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Upper limb swelling following mastectomy: lymphedema or not?

PostPosted: Fri May 25, 2007 1:49 am
by patoco
Upper limb swelling following mastectomy: lymphedema or not?

Oncology (Williston Park). 2007 Apr

Armer J.
Sinclair School of Nursing, University of Missouri at Columbia, USA.

Having experienced an excisional biopsy, sentinel lymph node biopsy,
and mastectomy, BH is at lifetime risk of developing post-breast
cancer lymphedema in the arm on the side where her breast cancer was
treated. She has two additional risk factors, among those documented
in the literature: history of an infection (specifically a systemic
infection, significant in that it required hospitalization for
intravenous antibiotics) in the postsurgery period, and a moderate
increase in bilateral limb volume and weight (body mass index) over
the months and years following the breast cancer diagnosis.

Further, the patient-reported transient hand swelling on the affected
side and gradual weight increase are cues indicating a need for
patient vigilance and careful monitoring by the health-care team.
Preventing future infections, managing weight at an optimal level,
and preventing trauma or injury to the affected arm and chest are
important self-management precautions to reduce risk of chronic
lymphedema development.

BH needs continued support in reviewing evidence-based risk-reduction
guidelines and understanding ways to apply them to her lifestyle. In
the absence of preoperative baseline or contralateral limb
measurements (with circumferences or perometry or water
displacement), assessment of limb change at a level identified as
diagnostic of lymphedema (commonly, 200-mL volume or 2-cm girth
increase from baseline or as compared to the contralateral limb) is
very challenging. Without bilateral preop limb measurements for
baseline and contralateral limb comparisons, BH might have been
diagnosed with lymphedema at postop or at 48 months, when both limbs
increased symmetrically.

Symptom assessment is also crucial, as symptom report of heaviness
and swelling is found to be associated with limb volume changes
indicative of lymphedema.

Transient hand swelling may be evidence of latent lymphedema and
cause for increased risk-reduction education and vigilance in
assessment for emergence of nonresolving chronic lymphedema. million
American women are breast cancer survivors.

According to the American Cancer Society, every person treated for
cancer with lymph node removal, surgery, or radiation has a lifetime
risk for lymphedema, swelling caused by an increase in protein-rich
interstitial fluid. Some will develop lymphedema soon after cancer
treatment (within weeks or months) and others may not experience

PMID: 17508496 [PubMed - in process

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?
db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17508496&itool=icon abstr&query_hl=1&itool=pubmed_docsum

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Pat O'Connor
Lymphedema People
http://www.lymphedemapeople.com