Lymphedema: Pathogenesis and Novel Therapies

Annu Rev Med. 2018 Jan 29:69:263-276. doi: 10.1146/annurev-med-060116-022900. Epub 2017 Sep 6.

Abstract

Lymphedema affects up to 1 in 6 patients who undergo treatment for a solid tumor in the United States. Its prevalence has increased as more effective oncologic therapies have improved patient survival, but there remains no definitive cure. Recent research has elucidated new details in the pathogenesis of the disease and has demonstrated that it is fundamentally an immunologic process that ultimately results in inflammation, fibroadipose deposition, impaired lymphangiogenesis, and dysfunctional lymphatic pumping. These findings have allowed for the development of novel medical and surgical therapies that may potentially alter the standard of care for a disease that has largely been treated by compression. This review seeks to provide an overview of the emerging therapies and how they can be utilized for effective management of lymphedema.

Keywords: CD4+ cells; complete decongestive therapy; lymph node transfer; lymphovenous bypass.

Publication types

  • Review

MeSH terms

  • Breast Cancer Lymphedema / physiopathology
  • Breast Cancer Lymphedema / therapy
  • Disease Progression
  • Exercise Therapy*
  • Genetic Therapy
  • Humans
  • Intermittent Pneumatic Compression Devices
  • Lipectomy
  • Low-Level Light Therapy
  • Lymph Nodes / transplantation*
  • Lymphatic Vessels / surgery
  • Lymphedema / physiopathology
  • Lymphedema / therapy*
  • Manual Lymphatic Drainage*
  • Severity of Illness Index
  • Stem Cell Transplantation*
  • Stockings, Compression
  • Vascular Endothelial Growth Factor C / genetics
  • Vascular Endothelial Growth Factor C / therapeutic use
  • Vascular Surgical Procedures*
  • Veins / surgery
  • Weight Reduction Programs*

Substances

  • Vascular Endothelial Growth Factor C