An investigation into the pathophysiology of breast cancer-related lymphoedema

• Main Author: Bains, Salena Raminder Ramanjeet Kaur
• Other Authors: Purushotham, Anand David
• Published: King's College London (University of London) 2015
• Subjects: 616.99
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.677133

Breast cancer-related lymphoedema (BCRL) is a chronic condition with associated physical and psychological sequelae. BCRL affects up to 25% of breast cancer patients, yet the aetiology is incompletely understood. The work described within this thesis will help further advance the understanding of the pathophysiology of BCRL, with a focus on whether patients are predisposed to developing BCRL. Studies were conducted using qualitative and quantitative lymphoscintigraphy to assess the lymphatic system in breast cancer patients. The first study investigated muscle lymph flow in the upper limb. Lymphatic clearance rates were measured to investigate whether there was an abnormality in lymph flow prior to axillary lymph node surgery in patients who subsequently developed BCRL. Secondly, patients were assessed for the presence of upper limb lymphovenous communications to determine if these acted as a protective mechanism against the development of BCRL. Finally, in order to determine if there was a global dysfunction of the lymphatic system in patients previously treated for breast cancer, lower limb lymphatic function was assessed. The first study demonstrated that those who went on to develop BCRL had a higher pre-operative muscle lymph flow compared with those who did not, indicating an underlying constitutional difference. The second study showed evidence of the presence of lymphovenous communications in several breast cancer patients studied, however the numbers were too small to show any correlation with the development of BCRL. The final study showed that patients with BCRL had significantly impaired lower limb lymph flow compared with non-BCRL patients. Intriguingly, several non-BCRL patients were also found to have impaired lower lymph flow, raising the question of whether systemic treatment with chemotherapy was a significant contributory factor to this phenomenon. In conclusion, these studies add evidence in support of the hypothesis that constitutional factors contribute to the development of BCRL.