Breast Cancer and Lymphedema
What is lymphedema?
During breast cancer surgery (mastectomy or lumpectomy), some of the lymph nodes in the underarm (called axillary lymph nodes) may be removed. They are checked to see if cancer cells are present. When axillary lymph nodes are removed (called axillary surgery) during breast surgery or are affected by radiation therapy, some of the vessels that carry lymph fluid can become blocked. This may prevent lymph fluid from leaving the area.
Lymphedema (LIMF-eh-DEE-ma) occurs when lymph fluid collects in the arm (or other area such as the hand, fingers, chest or back) causing it to swell (edema).
The swelling may be so slight you barely notice it or so great your arm grows very large. In severe cases, lymphedema can cause pain and limit movement. And, the look of the affected arm can be upsetting. For a picture of lymphedema, visit the Society for Vascular Surgery website.
Who gets lymphedema?
Lymphedema is related to axillary surgery and radiation therapy, but it is not
clear why some breast cancer survivors
get lymphedema and others do not. Some factors that increase risk include:
• Removal of a large number of axillary lymph nodes during surgery
• Radiation to the axillary area
• A combination of axillary surgery and radiation to the axillary lymph nodes
• Having a large number of axillary lymph nodes that contain cancer
• Infections in the area after breast surgery
• Being overweight
How often does lymphedema occur (axillary dissection versus sentinel node biopsy)?
Fortunately, most breast cancer survivors don’t get lymphedema. And, since modern surgery removes
fewer axillary lymph
nodes:
• Lymphedema is less common now than in the past
• The cases that do occur are less severe in terms of the impact on movement
and the way the arm looks
In the past, people almost always had a procedure called axillary dissection to remove axillary lymph nodes. Now, most people have a less-invasive procedure called sentinel node biopsy. This procedure removes fewer lymph nodes than axillary dissection, so there is less risk of lymphedema. Breast cancer survivors who have an axillary dissection are about three times more likely to develop lymphedema than those who have sentinel node biopsy. Some findings show that one year after breast surgery, fewer than five percent of breast cancer survivors who had sentinel node biopsy had lymphedema compared to 10 to 20 percent of women who had axillary dissection.
Breast reconstruction and lymphedema
For women who choose breast reconstruction after a mastectomy, the type of reconstruction does not seem to impact the risk of lymphedema.
When does lymphedema occur?
Lymphedema usually develops within years of breast surgery. It may occur immediately after surgery or many years after treatment.
Symptoms of lymphedema
If you notice early signs of lymphedema, talk to your health care provider. Although there is no cure
for lymphedema,
when it is caught early, treatment can reduce some symptoms and stop them from getting worse. Signs
of lymphedema may
include:
• Swelling in the arm or hand (for example, you may notice a tighter fit of rings or watches)
• Feeling of tightness, heaviness or fullness in the arm or hand
• Feeling of tightness in the skin or a thickening of the skin
• Pain or redness in the arm or hand
Treating lymphedema
Although there is no cure for lymphedema, treatment can improve movement and reduce pain and swelling in the affected arm.
Standard lymphedema treatment includes complex decongestive therapy. This approach aims to decrease
swelling and
infection related to lymphedema through a combination of:
• Skin and nail care
• Compression bandages or sleeves (these apply pressure around the arm and
help push lymph fluid out of the arm)
• Exercises (closing and opening a fist, for example)
• Manual lymphatic drainage (a special type of massage)
• Physical therapy
• Exercise
• Compression device (a pump connected to a sleeve that inflates and deflates
to apply pressure to the arm)
• Surgery
• Weight loss
Before starting any of these therapies, discuss them with your health care provider. Many therapies are done by a physical therapist. Your provider may recommend a physical therapist or you can find one through the National Lymphedema Network or the Lymphology Association of North America.
In the United States the onset of Lymphedema is associated with complications following cancer treatment by means of surgery, and or radiation therapy. An estimated 3-5 million Americans are affected with breast cancer-related Lymphedema alone. Women are particularly at risk of developing Lymphedema in their arms following surgery or radiation therapy for breast cancer, or in their legs following treatment for cervical, or uterine cancer. Men have also been known to have suffered from breast cancer, and both men and women have suffered from Lymphedema due to rectal cancer. Men also are at high risk for testicular cancer, and prostate cancer.
Lymphedema usually begins with swelling of the hands or feet. Anybody who notices persistent swelling in an extremity should seek medical advice as soon as possible. If Lymphedema is diagnosed and if treatment begins early, the prognosis for improvement of the condition is much greater than if the swelling is ignored and remains untreated.
No, Lymphedema is incurable, but is readily treatable.
Lymphedema can be controlled by a number of means. There is a considerable debate as to what method of treatment is best. Many physicians and therapists that we at Advanced Rehab Technologies work with believe that a multifaceted approach is most effective.
Chronic Lymphedema is a progressive condition that must be treated. When Lymphedema remains untreated, the limb becomes more swollen, (edematous) and the skin can harden. Elasticity diminishes in the limb, reducing range of motion, and flexibility. Limbs with untreated Lymphedema are more prone to developing problems like cellulitis. This type of infection can be serious if left untreated. Many patients end up in the hospital if the infection gets out of control. If you suspect you have a cellulitis infection, seek medical attention immediately.