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Swelling of the arm, hand or breast that happens when lymph fluid cannot drain because the lymph nodes have been removed or irradiated. It is permanent once established, it can appear years later, and it is the main reason surgeons now take one or two lymph nodes instead of twenty.
The risk is set mostly by what is done to the axilla. Axillary clearance carries the highest risk: in the AMAROS five-year analysis, lymphoedema occurred in 24.5 percent after clearance against 11.9 percent after axillary radiotherapy (p<0.001). In IBCSG 23-01 it was 13 percent with clearance and 4 percent without. In ALMANAC, at twelve months, sentinel node biopsy cut any lymphoedema from 13 to 5 percent (relative risk 0.37, 0.23 to 0.60) and sensory loss from 31 to 11 percent. Omitting the sentinel node entirely lowers it again: INSEMA found less lymphoedema, greater arm mobility and less pain on movement in the group that had no axillary surgery.
Radiotherapy to the axilla and supraclavicular fossa adds to the risk, which is why NICE NG101 recommendation 1.13.20 says not to give axillary radiotherapy after axillary clearance: the two together are the worst combination for the arm. Other risk factors are a higher body mass index, infection in the arm, and the number of nodes removed.
Treatment is decongestive: skin care, compression garments or bandaging, exercise, and manual lymphatic drainage, delivered by a lymphoedema service. Surgical options, lymphovenous anastomosis and vascularised lymph node transfer, exist in specialist centres. The important clinical point is that the swelling can start years after treatment and that early referral matters, because an arm treated early is easier to control than one treated late.
Cellulitis in a swollen arm is an emergency of a kind: it needs antibiotics quickly, and each episode makes the lymphoedema worse.
Shares ATNEC, Doing less to the armpit, Sentinel node biopsy, Lymphadenectomy (lymph node dissection).
Shares NSABP B-32, ACOSOG Z0011 (Alliance), Doing less to the armpit, Lymphadenectomy (lymph node dissection).
Shares Compression, decongestive therapy and exercise for lymphoedema, Sentinel node biopsy, Lymphadenectomy (lymph node dissection), Breast cancer (all types).
Shares ATNEC, Sentinel node biopsy, HER2-positive breast cancer, Breast cancer (all types).
Shares ALMANAC (Axillary Lymphatic Mapping Against Nodal Axillary Clearance), INSEMA (Intergroup Sentinel Mamma), SOUND (Sentinel Node vs Observation After Axillary Ultra-Sound), IBCSG 23-01.
Shares ATNEC, Sentinel node biopsy, HER2-positive breast cancer, Breast cancer (all types).
Shares Sentinel node biopsy, Lymphadenectomy (lymph node dissection), Breast cancer (all types).
Shares ATNEC, HER2-positive breast cancer, Breast cancer (all types), Triple-negative breast cancer (TNBC).