Upper extremity lymphedema after radiation therapy, chemotherapy and surgical treatment of breast cancer. Part 1. Epidemiology, factors affecting the frequency of occurrence, classification, staging, diagnosis, differential diagnosis. Review

Breast cancer is the leading malignant neoplasm in women in terms of frequency of occurrence. In its treatment, techniques including surgical interventions, radiation and chemotherapy are used. Despite the improvement of radiotherapy techniques and approaches to surgical interventions, various complications of antitumor treatment are still encountered. The most frequent among them is the development of upper limb lymphedema, which significantly reduces the quality of life of patients. The incidence of this disease varies considerably; according to various researchers, it can occur in 3-40% of patients after breast cancer treatment. A large number of factors have been identified that can influence this rate. Among them are the volume of surgery, radiation therapy regimens, chemo-therapy regimens, as well as high body mass index of the patient, comorbidity, smoking and many others. Now, there is no unified approach to the criteria for diagnosis and staging of this disease. Despite considerable experience in diagnosing lymphedema of the upper extremities, the diagnosis may be complicated by the presence of pathology with similar symptomatology. Most often, these are various disorders of venous circulation, causing edema and increase in volume of the limb. This review considers the epidemiology of upper limb lymphedema after breast cancer treatment, factors influencing the incidence of this disease, approaches to its classification and staging, as well as the issues of diagnosis and differential diagnosis.