Which signs and symptoms are related to secondary upper limb lymphedema?
Breast cancer survivors with secondary upper limb lymphoedema (ULL) may present in clinic with a wide range of self-reported symptoms. However, it is unclear if these signs and symptoms are strictly related to ULL. For example, many patients seeking care for ULL, report typical symptoms of swelling but also more general signs and symptoms such as tingling and pain. To which extent are all these signs and symptoms unique for ULL?
The present systematic review including 29 studies has revealed a total of 35 signs and symptoms of ULL described in the literature. The most frequently reported signs and symptoms were swelling (80.9%) and heaviness (66.7%). Second, from literature it appears that perceived larger arm size, as well as feelings of arm tightness, stiffness, puffiness, pain, sensory disturbances, and functional changes were predictive for the development of ULL later on. At last, moderate correlations were found between the presence of swelling, firmness in the past year, and tightness now and severity of ULL.
This overview highlights the need to further investigate the underlying physiological mechanisms (e.g. musculoskeletal/nociceptive, neuropathic, central, and/or the lymphoedema itself) of the symptoms of ULL to avoid confusion with signs and symptoms of other side effects of breast cancer treatments, such as neuropathies and scar tissue tightness. According to the results of the present systematic review, there is in particular a gap, with limited high quality studies with longitudinal design to prospectively investigate whether certain signs and symptoms of ULL are accurate predictors for the development of ULL. This information is crucial for early detection of ULL and adequate management.
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