Both arms at risk?

Binney4

Here's a newly-published study that indicates that LE risk may extend to both arms, once we've been diagnosed with LE on our affected side:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3370966/?tool=pubmed

Well, phooey!
Binney

o2bhealthy

I am living proof

BeckySharp

Now THIS is depressing.  Phooey is right Binney.  I am telling my non affected arm to ignore what I just read!

kira66715

Very, very scary and yet it makes sense, and AW Stanton had found the same "lymphatic pump failure" in the unaffected arms of women with BCRL.

http://www.ncbi.nlm.nih.gov/pubmed/19302022

Lymphat Res Biol. 2009;7(1):29-45.
Recent advances in breast cancer-related lymphedema of the arm: lymphatic pump failure and predisposing factors.
Stanton AW, Modi S, Mellor RH, Levick JR, Mortimer PS.
Source

Division of Cardiac & Vascular Sciences, Dermatology, St George's Hospital Medical School, University of London, London, United Kingdom.
Abstract

Axillary surgery for breast cancer may be followed, months to years later, by chronic arm lymphedema. A simple 'stopcock' mechanism (reduced lymph drainage from the entire limb through surviving lymphatics) does not explain many clinical aspects, including the delayed onset and selective sparing of some regions, e.g., hand. Quantitative lymphoscintigraphy reveals that lymph drainage is slowed in the subcutis, where most of the edema lies, and in the subfascial muscle compartment, which normally has much higher lymph flows than the subcutis. Although the muscle does not swell significantly, the impaired muscle drainage correlates with the severity of arm swelling, indicating a likely key role for muscle lymphatic function. A new method, lymphatic congestion lymphoscintigraphy, showed that the edema is associated with a reduced contractility of the arm lymphatics; the weaker the active lymphatic pump, the greater the swelling. Delayed lymphatic pump failure may result from chronic raised afterload, as in hypertensive cardiac failure, and may account for the delayed onset of swelling. A further novel finding is that lymph flow is raised in both the subcutis and muscle of both arms in postsurgical breast patients who later developed breast cancer-related lymphedema (BCRL), compared with patients who did not develop BCRL. This new observation indicates a predisposition to BCRL in some women. Further evidence for predisposing abnormalities is the finding of lymphatic abnormalities in the contralateral (nonswollen) arm in women with established BCRL. Such predisposing factors could explain why some women develop BCRL after sentinel node biopsy, whereas others do not after clearance surgery. Future research must focus on prospective observations made from before surgery until BCRL develops.

I brought this up in my CLT class, when we were taught that Lymph Transport Capacity is static--it is one thing before surgery/rads and another, fixed amount later. Not so.....

Very scary, but I do believe with good treatment, we can "beef up" the lymphatic pump and/or decrease the afterload overload.

Kira

KS1

Yuck.  Double yuck.  I don't have LE on my non-affected side, but my wedding ring used to slip right off my non-LE hand and now I can't even get it on.  The rest of my LE system is definitely working overtime to do the work of its fallen comrades:  many visible inginual nodes on my LE side, and a couple of palpable nodes on my non-LE axilla.  

 

That said, looking for signs of hope in the article ... the study is small, the description of the LE and control participants very sketchy, and it isn't a longitudinal study.  We don't know the mean ages of the two groups (and the youngest subjects in the control group was much younger than the youngest in the LE group), the ratio of males to females is higher in the control group than the LE group.  We don't know what procedures the LE subjects had: perhaps some of the LE subjects had procedures on the non-LE side (e.g., biopsy, PICC line, port). It is likely that some of the LE subjects had systemic treatment that increase the risk of LE  (e.g chemo), and perhaps are less active because of treatment-related side effects (AI aches/pains, peripheral neuropathy, etc.)  Lastly, with respect to the worse lymph function for the folks that have had LE the longest, perhaps this reflects more aggressive treatments given in the past (more mastectomies, less localized radition).  KS