Axillary web syndrome (AWS), also known as “cording”, is a condition that sometimes occurs after mastectomy or lymph node removal either by axillary lymph node dissection (ALND) or sentinel lymph node biopsy (SLNB) for breast cancer diagnosis or treatment. After these procedures, tender cords of tissue can sometimes be felt under the skin. They usually begin at the armpit and run down the inside of the arm to the elbow, sometimes extending down to the thumb.
The cords are believed to represent sclerosed veins and lymphatics with extensive surrounding fibrosis and the adhesion of the sclerotic bands to nearby tissue is what causes the largest impact on shoulder range of motion and function (Dinas, K., Kalder, M., Zepiridis, L., Mavromatidis, G. & Pratilas, G., 2019).
Cording can occur immediately after surgery or can be significantly more delayed (Yeung, W.M., McPhail, S. & Kuys, S., 2015). The exact mechanism and causes of AWS is not fully known or understood, and there are many factors that impact your risk of developing cording. Some of the key factors that were indicated in increasing the risk for cording development include (Dinas, K., Kalder, M., Zepiridis, L., Mavromatidis, G. & Pratilas, G., 2019):
- Lower BMI
- Younger in age
- Exposure to radiation treatment
- Exposure to chemotherapy treatment
- More extensive surgery (ALND vs. SLNB)
- Hypertension
Although these are the identified risk factors seen in the literature, the overall incidence of cording is generally unknown. When reviewing literature, the incidence rate varies widely from study to study with the range of reported incidence being 6%-91% (Dinas, K., Kalder, M., Zepiridis, L., Mavromatidis, G. & Pratilas, G., 2019).
Overall, the literature points to the frequent occurrence of this condition, and it is imperative breast cancer patients are aware of the condition and the treatment options. Although AWS is self-limiting and can resolve on its own impairment that is causes can be devastating for patients trying to return to normal activities. Optimal management with alternative therapies and pharmaceuticals remains unclear, however experts have outlined that physiotherapy appears to be beneficial in treating this condition (Dinas, K., Kalder, M., Zepiridis, L., Mavromatidis, G. & Pratilas, G., 2019). It is important that all members of an individual’s health care team work together to ensure quick and positive outcomes for those experiencing AWS.
References:
Dinas, K., Kalder, M., Zepiridis, L., Mavromatidis, G. & Pratilas, G. (2019). Axillary web syndrome: Incidence, pathogenesis, and management, Current Problems in Cancer, Volume 43, Issue 6, 100470, ISSN 0147-0272, https://doi.org/10.1016/j.currproblcancer.2019.02.002.
Yeung, W.M., McPhail, S. & Kuys, S. (2015). A systematic review of axillary web syndrome (AWS). J Cancer Surviv 9, 576–598, https://doi.org/10.1007/s11764-015-0435-1