Cancer related lymphedema

Abstract

Lymphedema is a prevalent, incurable, and morbid condition with the potential to degrade the health and quality of life of patients living with cancer and beyond cancer. Effective long term control requires coordination by an interdisciplinary team to ensure that lymphedema progression, complications, and related disablement are detected and appropriately addressed. This review provides an overview of lymphatic function and lymphedema pathogenesis with focused discussion of the unique characteristics of cancer related lymphedema (CRL) including natural history, clinical presentation, and risk factors for onset and progression. Surgical practice changes and supportive evidence for lymph node sparing and lymphatic reconstruction for CRL prevention are described. The review outlines evaluations to diagnose, stage, and monitor CRL, and characterizes evidence for current CRL prevention and management practices, including surgeries to restore lymphatic function. Multimodal management with complete decongestive therapy remains first line treatment for CRL, though patient-specific customization might be required to optimize patients’ clinical response and quality of life as outlined in the review.