What is lymphedema?
Lymphedema occurs when the lymph system (see below) is damaged or blocked. Fluid builds up in soft body tissues and causes swelling. It is a common problem that may be caused by cancer and cancer treatment. It usually affects an arm in breast cancer patients but it can also affect other parts of the body. Lymphedema can cause long-term physical, psychological, and social problems for patients.
What makes up the lymph system?
The parts of the lymph system that play a direct part in lymphedema include the following:
- Lymph: A clear fluid that contains lymphocytes (white blood cells) that fight infection and the growth of tumors.
- Lymph vessels: A network of thin tubes that helps lymph flow through the body and returns it to the bloodstream.
- Lymph nodes: Small, bean-shaped structures that filter lymph and store white blood cells that help fight infection and cancer. Lymph nodes are located along the network of lymph vessels found throughout the body. Clusters of lymph nodes are found in the underarm, pelvis, neck, abdomen, and groin.
The spleen, thymus, tonsils, and bone marrow are also part of the lymph system but do not play a direct part in lymphedema.
How does breast cancer affect the lymphatic system?
Lymphedema can occur after any cancer or treatment that affects the flow of lymph through the lymph nodes, such as removal of lymph nodes. It often occurs in breast cancer patients who had all or part of their breast removed and axillary (underarm) lymph nodes removed.
It may develop within days or many years after treatment. Most lymphedema develops within three years of surgery. Risk factors include the following:
- Removal and/or radiation of lymph nodes in the underarm. The risk of lymphedema increases with the number of lymph nodes affected. For those undergoing a full axillary dissection with radiation therapy a patient’s risk is 20-30% over their lifetime. There is less risk (less 2%) with the removal of only the sentinel lymph node/s (the first lymph nodes to receive lymphatic drainage from a tumor).
- Being overweight or obese.
- Slow healing of the skin after surgery.
- A tumor that affects or blocks the left lymph duct or lymph nodes or vessels in the neck, chest, or underarm
- Scar tissue in the lymph system caused by surgery or radiation therapy.
How do I know if I have lymphedema?
The most common symptom is swelling of an arm in breast cancer patients. Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems occur:
- Swelling of an arm which may include fingers
- A full or heavy feeling in the arm or tight feeling in the skin
- Trouble moving a joint in the arm
- Thickening of the skin
- A feeling of tightness when wearing clothing or jewelry
- Itching of arm or a burning feeling
- Loss of hair growth on arm
These symptoms may occur very slowly over time or more quickly especially if there is an infection or injury to the arm.
How to prevent lymphedema?
Often the damage to the lymph system cannot be repaired but this damage may not always manifest into lymphedema. So, there are some ways to prevent its lymphedema.
- Skin care and nail care to avoid infection– ie. keep your arm at risk moisturized and clean, use caution when cutting cuticles and going to nail salons that may not use sterile equipment, wear gloves when gardening or washing dishes
- Avoid damage to the skin to prevent infection – avoid needle sticks, extremes of temperature to skin, scratches or abrasions
- Avoid compression to arm- do not wear tight clothing, jewelry or allow blood pressure to be taken on that arm
- Weight management- if you are overweight work on weight loss with exercise and diet
How do you treat lymphedema?
The goal of treatment is to control the swelling and other problems caused by lymphedema. Notify your physician as soon as you suspect that you may have lymphedema. Treatment often includes:
- Referral to a physical therapist specializing in lymphedema management
- Compression garments and devices -ask your health care provider how you can be fitted for a compression sleeve and if a device is indicated
- Lymphatic Massage therapy- specialized massage to redirect fluid accumulation in the arm to other open lymphatic pathways
- Exercise for weight management and range of motion
- Aggressive treatment of any signs of infection in the arm with antibiotics
- Surgery- indicated in more advanced cases and daily advances in surgical procedures involving lymphatic bypasses and lymph node transfers
Questions to Ask Your Surgeon
- Will I need lymph nodes removed with my cancer removal?
- What is my risk of developing it with my cancer diagnosis and treatment plan?
- Do you have lymphedema specialists to assist in lymphedema education and management?
- When should I begin wearing a compression sleeve?