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Pathophysiology of Breast Cancer-Related Lymphoedema

  • Lymphedema Incidence, Prevention and Treatment (J Armer, Section Editor)
  • Published:
Current Breast Cancer Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

To review the literature regarding the pathophysiological changes found in BCRL and to link them to the cancer and the type and sequencing of treatments and raise attention to the fact that not all parts of the arm at risk or with lymphoedema may have underlying changes which are similar or are progressing at the same rate.

Recent Findings

There still remains a lack of awareness regarding BCRL-related pathophysiology and of the range of reasons for it. Linked to this is a lack of appropriate in-clinic assessment of these changes and of the use of this information to better target and sequence treatment. We are refining and improving our consensus documents related to lymphoedema and the impact of the pathophysiology on its staging which will help in this.

Summary

We should link the pathophysiological changes we find and record with the functional changes which are signs of that underlying structural change through increased use of a range of assessment tools such as indurometry, bio-impedance spectroscopy, tissue dielectric constants, ICG, lympho-scintigraphy, etc. We must better target and sequence our treatments and relate them to our measures of pathophysiological and functional changes.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Acknowledgments

This article is very different from what I set out to write about the pathophysiology of BCRL. Why? Well, our daughter (Chantelle O’Brien) at the age of 37 is currently undergoing the treatment programmes for her recently diagnosed BC. Talking with her about it, it soon become clear that I needed to try to look more holistically at the pathophysiological focus and link them more clearly with changes in the limb specifically linked to the issues of cancer and its infiltration impact and those of the treatments and their sequencing and then on what may occur in the follow-up stages of lymphatic disruption. I’m not sure if I have totally captured this intent, but I hope it will persuade others to think about the bigger picture, the cancer treatments and their sequencing, the patient at the centre of these, and the issues of pathophysiological progression and its treatment on patient functionality and of the measurements we can use to indicate approaching return to normalcy instead of continuing pathophysiological progression.

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Authors and Affiliations

  1. Lymphoedema Clinical Research Unit, Department of Surgery and Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, South Australia, Australia

    Neil B. Piller

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  1. Neil B. Piller
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Correspondence to Neil B. Piller.

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Neil Piller declares no conflicts of interest relevant to this manuscript.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Lymphedema Incidence, Prevention and Treatment

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Piller, N.B. Pathophysiology of Breast Cancer-Related Lymphoedema. Curr Breast Cancer Rep 12, 225–229 (2020). https://doi.org/10.1007/s12609-020-00377-w

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