# Exercise and metabolic disease/BCRL/Medical and Clinical Considerations

Treatment Options
There are many treatment options available for breast cancer lymphoedema and more than one is usually encouraged. Some examples of treatments for breast cancer related lymphoedema include; individualised exercise programs, compression garments, lymphatic drainage, surgery, liposuction, debulking, pharmaceutical treatments and natural supplements. A recent and extensive list and information about these treatments can be found on the National Lymphedema Network website. http://www.lymphnet.org/pdfDocs/nlntreatment.pdf
Risk factors
| Classification (JNC7) | Systolic pressure | Systolic pressure | Diastolic pressure | Diastolic pressure |
| Classification (JNC7) | mmHg | kPa | mmHg | kPa |
| Normal | 90–119 | 12–15.9 | 60–79 | 8.0–10.5 |
| Prehypertension | 120–139 | 16.0–18.5 | 80–89 | 10.7–11.9 |
| Stage 1 hypertension | 140–159 | 18.7–21.2 | 90–99 | 12.0–13.2 |
| Stage 2 hypertension | ≥160 | ≥21.3 | ≥100 | ≥13.3 |
| Isolated systolic hypertension | ≥140 | ≥18.7 | <90 | <12.0 |
Women with lymphoedema are reported to be likely to have comorbidity and should be thoroughly screened with that in mind. HypertensionHypertension has been postively linked to arm lymphoedema in more than one study.$^{[1]}$ These patients also are more likely to have a higher BMI making both hypertension and high BMI, key risk factors that could potentially increase the risk of breast cancer lymphoedema. Women who underwent radiation treatment and had more than 2 positive lymph nodes removed by lymph node dissection, have an increased risk of more severe lymphoedema.$^{[1]}$ Age as a risk factor has been reported as both a factor and not a factor, this area needs more research as identified by a study by Meeske et al(2009).
An increase in the severity of breast cancer lymphoedema in a patient can result in reduced functioning and higher levels of psychological stress.$^{[3]}$ An Australian study highlighted that; more extensive surgery, axillary node dissection and patient experiences treatment related complications or symptoms, are all associated with an increase in the odds of getting lymphoedema. They also reported that a patient with a lower socioeconomic status, a partner, participation in regular physical activity, having good upper body function, were associated with a decrease in the odds of developing lymphoedema. An intervention must take these important factors into consideration, making the patient plan and outcome much more successful.
Complications
Lymphoedema may present immediately or years after treatment although most cases are very likely to present int the first 18 months. Lymphedema leads to reduced physical function of the limb or upper body in general. Irrespective of lymphoedema status breat cancer surivors report a high prevelence of pain and stress in the upper body. $^{[7]}$ Complications can occur if skin care and hygiene recommendations for the affected area are not followed, fungis and infections can increase swelling to the area and therefore further complicate the lymphoedema. Self drainage is important for a patient to do to ensure fluid to the area is drained as much as possible to reduce further problems. Garments, if prescribed, should be worn especially when exercising.$^{[7]}$

## Medical/Clinical Considerations

References
* ↑ Norman, SA, Localio, AR, Potashnik, SL, Simoes Torpey, HA, Kallan, MJ, Weber, AL, Miller, LT, DeMichele, A, and Solin, LJ. Lymphedema in breast cancer survivors: incidence, degree, time course, treatment, and symptoms. Journal of Clinical Oncology 27: 390, 2009.
* ↑ Chobanian AV, Bakris GL, Black HR, et al. (December 2003). "Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure". Hypertension 42 (6): 1206–52. doi:10.1161/01.HYP.0000107251.49515.c2. PMID 14656957. http://hyper.ahajournals.org/content/42/6/1206.long.
* ↑ Ahmed, RL, Schmitz, KH, Prizment, AE, and Folsom, AR. Risk factors for lymphedema in breast cancer survivors, the Iowa Women’s Health Study. Breast Cancer Res. Treat. : 1-11, 2011.
* ↑ Deo SV, Ray S, Rath GK et al (2004) Prevalence and risk factors for development of lymphedema following breast cancer treatment. Indian J Cancer 41:8–12
* ↑ Chachaj, A, Małyszczak, K, Pyszel, K, Lukas, J, Tarkowski, R, Pudełko, M, Andrzejak, R, and Szuba, A. Physical and psychological impairments of women with upper limb lymphedema following breast cancer treatment. Psycho‐Oncology 19: 299-305, 2010.
* ↑ Tobin MB, Lacey HJ, Meyer L et al (1993) The psychological morbidity of breast cancer-related arm swelling. Psychological morbidity of lymphoedema. Cancer 72:3248–3252
* ↑ Kiel KD, Rademacker AW (1996) Early-stage breast cancer: arm edema after wide excision and breast irradiation. Radiology 198:279–283
* ↑ . Meeske, KA, Sullivan-Halley, J, Smith, AW, McTiernan, A, Baumgartner, KB, Harlan, LC, and Bernstein, L. Risk factors for arm lymphedema following breast cancer diagnosis in Black women and White women. Breast Cancer Res. Treat. 113: 383-391, 2009.
* ↑ Hayes, SC, Janda, M, Cornish, B, Battistutta, D, and Newman, B. Lymphedema after breast cancer: incidence, risk factors, and effect on upper body function. Journal of clinical oncology 26: 3536-3542, 2008
* ↑ Petrek JA, Heelan MC: Incidence of breast carcinoma-related lymphedema. Cancer 83:2776-2781, 1998
* ↑ Clark B, Sitzia J, Harlow W: Incidence and risk of arm oedema following treatment for breast cancer: A three-year follow-up study. QJM 98:343- 48, 2005