Lymphedema

Lymphedema is swelling in the arm and/or hand on the same side of your body as the breast that was treated for cancer.  It results from the accumulation of lymphatic fluid in the soft tissues.  The lymphatic system is a network of nodes that assist the immune system in fighting disease, and certain nodes can be involved in your cancer.  This swelling can occur as a side effect of breast cancer treatment that removes or damages the lymphatic channels and blood vessels that drain fluid from the lymph nodes. 

Lymphedema can be severe, affecting the whole arm and hand and causing serious discomfort and disability, or it can be relatively minor, affecting only part of the arm or hand and causing few problems.

You are at risk for lymphedema if you have had an axillary lymph node dissection  as part of your breast cancer surgery, or you have had radiation therapy to the axillary (armpit) lymph nodes.  Improvements in surgical techniques, including the sentinel node biopsy,  have lowered the incidence of lymphedema in breast cancer, but between 5-40% of patients still suffer from some degree of this condition.

Lymphedema can be managed when it does occur, and sometimes prevented.  The key to prevention is to avoid situations that might lead to infection or inflammation in your arm or hand.  The lymphatic system plays a key role in fighting infection, so when any infection does occur, it increases lymphatic activity – producing more fluid, which is then difficult to drain.  This situation can lead to swelling. 

To avoid infection:

• Keep the skin of your arm and hand clean
• Use gloves to do house or yard work
• Be careful to avoid paper cuts and hangnail problems
• Avoid sunburn, and use insect repellent to discourage bug bites
• If you are having dental work, let your dentist know of your condition in advance– you may need to take antibiotics
• Heat and heavy weights can also irritate your arm and cause swelling
• Avoid very hot showers and baths, as well as saunas and hot tubs
• Carry your purse or briefcase on your unaffected side
• If you do develop redness, soreness, or swelling in your arm, let your doctor or nurse know right away

  Recent studies have shown that moderate exercise, including stretching and weight training, can help prevent lymphedema.  Before you start an exercise program, you should consult a doctor, nurse, or physical therapist who is experienced in working with breast cancer patients and lymphedema. 

If you have lymphedema, a number of steps can help you manage it.  These include wearing compression sleeves, manual drainage massage or pumps,  and arm exercises.  All of these should be done under the guidance of a physician or physical therapist who specializes in lymphedema management.

Next: Bone Health.