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Cancer-associated secondary lymphoedema

Nature Reviews Disease Primers volume 5, Article number: 22 (2019) Cite this article

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Abstract

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.

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Fig. 1: Cumulative occurrence of breast cancer-related lymphoedema at successive intervals of follow-up.
Fig. 2: Proposed natural history of tissue pathogenesis in lymphoedema.
Fig. 3: Clinical stages of lymphoedema.

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Acknowledgements

S.G.R.’s work is funded in part by the Allan and Tina Neill Chair of Lymphatic Research and Medicine, Stanford University.

Reviewer information

Nature Reviews Disease Primers thanks N. Liu, P. Mortimer, S. Ridner, A. Taghian and the other anonymous reviewer(s), for their contribution to the peer review of this work.

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Authors and Affiliations

  1. Stanford Center for Lymphatic and Venous Disorders, Stanford University School of Medicine, Stanford, CA, USA

    Stanley G. Rockson

  2. University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK

    Vaughan Keeley

  3. Medical School, University of Nottingham, Nottingham, UK

    Vaughan Keeley

  4. Faculty of Health Sciences, University of Sydney, Sydney, Australia

    Sharon Kilbreath

  5. Division of Angiology, Wroclaw Medical University, Wroclaw, Poland

    Andrzej Szuba

  6. Department of Oncology, McGill University, Montreal, Canada

    Anna Towers

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Contributions

Introduction (A.T. and S.G.R.); Epidemiology (V.K. and S.G.R.); Mechanisms/pathophysiology (S.G.R.); Diagnosis, screening and prevention (S.K. and S.G.R.); Management (A.S. and S.G.R.); Quality of life (V.K. and S.G.R.); Outlook (A.T. and S.G.R.); Overview of Primer (S.G.R.).

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Rockson, S.G., Keeley, V., Kilbreath, S. et al. Cancer-associated secondary lymphoedema. Nat Rev Dis Primers 5, 22 (2019). https://doi.org/10.1038/s41572-019-0072-5

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