Lymphedema after breast cancer treatment

Women who’ve been or will be treated for breast cancer may be at risk of developing a swelling of the arm, breast and chest called lymphedema.

Lymphedema occurs when lymph fluid that can’t be properly drained builds up and causes swelling. Most women won’t develop lymphedema, but unfortunately about 25% of patients who’ve undergone breast cancer surgery and lymph node dissection will. The risk doubles if you’ve received radiation treatments to the underarm in addition to lumpectomy or mastectomy.

WHAT IS LYMPHEDEMA?

A network of lymph vessels collect lymph fluid from the body’s tissues, much like veins collect blood, and carries the fluid to the lymph nodes, the small collections of tissue that act like filters and contain white blood cells that help us fight infection.

When one or more lymph nodes are removed, the way the lymph fluid flows in that side of the upper body changes. These changes make it harder for fluid in the chest, breast, and arm to flow out of this area. If the remaining lymph vessels and lymph nodes cannot sufficiently compensate for those that were removed, excess fluid builds up and causes lymphedema.

Lymphedema usually develops slowly over time, but it can develop at any time after surgery. If the condition does develop very soon after surgery, it’s usually only a mild case and goes away within a week or two. Most women that develop lymphedema after mastectomy or lumpectomy do so many months or sometimes even years after their operation. In these cases, swelling can range from moderate to severe.

HOW IS LYMPHEDEMA TREATED?

Lymphedema can’t be cured, but the symptoms can be improved. Treatment varies depending on the severity of lymphedema.

In most situations managing swelling with elastic sleeves, bandages and massages is very successful. The goals of lymphedema treatment are to reduce swelling, prevent swelling from getting worse, and decrease the chances of complications. Standard non-surgical treatment usually involves Manual Lymphatic Drainage, a type of medical massage designed to move the accumulated fluid out of the affected hand and arm. Complete Decongestive Therapy combines MLD with meticulous skin care and hygiene, exercises, bandaging and using a specially fitted compression sleeve or stocking. Treatments are usually prescribed by a woman’s breast surgeon or oncologist and are performed by an experienced physical therapist with special training in lymphedema therapy.

While these techniques can be effective, they can also be uncomfortable, inconvenient and time-consuming. Strict compliance is essential, and since these treatments are palliative rather than curative, treatment lasts a lifetime.

When lymphedema cannot be controlled with standard treatments, surgery may offer relief. Surgical options include liposuction if in the early stages, bypass surgery of lymphatic vessels and as well lymph node transfer to the armpit if in later stages.

PREVENTION AND CONTROL

Although it’s impossible to predict who’ll develop lymphedema, there are steps patients can take to lessen their risk. If you’ve already developed lymphedema, it can be controlled and managed by following some of the below guidelines:

Ask your doctor about daily stretching exercises that can be performed after your surgery to maintain your range of motion

Don’t suddenly increase the amount of physical work performed with the arm on the surgery side. Lymph production is directly proportional to blood flow, so overly strenuous arm exercises that increase blood flow in the arm can increase lymph production and therefore increase the risk of lymphedema.

Avoid alcohol and drink plenty of water. Avoid foods high in salt and fat. Try to stick to healthy foods that are high in fiber like fruits, vegetables and whole grains.

Wear comfortable clothing and jewelry that does not squeeze or pinch your arm or hand. A tight sleeve or bracelet for instance can cause fluid to build up in the arm and lead to lymphedema.

Burns on the hand or arm can increase the risk of lymphedema, so avoid overly hot water when bathing or washing dishes. Always wear sunscreen as well to prevent your skin from burning.

When sleeping or sitting, try to keep your arm elevated with a pillow and avoid lying on your surgery side for extended periods.

Take extra care of your skin to avoid infections. Do your best to protect skin from cuts, burns and sores. Wash your hands frequently and wear gloves when doing house or yard work. Apply moisturizer to chapped skin and use insect repellent to avoid bug bites.

These are just a few of the steps you can take to manage and prevent lymphedema. Contact your physician at the first signs of lymphedema or if you suspect an infection is developing.