Pathophysiology of Breast Cancer-Related Lymphoedema

Abstract

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. 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. 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.