What is lymph?
Lymph is a clear fluid that contains white blood cells (these 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 (http://www.cancer.gov)
What is lymphedema?
During surgery (mastectomy or lumpectomy) for breast cancer, some of the lymph nodes in the underarm (called axillary lymph nodes) may be removed and checked to see if they contain cancer. 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 cosmetic look of the affected arm can be upsetting. For a picture of lymphedema, visit the Society for Vascular Surgery website.
Who gets lymphedema?
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. However, a few factors increase risk, including [75-77]:
- Removal of a large number of axillary lymph nodes during surgery
- Radiation to the axillary area
- A combination of axillary surgery and radiation to the axillary lymph nodes
- Having a large number of axillary lymph nodes that contain cancer
- Infections in the area after breast surgery
- Being overweight
How often does lymphedema occur (axillary dissection versus sentinel node biopsy)?
Fortunately, most breast cancer survivors don’t get lymphedema. And, since modern surgery removes fewer lymph nodes:
- Lymphedema is less common these days
- The cases that do occur are less severe in terms of the impact on movement and the way the arm looks
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 and thus, lowers the 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 . A recent study found that 10 years after breast surgery, about five percent of breast cancer survivors who had sentinel node biopsy had lymphedema compared to about 35 percent of women who had axillary dissection .
Learn more about sentinel node biopsy and axillary dissection.
Breast reconstruction and lymphedema
For women who choose breast reconstruction after a mastectomy, the type of reconstruction does not appear to affect the risk of lymphedema .
When does lymphedema occur?
Lymphedema usually develops within three years of breast surgery. Sometimes it occurs immediately after surgery and sometimes it can take many years to develop .
Symptoms of lymphedema
If you notice early signs of lymphedema, talk to your health care provider. The signs may include [75-76]:
- Swelling in the arm or hand (for example, you may notice a tighter fit of rings or watches)
- 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
For a picture of lymphedema, visit the Society for Vascular Surgery website.
Screening and diagnosis of lymphedema
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]:
- 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 [75,87,150-152]:
- Compression device (a pump connected to a sleeve that inflates and deflates to apply pressure to the arm)
- 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 Lymphology Association of North America.
New treatments for lymphedema, such as laser therapy, 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.
Strenuous exercise should be avoided immediately after breast surgery. However, after recovery, arm exercises (such as weight-lifting) do not appear to increase the risk of lymphedema in survivors [70-72,151,153]. 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].
Talk to your health care provider before starting an exercise program to manage lymphedema.
Reducing the risk of lymphedema
We do not yet know how to prevent lymphedema. However, injury or infection to the arm may trigger it . 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.
Adapted from National Cancer Institute materials .
Calling attention to lymphedema
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.
Living Beyond Breast Cancer
Find information on lymphedema.
Lymphatic Research Foundation
Find information on lymphedema and clinical trials on lymphedema.
Lymphology Association of North America (LANA)
Find a list of physical therapists.
National Cancer Institute—Lymphedema
Find information on lymphedema.
National Lymphedema Network
Find a support group, physical therapist, financial assistance for garments and information on lymphedema.
CancerCare’s Linking A.R.M.S.TM
Financial assistance for lymphedema supplies.
*Please note, the information provided within Komen Perspectives articles is only current as of the date of posting. Therefore, some information may be out of date at this time.