title: Upper limb swelling following mastectomy: lymphedema or not?
abstract: 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
authors.affiliation: Sinclair School of Nursing, University of Missouri at Columbia, USA.
authors.forename: Jane
authors.initials: J
authors.lastname: Armer
mesh_terms: D001943:Breast Neoplasms / Q000188:drug therapy / Q000601:surgery*; D003520:Cyclophosphamide; D004317:Doxorubicin; D005260:Female; D006801:Humans; D008209:Lymphedema / Q000209:etiology*; D008408:Mastectomy / Q000009:adverse effects*; D008875:Middle Aged; D011183:Postoperative Complications; D013995:Time; D034941:Upper Extremity / Q000473:pathology*; D044465:White People
chemical_list: D004317:Doxorubicin; D003520:Cyclophosphamide