the diagnostic criteria used and the duration of follow-up.
The natural history of cancer-associated lymphoedema is defined by increasing
limb girth, fibrosis, inflammation, abnormal fat deposition and eventual marked
cutaneous pathology, which also increases the risk of recurrent skin infections.
Lymphoedema can substantially affect the daily quality of life of patients, as,
in addition to aesthetic concerns, it can cause discomfort and affect the ability
to carry out daily tasks. Clinical diagnosis is dependent on comparison of the
affected region with the equivalent region on the unaffected side and, if
available, with pre-surgical measurements. Surveillance is indicated in this
high-risk population to facilitate disease detection at the early stages, when
therapeutic interventions are most effective. Treatment modalities include
conservative physical strategies that feature complex decongestive therapy
(including compression garments) and intermittent pneumatic compression, as well
as an emerging spectrum of surgical interventions, including liposuction for
late-stage disease. The future application of pharmacological and microsurgical
therapeutics for cancer-associated lymphoedema holds great promise.
DOI: 10.1038/s41572-019-0072-5
PMID: 30923312
