Els efectes adversos dels tractaments del càncer de mama sobre l'extremitat superior

Abstract

In women, breast cancer is the most common cancer diagnosed in more and less developed regions, with more cases occurring in less developed. The survival of breast cancer has increased in recent decades, reaching around 80 %, in developed regions. With an increasing number of breast cancer survivors, it becomes important to identify factors, that could affect the morbidity after breast cancer treatment. Identification, prevention and treatment of morbidity are important in order to avoid adverse effects and decline in quality of life in this patients. After breast cancer treatment the most persistent upper-limb impairments are lymphedema, loss of shoulder function, pain and winged scapula. Lymphedema is the principal impairment after breast cancer surgery due to the incidence and the chronic condition. The incidence of lymphedema after breast cancer surgery varies from 11 to 65%.The factors associated with lymphedema development in this patients are not well established. Around 15-45% of breast cancer survivors have loss of shoulder strength and mobility after surgery and persisting seven year after surgery. The loss of shoulder function cause pain, injury in rotator cuff tendons, adhesive capsulitis or early shoulder osteoarthrosis. There are few information reporting results about specific muscles affected and the magnitude of the loss of shoulder strength. Breast cancer surgery and radiotherapy damage long thoracic nerve. The most common clinical feature in long thoracic nerve injury is winged scapula, related to palsy of the serratus anterior muscle. The incidence of winged scapula after breast cancer surgery varies from 0.6 to 74.7% The aims of this thesis are to study the principal adverse effects in upper limb after breast cancer surgical treatment: 1) to asses incidence and risk factors of lymphedema; 2) to study changes in shoulder strength and to compare the effect of sentinel lymph node biopsy (SLNB) and axillary lymph node dissection (ALND); 3) to describe long thoracic nerve lesions in winged scapula. Among 371 patients, 33.4% developed lymphedema. 83.4% lymphedema appeared during the first year after surgery. Only ALND and radiotherapy were related to lymphedema. Shoulder internal rotators strength decreased significantly after ALND. 1 year after breast cancer surgery, patients had not recovered previous shoulder strength. Among 264 patients 36 (13.6%) presented winged scapula after ALND. The EMG confirmed long thoracic nerve injury in 30 (11.3%) of them. The majority, 27 were partial axonotmesis. Long thoracic nerve injury had associated a significantly lower body mass index.

Date of Award	22 Jul 2016
Original language	Catalan
Awarding Institution	Hospital del Mar
Supervisor	Juan Pedro Botet Montoya (Tutor) & Roser Belmonte Martínez (Director)