Abstract
Lymphoedema is a well-known concern for cancer survivors. A crucial issue in lymphoedema is that we cannot predict who will be affected, and onset can occur many years after initial cancer treatment. The variability of time between cancer treatment and lymphoedema onset is an unexplained mystery. Retrospective cohort studies have investigated the risk factors for lymphoedema development, with extensive surgery and the combination of radiation and surgery identified as common high-risk factors. However, these studies could not predict lymphoedema risk in each individual patient in the early stages, nor could they explain the timing of onset. The study of anatomy is one promising tool to help shed light on the pathophysiology of lymphoedema. While the lymphatic system is the area least investigated in the field of anatomical science, some studies have described anatomical changes in the lymphatic system after lymph node dissection. Clinical imaging studies in lymphangiography, lymphoscintigraphy and indocyanine green (ICG) fluorescent lymphography have reported post-operative anatomical changes in the lymphatic system, including dermal backflow, lymphangiogenesis and creation of alternative pathways via the deep and torso lymphatics, demonstrating that such dynamic anatomical changes contribute to the maintenance of lymphatic drainage pathways. This article presents a descriptive review of the anatomical and imaging studies of the lymphatic system in the normal and post-operative conditions and attempts to answer the questions of why some people develop lymphoedema after cancer and some do not, and what causes the variability in lymphoedema onset timing.
Highlights
Lymphoedema is a well-known side-effect of post-cancer treatment
I speculate that the anatomy of the lymphatics changes in all patients after cancer treatment, but for the majority of them, those changes do not reach the threshold for developing into lymphoedema
Excess lymph fluid and proliferation of adipose tissue occur predominantly in the subcutaneous fat layer above the deep fascia [20,21]. These findings indicate that dysfunction of the superficial lymphatic system can be considered a major cause of lymphoedema
Summary
Lymphoedema is a well-known side-effect of post-cancer treatment. The standard treatment for lymphoedema includes the daily wearing of a compression garment on the affected body part to prevent the progression of the disease [1]. Cancers 2020, 12, 1338 of these studies helped to provide a ratio of odds for lymphoedema development, but they are of no help to patients at an individual level. The lymphatic system is commonly targeted in cancer treatment to prevent the disease from spreading. In this way, cancer treatment is a direct cause of lymphoedema. I speculate that the anatomy of the lymphatics changes in all patients after cancer treatment, but for the majority of them, those changes do not reach the threshold for developing into lymphoedema. This article presents a review of studies into the anatomical changes that occur in the lymphatic system post-lymph node dissection and discusses anatomical theories as to why some patients develop lymphoedema and others do not
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