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Lymphedema (PDQ®): Supportive care - Health Professional Information [NCI] - Overview

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Psychological symptoms

Breast cancer survivors with arm lymphedema have been found to be more disabled, experience a poorer quality of life, and have more psychological distress than do survivors without lymphedema.[8,9] In addition, women reporting swelling have reported significantly lower quality of life with multiple functional assessments.[10]

Epidemiology

Lymphedema can occur after any cancer or its treatment that affects lymph node drainage. It has been reported to occur within days and up to 30 years after treatment for breast cancer.[11] Eighty percent of patients experience onset within 3 years of surgery; the remainder develop edema at a rate of 1% per year.[12] Upper-extremity lymphedema most often occurs after breast cancer; lower-extremity lymphedema most often occurs with uterine cancer, prostate cancer, lymphoma, or melanoma.[1] A large population-based study supports the evidence that lower-limb lymphedema is experienced by a significant proportion of women after treatment for gynecological cancer, with the highest prevalence (36%) among vulvar cancer survivors and the lowest prevalence (5%) among ovarian cancer survivors.[13]

There is no consistency in the data on the incidence and prevalence of lymphedema after breast cancer, probably because of differences in diagnosis, the different characteristics of the patients studied, and inadequate follow-up to capture delayed development of the disorder. The overall incidence of arm lymphedema can range from 8% to 56% at 2 years postsurgery.[10]

It is important to diagnose and treat lymphedema when it is mild because those with mild lymphedema make up the cohort that gives rise to preventable severe, debilitating lymphedema. Women with mild lymphedema are more than three times as likely to develop severe lymphedema than are women with no lymphedema.[14]

Risk Factors

Patients undergoing axillary surgery and/or axillary radiation therapy for breast cancer are at higher risk for developing lymphedema of the arm. Previous convention suggested that nodal positivity was a predisposing factor for the development of lymphedema in breast cancer patients.[15] Controlling for axillary radiation, one study actually found an inverse relationship between nodal positivity and arm volume.[15]

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