What is lymphedema?
Lymphedema (LIMF-eh-DEE-ma) is a condition where fluid collects in the arm (or other areas such as the hand, fingers, chest or back) causing it to swell (edema).
Lymph vessels, like blood vessels, run all through the body. They carry lymph fluid, cells and other material. When lymph nodes in the armpit are removed or damaged, some of the lymph vessels can become blocked. This may prevent fluid from leaving the arm and cause swelling.
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 cosmetic look of the affected arm can be upsetting. For a picture of lymphedema, visit the Society for Vascular Surgery website.
Fortunately, most survivors do not get lymphedema. For those who do, it usually occurs within a year or two after surgery, though a few survivors get symptoms much later on [56].
At this time, there is no standard way to diagnose lymphedema.
Who gets lymphedema?
Breast cancer survivors usually get lymphedema as a result of surgery or radiation to the lymph nodes in the armpit. It is not clear why some survivors get lymphedema and others do not. However, a few factors increase risk, including [56-58]:
- Removal of a large number of lymph nodes from the armpit during breast cancer surgery
- Having a large number of lymph nodes that contain cancer
- Radiation to the lymph nodes in the armpit
- Removal of lymph nodes during surgery plus radiation to the lymph nodes
- Being overweight
- Getting infections in the area after surgery
How often does lymphedema occur (axillary dissection versus sentinel node biopsy)?
During surgery for invasive breast cancer, some of the lymph nodes in the armpit (axillary nodes) are removed to check for cancer cells (to see how far the cancer has spread in the lymph nodes).
In the past, people almost always had a procedure called axillary dissection to remove these nodes. Now, most people have a less invasive procedure called sentinel node biopsy. This procedure removes fewer lymph nodes than axillary dissection and lowers the risk of lymphedema after treatment [56-63]. Breast cancer survivors who have an axillary dissection are about three times more likely to develop lymphedema than those who have sentinel node biopsy [61]. A recent study found about five percent of breast cancer survivors who had sentinel node biopsy had lymphedema 10 years after treatment compared to about 35 percent of women who had axillary dissection [63]
As use of sentinel node biopsy increases, lymphedema should become less common and the cases that do occur should be less severe in terms of functional and cosmetic impact.
Learn more about sentinel node biopsy and axillary dissection.
Symptoms of lymphedema
If you notice early signs of lymphedema, talk to your health care provider right away. The signs may include [56-57]:
- Swelling in the arm or hand
- 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
- Tight fit of rings, watches or bracelets
- Sleep problems
- Hair loss
For a picture of lymphedema, visit the Society for Vascular Surgery website.
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 is complex decongestive therapy. This approach aims to decrease swelling and lymphedema-related infection through a combination of [58,64-67]:
- 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
Other treatments may include [56,68]:
- 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 Lymphedema Association of North America.
New treatments for lymphedema are under study.
Exercise and lymphedema
In the past, there was some concern that exercise might increase the risk of lymphedema in breast cancer survivors and worsen symptoms in those who developed the condition. However, arm exercise, such as weight-lifting, does not appear to increase the risk of lymphedema in survivors [69-70]. Moreover, studies now show weight-lifting can reduce symptoms in survivors with lymphedema as well as improve body image, sexuality and physical strength [71-73].
Reducing the risk of lymphedema
We do not yet know how to prevent lymphedema. However, injury or infection to the arm may trigger it [60]. 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
- Treat infections of the at-risk arm and hand right away.
- Wear gloves when doing house or garden work.
- Keep skin clean and well-moisturized.
- Use the arm not at risk when having blood drawn, getting injections or having blood pressure taken.
- Avoid sunburn and excess heat from saunas, hot baths, tanning and other sources.
- Do not cut nail cuticles.
- Use insect repellant when outdoors.
- Avoid injuries, including scratches and bruises, to the at-risk arm.
- Rest the at-risk arm in an elevated position (above the heart or shoulder).
- If you have an infection, injury or any of the symptoms listed above, see your health care provider right away.
Adapted from National Cancer Institute materials [56].
Screening for lymphedema
Just as there is no standard way to diagnosis lymphedema, there is no standard screening tool. 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 and bioimpedance measures [56,74-77].
Calling attention to lymphedema
Although lymphedema can be a lifelong concern once it develops, many people do not know it may be a side effect of breast cancer treatment. For this reason, survivors 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 right away.
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.
Lymphedema resources
Living Beyond Breast Cancer
Find information on lymphedema.
http://www.lbbc.org/
Lymphatic Research Foundation
Find information on lymphedema and clinical trials on lymphedema.
http://www.lymphaticresearch.org
Lymphology Association of North America (LANA)
Find a list of physical therapists.
http://www.clt-lana.org
Lymph Notes
Find a local or online support group.
http://www.lymphnotes.com
National Cancer Institute—Lymphedema
Find information on lymphedema.
http://www.cancer.gov
National Lymphedema Network
Find a support group, physical therapist, financial assistance for garments and information on lymphedema.
http://www.lymphnet.org
CancerCare’s Linking A.R.M.S.TM
Financial assistance for lymphedema supplies.
http://www.cancercare.org/
Updated 06/24/11
