Risk Factors for lymphedema

Who is at risk for lymphedema?

What are the risk factors for lymphedema? Is there an answer to how to prevent lymphedema? Anyone who has one or more of the following factors can acquire lymphedema:

Lymph node removal for biopsies

Serious infections that include lymphangitis, cellulitis or erysipelas.

Deep invasive wounds that might tear, cut or damage the lymphatics.

Radiation treatments, especially ones that are focused in areas that might contain “clusters” of lymph nodes

Morbid obesity can cause secondary lymphedema by “crushing” the lymphatics

Serious burns, even intense sunburn

Infection of the microscopic parasite filarial larvae, though this is more common in tropical countries

For primary lymphedema any person who has a family history of unknown swelling of a limb

Radiation and chemotherapy for cancer

Insect bites

Bone fractures and breaks

If you are a person with any of these risk factors, you will want to learn the warning signs of lymphedema.

It is critical for proper management to achieve an early diagnosis and to establish a treatment program to prevent serious the complications of lymphedema.

The risk of developing arm lymphedema among breast cancer survivors: a meta-analysis of treatment factors

Ann Surg Oncol. 2009 July

Tsai RJ, Dennis LK, Lynch CF, Snetselaar LG, Zamba GK, Scott-Conner C. Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA. rebecca-tsai@uiowa.edu

BACKGROUND: As more women survive breast cancer, long-term complications that affect quality of life, such as lymphedema of the arm, gain greater importance. Numerous studies have attempted to identify treatment and prognostic factors for arm lymphedema, yet the magnitude of these associations remains inconsistent.

METHODS: A PubMed search was conducted through January 2008 to locate articles on lymphedema and treatment factors after breast cancer diagnosis. Random-effect models were used to estimate the pooled risk ratio.

RESULTS: The authors identified 98 independent studies that reported at least one risk factor of interest. The risk ratio (RR) of arm lymphedema was increased after mastectomy when compared with lumpectomy [RR = 1.42; 95% confidence interval (CI) 1.15-1.76], axillary dissection compared with no axillary dissection (RR = 3.47; 95% CI 2.34-5.15), axillary dissection compared with sentinel node biopsy (RR = 3.07; 95% CI 2.20-4.29), radiation therapy (RR = 1.92; 95% CI 1.61-2.28), and positive axillary nodes (RR = 1.54; 95% CI 1.32-1.80). These associations held when studies using self-reported lymphedema were excluded.

CONCLUSIONS: Mastectomy, extent of axillary dissection, radiation therapy, and presence of positive nodes increased risk of developing arm lymphedema after breast cancer. These factors likely reflected lymph node removal, which most surgeons consider to be the largest risk factor for lymphedema. Future studies should consider examining sentinel node biopsy versus no dissection with a long follow-up time post surgery to see if there is a benefit of decreased lymphedema compared with no dissection.

SpringerLink

Risk factors for lower limb lymphedema after lymph node dissection in patients with ovarian and uterine carcinoma.

BMC Cancer. 2009 Feb

Tada H, Teramukai S, Fukushima M, Sasaki H. Department of Clinical Trial Design and Management, Translational Research Center, Kyoto University Hospital, Sakyo-ku, Kyoto, Japan. haru.ta@kuhp.kyoto-u.ac.jp

BACKGROUND: Lymph node dissection has proven prognostic benefits for patients with ovarian or uterine carcinoma; however, one of the complications associated with this procedure is lymphedema. We aimed to identify the factors that are associated with the occurrence of lymphedema after lymph node dissection for the treatment of ovarian or uterine carcinoma.

METHODS: A total of 694 patients with histologically confirmed ovarian (135 patients) or uterine cancer (258 with cervical cancer, 301 with endometrial cancer) who underwent lymph node dissection were studied retrospectively. Logistic regression analyses were used to identify the risk factors associated with occurrence of lymphedema.

RESULTS: Among ovarian and uterine cancer patients who underwent pelvic lymph node dissection, post-operative radiotherapy (odds ratio: 1.79; 95% confidence interval: 1.20-2.67; p = 0.006) was statistically significantly associated with occurrence of lymphedema.

CONCLUSION: There was no relationship between any surgical procedure and occurrence of lymphedema among patients undergoing pelvic lymphadenectomy. Our findings are supported by a sound biological rationale because they suggest that limb lymphedema is caused by pelvic lymph node dissection.

Full Text Article

PubMed Central