What Are Lymphedema Pumps?

Upper-extremity lymphedema of the affected breast is a common complication of axillary lymph node dissection and radiotherapy of the axillary site. In the 1960s, the incidence of lymphedema in the upper limbs after radical mastectomy was 25%, and the incidence increased to 52% after surgery plus radiotherapy. In the 1980s, it was reported in the literature that the incidence of upper limb lymphedema was 15%. In recent years, the incidence of moderate and severe upper extremity lymphedema after axillary lymph node dissection is less than 5%. The degree of lymphedema is related to individual factors. In some patients, the upper limb lymphatic communication branch is underdeveloped and prone to lymphedema. Lymphedema is more common in older and obese breast cancer patients.

Basic Information

English name

upper limb lymphedema of breast carcinoma

Visiting department

surgical

Common causes

Common complications of axillary lymph node dissection and axillary radiotherapy

Common symptoms

Ipsilateral upper limb pain, limb deformation, dysfunction, and secondary infection

Causes of upper limb lymphedema on the side of breast cancer

1. Axillary lymph node dissection removes the axillary lymph nodes, and at the same time cuts off and ligates the lymph vessels, thereby blocking the lymphatic return flow path and causing upper limb lymphatic flow obstruction. A large amount of protein-containing lymph fluid stays in the interstitial space and causes tissue swelling in related parts. Over time, it can also cause skin and subcutaneous tissue thickening, edema and fibrous tissue hyperplasia. After surgery, axillary effusion, infection, and scar contracture also hinder upper limb lymphatic and venous reflux.

2. Radiation therapy of breast cancer at the axillary site will cause vein occlusion and lymphatic destruction in the radiation field, and it will also compress veins and lymphatic vessels due to local muscle fibrosis, which will affect lymphatic return in the upper limbs.

Clinical manifestations of upper limb lymphedema on the side of breast cancer

Upper limb lymphedema on the affected side of breast cancer occurs at any time after surgery and can occur immediately after surgery or after 30 years. Acute lymphedema is manifested by thickening of the upper limb of the affected side. If the peripheral diameter of the upper limb increases by more than 2 cm, it can be detected by the naked eye. Chronic lymphedema is rubber-like swelling in the upper arm. Lymphedema can cause pain, deformity, and dysfunction in the upper limb of the affected side, and can cause secondary infections, which in turn cause lymphatic sclerosis and occlusion to increase edema. The International Lymphatic Society has divided it into the following three phases:

Stage : Stomach edema is present in the upper limbs, and the edema disappears when the limbs are elevated.

Stage : Edema is non-concavity, moderate fibrosis of upper limb tissue, and edema of limb elevation does not disappear.

Stage : rubber swollen, cartilage-like hardness of the upper extremities, skin papillomas.

It is divided into three degrees according to the scope and degree of edema:

Degree : The volume of the upper arm is increased by <10%, which is generally not obvious. It is not easy to detect with the naked eye, and it mostly occurs in the proximal and proximal sides of the upper arm.

Degree : The volume of the upper arm increases by 10% to 80%, and the swelling is obvious, but generally does not affect the activity of the upper limbs.

degree (severe): The volume of the upper arm is increased by 80%, the swelling is significant, and the range of involvement is wide, which can affect the entire upper limb and have severe upper limb mobility disorders.

Upper limb lymphedema treatment for breast cancer

Mild upper extremity lymphedema can be relieved within a few months after operation. Severe upper extremity swelling is difficult to recover on its own, and the effects of various non-surgical and surgical treatments are limited.

1. Raise the affected limb for local massage, and raise your elbows at night to make the upper arm higher than the level of the chest wall. During the local massage, the patient lifts the affected limb, the hands of the massager are buckled in a ring, and they are continuously squeezed with a certain pressure from the distal end to the proximal side. Each time they are repeatedly pressed from top to bottom for 10 to 15 minutes, several times a day, Promote reflux.

2. If necessary, use elastic bandages to compress the upper limbs to reduce swelling, or use a massage, and use elastic bandages immediately after the massage. Some hospital rehabilitation clinics use pressure pumps instead of manual massage to promote reflux. An inflatable cuff is placed on the edema limb and intermittently inflated to promote the edema fluid to flow to the heart. The air pressure pump is suitable for the early stage of lymphedema, and the effect of subcutaneous fibrosis is not good.

3. Dietary intake of salt should be controlled.

4. The ganglion is closed to relieve blood vessel and lymphatic spasm and improve circulation.

5. Surgical treatment is aimed at reducing the load on the lymphatic system (removing edema-proliferated diseased tissue) or improving the lymphatic system's transport capacity (promoting lymphatic reflux and rebuilding lymphatic channels). According to the literature, some studies have achieved good results.

In the treatment of upper limb lymphedema after breast cancer surgery, it is necessary to reduce the accumulation of lymph fluid and improve lymphatic reflux to obtain long-term relief and avoid recurrence, which is a hot topic at home and abroad.

Prevention of upper limb lymphedema on the side of breast cancer

1. When performing axillary lymph node dissection, standard operations should be performed, and the axillary vein trunk should not be damaged.

2. Avoid excessive physical work, trauma, and venipuncture of the affected limb as much as possible, and prevent infection.

3. Clinical examination For patients with breast cancer without axillary metastasis, the first sentinel lymph node may be removed for pathological examination (ie sentinel lymph node biopsy) to determine the status of axillary lymph nodes in patients. Do axillary lymph node dissection to reduce the occurrence of lymphedema. Sentinel lymph node biopsy is currently only carried out in a few hospitals in China. This technique requires high accuracy. Whether it is performed during surgery should be determined by the medical institution in accordance with the existing equipment and technical conditions.