Breast Cancer: Lymphedema After Treatment

Breast Cancer: Lymphedema After Treatment  

Lymphedema is swelling that may occur
after cancer surgery when lymph nodes are removed. It may also happen after radiation
to
the lymph nodes. It can start months or years after treatment. It’s a long-term (chronic)
condition that has no cure. But you can take steps to help keep it from starting.
If it
does start, there are things you can do to reduce or ease symptoms.

If left untreated, lymphedema can get
worse. It’s important to know what lymphedema is and what you should watch for. Lymphedema
is easier to treat and treatment is more likely going to work if it’s treated right
away.

What is the lymphatic system?

The lymphatic system helps the body
fight infection. It’s a network of tiny vessels and small, bean-shaped organs called
lymph nodes. The vessels carry lymph throughout the body. Lymph is a clear, colorless
fluid that contains a few blood cells. The nodes filter lymph to help fight
infection.

The lymph system helps protect and
maintain the fluid balance of your body. It filters and drains lymph and waste
products away from every part of the body. The lymph is carried back to bigger vessels
near your heart.

How lymphedema happens in breast
cancer

The lymph nodes under the arm are
called the axillary lymph nodes. They drain the
lymphatic vessels from the upper arms, most of the breast, and from the chest, neck,
and
arm pit. During surgery for breast cancer, these nearby lymph nodes (and vessels)
are
often removed. This disrupts the flow of lymph. The axillary lymph nodes also might
be
treated with radiation therapy. This can cause damage and scarring that also affects
the
way lymph flows through that area. All of this can lead to fluid buildup and swelling
on
the affected side. This is lymphedema.

When many lymph nodes under the arm
have been affected, you are at higher risk for lymphedema for the rest of your life.
Swelling can get worse and become severe. Skin sores, infection, pain, and other
problems can develop.

Lymphedema may start right
after surgery or radiation, or months or even years later.

  • A mild type of lymphedema
    happens within a few days after surgery. This is normal. It usually lasts a
    short time.

  • Lymphedema can also happen
    about 4 to 6 weeks after surgery or radiation and then go away over time.

  • The most common type of
    lymphedema is painless. It tends to slowly develop, most often within 3 years
    of surgery. It does not get better without treatment.

Can lymphedema be prevented?

Lymphedema can happen any time
after surgery or radiation to the lymph nodes. The risk continues for the rest of
the
person’s life. Lymphedema can’t be cured, but it can be managed. Any swelling should
be
checked by a healthcare provider right away.

Doctors don’t know who will or
won’t get lymphedema. But there are things that can be done to help prevent it.

Women treated for breast cancer who
take good care of their skin and exercise after treatment may be less likely to develop
lymphedema. Staying at or getting to a healthy weight may also help lower your risk.

Newer types of lymph node surgery
have also helped lower lymphedema risk. But there’s no sure way to prevent
lymphedema.

Preventing infection and injury

Protecting the arm on the side of
the surgery is very important after breast surgery. Poor drainage of the lymphatic
system can put that arm at risk for infection. Poor drainage can also make the arm
less
sensitive to extreme temperature. Be aware of activities that put too much stress
on the
affected arm.

To protect your arm from injury and
infection, make sure to:

  • Ask for injections and blood
    draws to be done on the unaffected arm if possible.

  • Ask for blood pressure
    tests to be done on the unaffected arm if possible.

  • Not wear nightgowns or
    clothing with elastic cuffs or tight bands.

  • Carry your handbag or heavy
    packages with the unaffected arm or both arms.

  • Be very careful and use a
    clean razor when shaving underarms.

  • Prevent sunburns and other
    burns to the affected arm.

  • Wear gloves when gardening
    and when using strong household cleaners.

  • Clean the skin of the
    affected arm daily, gently dry well, and apply lotion.

  • Do approved exercises
    regularly to improve drainage.

  • Eat a healthy, low-sodium
    diet.

  • Not put extreme hot or cold
    temperatures on the affected arm. This includes hot tubs, saunas, and heating pads
    or ice packs.

  • Take good care of your
    fingernails. Don’t cut or bite your cuticles.

  • Clean all cuts with soap and
    water. Put antibacterial ointment and a sterile dressing on the cut.

  • Protect your fingers from
    needle pricks and sharp objects. Use a thimble when sewing.

  • Not do vigorous, repetitive
    movements against resistance with the affected arm. This includes scrubbing,
    pulling, or pushing.

  • Tell your doctor right away
    if you have any signs of infection. These include redness, pain, heat, increased
    swelling, or fever.

Symptoms of lymphedema

The main symptom of
lymphedema after breast cancer treatment is swelling of the arm on the side where
lymph
nodes were removed. The amount of swelling may vary. Some people may have severe
swelling (edema). The affected arm can be several inches larger than the other arm.
Others will have a milder form of edema where the affected arm is only slightly larger
than the other arm.

Other symptoms of lymphedema may
include:

  • Feeling of fullness,
    heaviness, or tightness in the arm, chest, or armpit area

  • Bra, clothing, or jewelry
    don’t fit as normal

  • Aching or new pain in the
    arm

  • Trouble bending or moving a
    joint, such as the fingers, wrist, elbow, or shoulder

  • Swelling in the hand

  • Thickening of or changes in
    the skin

  • Weakness in the arm

If you notice any of these
symptoms, see your healthcare provider right away. Treatment needs to be started right
away to keep lymphedema from getting worse.

How is lymphedema diagnosed?

There are no tests for lymphedema.
Instead, your healthcare provider will ask about your health history and do a physical
exam. You’ll be asked about:

  • Past surgeries you’ve had

  • Any problems after your
    surgeries

  • When the swelling started

  • If you’ve had severe swelling
    in the past

  • What medicines you’re
    taking

  • What other health conditions
    you have. These might be high blood pressure, heart disease, or diabetes.

You may need other tests to
diagnose lymphedema. These include imaging tests, measures of volume, and blood
tests.

Treatment for lymphedema

Treatment depends on how severe the
problem is. Treatment focuses on ways to help prevent and manage the condition. It
may
include:

  • Exercise. Exercise helps improve lymph drainage. Your doctor, certified
    lymphedema therapist, or physical therapist will recommend specific
    exercises. 

  • Bandages. Wearing a compression sleeve or elastic bandage may help
    to move fluid. It can also prevent fluid buildup.

  • Diet and weight management. Eating a healthy diet and controlling your
    weight are an important part of treatment.

  • Elevation.  Raising your arm above the level of your heart when possible
    lets gravity help drain the fluid.

  • Preventing infection. It’s important to protect the skin in
    the affected area from drying, cracking, infection, and skin breakdown.

  • Massage therapy. Massage by a certified lymphedema therapist can help
    move fluid out of the swollen area.

Ask your healthcare provider for a referral to a certified lymphedema therapist. This
is a provider who
specializes in lymphedema teaching and management.

Working with your healthcare
provider 

Talk with your doctor about what
you can do to try to keep lymphedema from happening to you. Make these precautions
part
of your daily habits. Plan to follow them for the rest of your life.

Compare your hands and arms. Look
at them in the mirror. Learn what’s normal for you so you can notice changes right
away.
If lymphedema does develop, let your doctor know right away. You can take steps to
try
to keep it from getting worse.