Use this URL to cite or link to this record in EThOS:
Title: Lymphatic function in the arm following treatment for breast cancer
Author: Modi, Stephanie
ISNI:       0000 0001 3412 9564
Awarding Body: St George's, University of London
Current Institution: St George's, University of London
Date of Award: 2007
Availability of Full Text:
Full text unavailable from EThOS.
Please contact the current institution’s library for further details.
Aims. The primary aim was to quantify changes in ann lymphatic function after axillary treatment for breast cancer. The hypotheses tested were that [1] impairment ofmuscle lymph drainage after axillary surgery precedes the onset of overt subcutaneous breast cancer related lymphoedema (BCRL); [2] regionality ofswelling in BCRL is due to . local regional impairment oflymph drainage; [3] the force oflymphatic collector pumping is weakened by the chronically raised afterload in BCRL anns. Methods. The removal rate constant, k, was used to measure local lymph drainage of 99mTc-HIG injected jnto the subcutis and muscle. Lymphatic collector pump force (Ppump) was assessed using a novellymphoscintigraphic method based on the escape of distally injected 99mTc-HIG under a pressurised upper ann cuff. Principal results. (i) No pre-BCRL reduction was found in kmusc/e (or ksubcutis) 7 months after surgery (ii) kwas faster in both anns ofnon-BCRL patients destined to develop BCRL compared with those who did not develop BCRL (ksubcutis by 37%, n =7, p = 0.0008; kmusc/e by 23%, P =0.035, n =7) (iii) In non-BCRL and mild BCRL anns kmusc/e was 2-3 fold faster than ksubcutis (p« 0.001, n ~ 26) (iv) ksubcutis was not significantly lower at sites ofmaximal swelling than minimal swelling in BCRL anns (v) proximal ksubcutis was 26 % faster than distal ksubcutiS (p = 0.02, n = 11) and correlated positively with ann circumference (r =0.32, p = 0.03, n = 44) irrespective ofBCRL (vi) P pump was reduced by 38% in BCRL anns relative to healthy anns (p = 0.014, n = 16 ofeach) and correlated negatively with foreann swelling (r =0.22, p = 0.011, n = 16). Conclusions. Non-BCRL patients with higher capillary filtration rates had an increased risk ofdeveloping BCRL. Weakening ofPpump was a factor contributing to BCRL. Proximal foreann subcutis lymph drainage was greater than in the distal foreann regardless of swelling, possibly due to faster muscle than subcutis lymph flow.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available