Lymph is a clear fluid that contains white blood cells. White blood cells help fight infections. Lymph vessels, like blood vessels, run all through the body. They carry lymph, cells and other material. Lymph from tissues and organs drains into the lymph vessels and is carried to the lymph nodes where it is filtered. While lymph nodes are found throughout the body, the ones near the breast (see image below) are those affected during treatment for breast cancer.
Source: National Cancer Institute (www.cancer.gov)
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.
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 [75-77]:
Fortunately, most breast cancer survivors don’t get lymphedema. And, since modern surgery removes fewer axillary lymph nodes:
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 [75-82]. 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 [81-82].
Learn more about sentinel node biopsy and axillary dissection.
For women who choose breast reconstruction after a mastectomy, the type of reconstruction does not seem to impact the risk of lymphedema .
Lymphedema usually develops within three years of breast surgery. It may occur immediately after surgery or many years after treatment .
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 [75-76]:
For a picture of lymphedema, visit the Society for Vascular Surgery website.
At this time, there are no standard screening tools for lymphedema and there is no standard way to diagnose it.
The most common way health care providers check for lymphedema is by measuring upper and lower arm widths. Measurements may be taken before surgery to have a comparison for measures taken after surgery.
Other screening methods include water displacement, perometers, photography, bioimpedance measures and special imaging called lymphoscintigraphy (only available at some medical centers) [75,88-91,149-150].
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 [76,83-87]:
Other treatments may include [75,87,150-152]:
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.
New treatments for lymphedema, such as laser therapy, are under study .
In the past, there was some concern that exercise might increase the risk of lymphedema for breast cancer survivors and worsen symptoms in those who developed the condition.
Studies now show that after recovery from breast surgery, arm exercises (such as weight-lifting) do not appear to increase the risk of lymphedema in survivors [70-72,151,177]. Moreover, studies now show weight-lifting (in a supervised research setting) can reduce symptoms in survivors with lymphedema, as well as improve body image, sexuality and physical strength [72-74,151]. However, strenuous exercise should be avoided immediately after breast surgery.
Talk to your health care provider before starting an exercise program to manage lymphedema.
Although there is no proven way to prevent lymphedema, survivors can:
Injury or infection to the arm may trigger lymphedema . So it is best to take steps to reduce the risk of injury or infection. Although the tips below have not been proven in clinical trials, they may work for some people.
Tips on reducing the risk of injury or infection to the arm
If you have an infection, injury or any of the symptoms listed above, see your health care provider.
Adapted from selected materials [75,177].
Lymphedema can be a lifelong concern once it develops. However, many breast cancer survivors do not know it is a possible side effect of treatment. They may not take steps to try to reduce their risk of lymphedema—or to seek care if it develops. If you have any symptoms of lymphedema, see your health care provider.
Though most health care providers understand the impact of lymphedema, there is room for improvement. One organization working to increase awareness of lymphedema is the National Lymphedema Network.
Read our perspective on lymphedema (January 2013).*
CancerCare’s Linking A.R.M.S.TMProvides financial assistance for lymphedema care and supplies, as well as other treatment expenses.www.cancercare.org/
Living Beyond Breast CancerFind information on lymphedema.www.lbbc.org/
Lymphatic Education and Research Network Find a clinical trial and other information on lymphedema. www.lymphaticnetwork.org/
Lymphology Association of North America (LANA)Find a list of physical therapists. www.clt-lana.org
National Cancer Institute—LymphedemaFind information on lymphedema.www.cancer.gov
National Lymphedema NetworkFind a support group, physical therapist, financial assistance for garments and information on lymphedema. www.lymphnet.org
Patient Advocate Foundation – Financial Aid Fund Provides financial assistance for lymphedema care and supplies, as well as other treatment expenses. www.patientadvocate.org
Facts for Life: Lymphedema
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