What is lymphedema?
Lymphedema is a condition of swelling in the arm that sometimes occurs after breast surgery with axillary node dissection (removal of lymph nodes from the underarm area) and/or radiation to the breast and lymph node areas. Most women with breast cancer who undergo these treatments will not develop lymphedema; but some women will. It is wise for all women who are treated for breast cancer to be aware of the risk of developing lymphedema, its early signs, and precautions that can be taken to possibly help prevent it or delay its onset. If lymphedema does occur, it can be treated and managed.
Who is at risk for developing lymphedema?
The exact incidence of lymphedema in women treated for breast cancer is not known; it is estimated to be somewhere between 5-30%. It can occur weeks or months after treatment, or even years later. Besides axillary node dissection and axillary radiation, certain other conditions can increase the risk of developing lymphedema. These include: high blood pressure, diabetes, obesity, and prior episodes of cellulites or phlebitis. If you have one of these conditions, you will need to be more vigilant in watching for early signs of lymphedema.
What are the early signs of lymphedema?
Early signs include feeling of heaviness or pressure in the arm, perhaps without any visible swelling. Jewelry or clothing may feel tight on the arm. There may be swelling in the upper arm, forearm, or any combination of these sites. Some women experience lymphedema in the breast and underarm area.
Take extra care to prevent injuries (even small injuries) to the arm or your affected side. Avoid cuts, kitchen burns. sunburn, and other trauma. Avoid injections, blood draws and blood pressure readings on the affected arm. Practice good skin hygiene; keep the skin supple and moist. Wash thoroughly and apply an antibiotic ointment to open skin areas.
Rationale: The lymphatic system is important in fighting infections. Trauma that results in openings in the skin or other damage makes the lymphatic system work harder. If it has already been compromised by cancer treatment, additional trauma could possibly overload the system and result in swelling. It is best to not make the system work any harder than it needs to.
Rationale: Regaining full motion and flexibility of the shoulder and chest areas after breast cancer treatment will help the remaining lymph nodes in the axilla to function better, because they will not be restricted by tight skin and other tissues. Also, muscle contractions help stimulate increased lymphatic flow in these areas. If you have difficult regaining full motion or experience tightness across the chest or underarm area when you move your shoulder, inform your physician. He or she may refer you to an occupational or physical therapist who will provide you with an effective stretching and strengthening program.
Rationale: The goal is for you to be able to resume your work and leisure activities without restriction and without fear of developing lymphedema. Resuming these activities gradually will allow you to monitor your arm's response to physical activity, and make adjustments, if necessary.
For example, physical activities like gardening, snow shoveling, carrying heavy loads, or weight machines at the gym, might cause the arm to swell, particularly if you are unused to such activity , or haven't done it for many months. Start slowly. If you experience swelling that persists for more than a few hours, consider it to be a warning sign that you are overworking the lymphatic system and should reduce that level of activity. If your arm tolerates the activity in the same way as the arm on your unaffected side, then you can increase the level of activity slightly, and again monitor the results.
Rationale: An arm with lymphedema is more prone to infection than an arm with a normal lymphatic system. Signs of infection include redness, warmth, swelling, and pain. If you develop these signs notify your physician as soon as possible. In an arm that already has developed lymphedema, another sign of infection can be change in tissue texture, e.g. the arm might feel harder or tighter. Infections can trigger the onset of lymphedema or lead to a worsening of existing lymphedema; prompt medical attention is essential.
Consult your physician. He or she may refer you to Anne Matthews, our registered occupational therapist with special training in lymphedema evaluation and treatment. Anne will work with you to reduce the swelling and teach you how to manage the condition.
If you have questions or would like further information, please call us at 610-622-3818. We are committed to providing total care to our patients.
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