Breast Cancer Induced Lymphedema

Lymphedema is swelling caused by a buildup of fluid and fat that happens most commonly in the arms, legs, or face in people who have been treated for cancer. Lymphedema is one of the most troubling complications that can develop after cancer surgery. Many people find that lymphedema worsens the physical and emotional strain of living with (or following treatment for) cancer.

The risk of developing lymphedema depends upon the type of surgery performed, individual factors such as obesity or weight gain after surgery, treatment factors such as radiation or some types of chemotherapy, and complications after surgery, including infections or fluid collections (called “seromas”).

Lymphedma Symptoms

The most noticeable symptom of lymphedema is swelling. Early symptoms of lymphedema may include any or all of the following in the treated limb or tissues:

• A heavy sensation or an aching discomfort
• Fatigue with use
• Numbness or tingling

In some cases, these symptoms develop before swelling is noticeable. Let your doctor or nurse know as soon as possible if you have any of these symptoms; recognizing and treating lymphedema in the early stages can help prevent worsening of these symptoms over time and may help reduce its severity.

Impact of Lymphedema 

While lymphedema is usually not a life-threatening condition, it can have a major impact on your quality of life. A change in how your limb looks can be distressing as well as painful.

• After breast cancer surgery, having a swollen or misshapen arm may increase the worry about how it looks.
• If lymphedema affects the ability to use your arm or leg, this can affect your quality of life, particularly if it is your dominant arm (eg, right arm if you are right-handed).
• Lymphedema can reduce tissue healing and occasionally causes chronic pain. For these reasons, early recognition and treatment of lymphedema are recommended.
• The limb with lymphedema can develop cellulitis, a skin infection that requires antibiotics and possible hospitalization.

Managing and Treating Lymphedema

Relieving side effects is an important part of cancer care and treatment.

Lymphedema treatments:

• Reduce swelling
• Prevent it from getting worse
• Prevent infection
• Improve how the affected body part looks
• Improve the person’s ability to function

Although treatment can help control lymphedema, it currently does not have a cure. A treatment plan for you may include:

• Manual lymphatic drainage (MLD). MLD involves gentle skin massage. It helps blocked lymphatic fluid drain properly into the bloodstream and may reduce swelling. For best results, you should begin MLD treatments as close to the start of lymphedema symptoms as possible. A member of your health care team can refer you to a CLT trained in this technique.
  
  
• Exercise. Exercising usually improves the flow of  lymph fluid through the lymphatic system and strengthens muscles. A CLT can show you specific exercises that will improve your range of motion. Ask your doctor or therapist when you can start exercising and which exercises are right for you.
  
  
• Compression. Non-elastic bandages and compression garments, such as elastic sleeves, place gentle pressure on the affected area. This helps prevent fluid from refilling and swelling after decongestive therapy (see below). There are several options, depending on the location of the lymphedema. All compression devices apply the most pressure farthest from the center of the body and less pressure closer to the center of the body. Compression garments must fit properly and should be replaced every 3 to 6 months.
  
  
• Complete decongestive therapy (CDT). This is also known as complex decongestive therapy. It combines skin care, manual lymphatic drainage, exercise, and compression. A doctor who specializes in lymphedema or a CLT should do this therapy. The therapist will also tell you how to do the necessary techniques by yourself at home and how often to do them. Ask your doctor for a referral.
  
  
• Skin care. Lymphedema can increase the risk of infection. So it is important to keep the affected area clean, moisturized, and healthy. Apply moisturizer each day to prevent chapped skin. Avoid cuts, burns, needle sticks, or other injury to the affected area. If you shave, use an electric razor to reduce the chance of cutting the skin. When you are outside, wear a broad-spectrum sunscreen that protects against both UVA and UVB radiation and has a sun protection factor (SPF) of at least 30. If you do cut or burn yourself, wash the injured area with soap and water and use an antibiotic cream as directed by your health care team.
  
  
• Elevation. Keeping your affected limb raised helps to reduce swelling and encourage fluid drainage through the lymphatic system. But it is often difficult to keep a limb raised for a long time.
  
  
• Low-level laser treatments (LLLT). A  number of clinical trials have found that LLLT could provide some relief from lymphedema after removal of the breast, particularly in the arms.
  
  
• Medications. Your doctor may prescribe antibiotics to treat infections or drugs to relieve pain when necessary.
  
  
• Physical therapy. If you have trouble swallowing or other issues from lymphedema of the head and neck, you may need physical therapy.