Breast Cancer and Lymphedema: A Narrative Review


  • Athena Michaelides University of Nicosia Medical School
  • Constantina Constantinou University of Nicosia Medical School



Breast cancer, Breast tumor, Lymphedema, Review, Literature review


Breast cancer is the second most common cancer diagnosed worldwide, and the leading cause of cancer death in women. The understanding of disease presentation by patients and health care providers is crucial for a correct diagnosis and management.  Preventive measures emphasize risk-reducing behaviors such as a healthy diet, reduced alcohol consumption, increased physical activity, and breastfeeding children. Screening techniques such as mammography, ultrasound, and MRI aid in early detection. Following the screening, a breast biopsy is performed, and a histopathological assessment is carried out to confirm a breast cancer diagnosis. In addition to surgery, radiotherapy, and lifestyle modifications, treatment regimens include a range of medications such as anti-hormonal drugs and chemotherapy. Lymphedema is a severe and major long-term consequence of breast cancer treatment. The major contributors to the diminished lymph drainage are a lumpectomy/mastectomy procedure that involves the surgical removal of lymph nodes, and radiotherapy. The fluid accumulation of lymphedema poses physical limitations to the patient and impacts the overall quality of life. A sentinel lymph node biopsy is an essential method of identifying the first draining lymph nodes affected by metastasis. This procedure allows surgeons to later remove only affected lymph nodes, sparing those that are unaffected and hence reduce the risk and magnitude of lymphedema development. Patients who receive education about lymphedema demonstrate higher compliance with treatment and self-care management practices. The purpose of this review is to provide information about breast cancer, the development of lymphedema, and how to recognize and manage both.


Metrics Loading ...

Author Biographies

Athena Michaelides, University of Nicosia Medical School

Medical Student

Constantina Constantinou, University of Nicosia Medical School

BA, MSc, Ph.D., Associate Professor of Molecular Biology, Director of Research


Watson M. Assessment of Suspected Cancer. InnovAiT. 2008 Feb;1(2):94-107.

Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, and Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018 Nov;68(6):394–424.

Gross JM, and Yee D. How does the estrogen receptor work? Breast Cancer Res. 2002 Apr;4(2):62.

Shah C, Arthur DW, Wazer D, Khan A, Ridner S, Vicini F. The impact of early detection and intervention of breast cancer-related lymphedema: a systematic review. Cancer Med. 2016 Jun;5:154-62

Wang L. Early Diagnosis of Breast Cancer. Sensors. 2017 Jul;17(7):1572.

Calhoun KE, and Anderson BO. Needle Biopsy for Breast Cancer Diagnosis: A Quality Metric for Breast Surgical Practice. J Clin Oncol. 2014 Jul;32(21):2191–2.

Weigelt B, Horlings HM, Kreike B, Hayes MM, Hauptmann M, Wessels LFA, et al. Refinement of breast cancer classification by molecular characterization of histological special types. J Pathol. 2008 Oct;216(2):141–50

Marshall SA, Yang CC, Ping Q, Zhao M, Avis NE, and Ip EH. Symptom clusters in women with breast cancer: an analysis of data from social media and a research study. Qual Life Res. 2016 Mar;25(3):547–57.

Brem S, and Kumar NB. Management of Treatment-Related Symptoms in Patients With Breast Cancer. Clinical Journal of Oncology Nursing. 2011 Feb;15(1):63–71.

Zampell JC, Haimovitz-Friedman A, Mehrara BJ, Daluvoy SV, Avraham T, Cordeiro AP, et al. Radiation therapy causes loss of dermal lymphatic vessels and interferes with lymphatic function by TGF-β1-mediated tissue fibrosis. Am J Physiol Physiol. 2010 Sep;299(3):C589-C605.

Wanchai A, Armer JM, Stewart BR, and Lasinski BB. Breast cancer-related lymphedema: A literature review for clinical practice. International Journal of Nursing Sciences. 2016 Apr;3(2016):202–7.

Basta MN, Fox JP, Kanchwala SK, Wu LC, Serletti JM, Kovach SJ, et al. Complicated breast cancer-related lymphedema: Evaluating health care resource utilization and associated costs of management. Am J Surg. 2016 Jan;211(1):133–41.

Disipio T, Rye S, Newman B, and Hayes S. Incidence of unilateral arm lymphoedema after breast cancer: a systematic review and meta-analysis. Lancet Oncol 2013 May;14:500–15.

Cheifetz O, and Haley L. Management of secondary lymphedema related to breast cancer. Vol. 56, Can Fam Physician. 2010 Dec;56(12)1277–84.

Bani HA, Fasching PA, Lux MM, Rauh C, Willner M, Eder I, et al. Lymphedema in breast cancer survivors: Assessment and information provision in a specialized breast unit. Patient Educ Couns. 2007 Jun;66(3):311–8.

Provencher L, Hogue JC, Desbiens C, Poirier B, Poirier E, Boudreau D, et al. Is clinical breast examination important for breast cancer detection? Curr Oncol. 2016 Aug;23(4):332–9.

Schneble EJ, Graham LJ, Shupe MP, Flynt FL, Banks KP, Kirkpatrick AD, et al. Future directions for the early detection of recurrent breast cancer. J Cancer. 2014 Mar;5(4):291–300.

Shah R. Pathogenesis, prevention, diagnosis and treatment of breast cancer. World J Clin Oncol. 2014 Aug;5(3):283-298.

Hooley RJ, Scoutt LM, and Philpotts LE. Breast ultrasonography: State of the art. Radiology 2013;Sep 268(3):642–59.

Pennant M, Takwoingi Y, Pennant L, Davenport C, Fry-Smith A, Einsinga, et al. A systematic review of positron emission tomography (PET) and positron emission tomography/computer tomography (PET/CT) for the diagnosis of breast cancer recurrence. Health Technol Assess. 2010 Oct;14(50):1-103.

Yuan L, Qi X, Zhang Y, Yang X, Zhang F, Fan L, et al. Comparison of sentinel lymph node detection performances using blue dye in conjunction with indocyanine green or radioisotope in breast cancer patients: a prospective singlecenter randomized study. Cancer Biol Med. 2018 Nov;15(4):452–60.

Malhotra GK, Zhao X, Band H, and Band V. Histological, molecular and functional subtypes of breast cancers. Cancer Biol Ther. 2010 Nov;10(10):955–60.

Howell LP, Gandour-Edwards R, and O’Sullivan D. Application of the Scarff-Bloom-Richardson tumor grading system to fine- needle aspirates of the breast. Am J Clin Pathol 1994 Mar;101(3):262–5.

Giuliano AE, Connolly JL, Edge SB, Mittendorf EA, Rugo HS, Solin LJ, et al. Breast Cancer-Major changes in the American Joint Committee on Cancer eighth edition cancer staging manual. CA Cancer J Clin. 2017 Mar;67(4):290–303.

Balleyguier C, Ayadi S, Van Nguyen K, Vanel D, Dromain C, and Sigal R. BIRADS classification in mammography. Eur J Radiol. 2007 Feb;61(2):192-4

Travis RC, and Key TJ. Oestrogen exposure and breast cancer risk. Breast cancer Res. 2003 Jul;5(5):239–47.

Henderson BE, Ross R, and Bernstein L. Estrogens as a Cause of Human Cancer: The Richard and Hinda Rosenthal Foundation Award Lecture. Cancer Res. 1988 Jan;15;48(2):246-53.

Cavalieri E, Chakravarti D, Guttenplan J, Hart E, Ingle J, Jankowiak R, et al. Catechol estrogen quinones as initiators of breast and other human cancers: Implications for biomarkers of susceptibility and cancer prevention. Biochim Biophys Acta. 2006 Aug;1766(1):63–78.

Slamon DJ, Leyland-Jones B, Shak S, Fuchs H, Paton V, Bajamonde A, et al. Use of Chemotherapy plus a Monoclonal Antibody against HER2 for Metastatic Breast Cancer That Overexpresses HER2. N Engl J Med. 2001 Mar;344(11):783–92.

Porta C, Paglino C, and Mosca A. Targeting PI3K/Akt/mTOR Signaling in Cancer. Front Oncol. 2014 Apr;4:64.

Vara JÁF, Casado E, de Castro J, Cejas P, Belda-Iniesta C, and González-Barón M. PI3K/Akt signalling pathway and cancer. Cancer Treat Rev 2004 Apr;30(2):193–204.

Dunning AM, Healey CS, Pharoah PDP, Teare MD, Ponder BAJ, and Easton DF. A Systematic Review Of Genetic Polymorphisms and Breast Cancer Risk. Cancer Epidemiol. Biomarkers Rev. 1999 Oct;8(10):843–54.

Moyer VA. Risk Assessment, Genetic Counseling, and Genetic Testing for BRCA-Related Cancer in Women: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med 2014 Feb;160(4):271–81.

NICE. Managing advanced breast cancer. NICE Pathways 2018 Jul;(2):1–22. Available from:

Brown LC, Mutter RW, and Halyard MY. Benefits, risks, and safety of external beam radiation therapy for breast cancer. Int J Womens Health 2015 Apr;7:449–58.

Livingston EH, and Li HC. Breast Cancer Surgery: Less Is More. JAMA 2017 Sep 12;318(10):909-911. Types of Radiation Therapy for Breast Cancer. 2018. Available from:

Sakorafas GH, Peros G, Cataliotti L, and Vlastos G. Lymphedema following axillary lymph node dissection for breast cancer. Surg Oncol 2006 Nov;15(3):153–65.

Hayes SC, Janda M, Cornish B, Battistutta D, Newman B. Lymphedema after breast cancer: Incidence, risk factors, and effect on upper body function. J Clin Oncol 2008 Jul;26(21):3536–42.

International Society of Lymphology (ISL). The diagnosis and treatment of peripheral lymphedema: 2013 consensus document of the international society of lymphology. Lymphology. 2013 Mar;46(1):1–11.

Cornish B, Chapman M, Hirst C, Mirolo B, Bunce lH, Ward L, et al. Early Diagnosis of Lymphedema Using Multiple Frequency Bioimpedance. Lymphology. 2001;34:2–11.

Shaw C, Mortimer P, and Judd PA. Randomized controlled trial comparing a low-fat diet with a weight-reduction diet in breast cancer-related lymphedema. Cancer. 2007 May;109(10):1949–56.

Thomas-Maclean R, Miedema B, Tatemichi SR. Women’s experiences with an underestimated condition. Can Fam Physician. 2005 Feb;(51):246-247

Tripathi S, Trasil H, and Telisinghe PU. Methylene blue for sentinel lymph node localisation in breast cancer surgery: Experience of RIPAS Hospital. Brunei Int Med J. 2010 Dec;6(3):117–21.

Cheng G, Kurita S, Torigian DA, and Alavi A. Current status of sentinel lymph-node biopsy in patients with breast cancer. Eur J Nucl Med Mol Imaging. 2011 Mar;38(3):562–75.

Taghian AG, Brunelle CL, Sayegh HE, Gillespie TC, and Daniell KM. Breast cancer-related lymphedema: risk factors, precautionary measures, and treatments. Gland Surg. 2018 Aug;7(4):379–403.

McLaughlin SA, Staley AC, Vicini F, Thiruchelvam P, Hutchison NA, Mendez J, et al. Considerations for Clinicians in the Diagnosis, Prevention, and Treatment of Breast Cancer-Related Lymphedema: Recommendations from a Multidisciplinary Expert ASBrS Panel. Ann Surg Oncol. 2017 Aug;24(10):2818-26.

Park JH, Lee WH, and Chung HS. Incidence and risk factors of breast cancer lymphoedema.' J Clin Nurs 2007 Jun;(11):1450–9.

Kligman L, and Younus J. Management of hot flashes in women with breast cancer. Curr Oncol 2010 Frb;17(1):81–6.

van Geel AN. Prophylactic mastectomy: The Rotterdam experience. Breast. 2003 Dec;12(6):357–61.

Hwang ES, and Nho J. Lifestyle Intervention for Breast Cancer Women. J Lifestyle Med. 2019 Jan;9(1):12-14.

Hartmann LC, Schaid DJ, Woods JE, Crotty TB, Myers JL, Arnold P, et al. Efficacy of bilateral prophylactic mastectomy in women with a family history of breast cancer. N Engl J Med. 1999 Jan;340(2):77–84.

Nelson HD, Smith B, Griffin JC, and Fu R. Use of Medications to Reduce Risk for Primary Breast Cancer: A Systematic Review for the US Preventive Services Task Force. Ann Intern Med. 2013 Apr;158(8):604-614.



How to Cite

Michaelides, A., & Constantinou, C. (2019). Breast Cancer and Lymphedema: A Narrative Review. International Journal of Medical Students, 7(3), 66–72.