Axillary Lymph Node Dissection Can Increase Arm Morbidity

Young breast cancer survivors suffer high rates of arm swelling and impaired range of motion following surgery for breast cancer, according to a new study.

Researchers at Dana-Farber Cancer Institute (Boston, MA, USA), Diakonessen Hospital (Utrecht, The Netherlands), and other institutions conducted a study to assess the incidence of self-reported arm swelling and decreased range of motion in 1,037 young patients (median age 35 years); 30% of the young women underwent breast conserving surgery, 25% underwent mastectomy, and the 45% underwent bilateral mastectomy. Axillary sentinel lymph node biopsy (SLNB) was performed in 55% of the patients, while the remaining 45% of patients underwent more extensive axillary lymph node dissection (ALND).

In all, 40% of the women experienced decreased range of motion, and 13% reported arm-swelling a year after surgery. Patients undergoing mastectomy with radiation therapy (RT) were twice as likely to suffer decreased range of motion, compared to those treated with breast-conserving therapy. ALND, increased body mass index (BMI), and lower financial status were all independently associated with increased self-reported arm swelling. The study was presented at the annual San Antonio Breast Cancer Symposium, held during December 2017 in San Antonio (TX, USA).

“Breast cancer is the most common form of cancer in women under the age of 40, but younger breast cancer patients are frequently underrepresented in clinical trials,” said lead author Anne Kuijer, PhD, of Diakonessen Hospital Utrecht. “As a result, little is known about optimal treatment strategies and comorbidities, such as arm swelling and decreased range of motion, in younger patients. These issues are of particular importance in these patients given their long survivorship period, frequently active lifestyle, and the importance of body image.”

“Arm morbidity is of particular importance in young patients, given the longer survivorship period and detrimental effects of arm-impairment on body image, as well as home and personal care functions,” said senior author Tari King, MD, chief of breast surgery at Dana-Farber Cancer Institute. “These findings highlight an opportunity for pre-operative education and early referral to physical therapy to help minimize arm impairment in this population. Attention to the risks and benefits of local therapy strategies, specifically breast conserving therapy versus mastectomy, in this population is also warranted.”

Lymph nodes, located throughout the body, serve as biologic filters that contain immune cells to fight infection and clean the blood. When cancer cells break away from a tumor, the cells can travel through the lymph system; sentinel node surgery allows the surgeon to remove the nodes to determine cancer spread. Human nodes, however, are only half a centimeter in size, and are difficult to discern among the surrounding tissue during surgery. Furthermore, even when surgeons are able to map the location of the nodes, there is no current technique to indicate if the lymph nodes contain cancer, requiring removal of more lymph nodes than necessary.

Related Links:
Dana-Farber Cancer Institute
Diakonessen Hospital