What Is Lymphedema?
Lymphedema (LIMF-eh-DEE-ma) is a condition in which fluid collects in the arm (or other areas such as the hand, fingers, chest or back) causing it to swell (edema). Lymph vessels, much 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 keep fluid from leaving the arm and cause swelling. The swelling can be so small that it is barely noticed or so great that the arm grows very large. In more severe cases, lymphedema can cause pain and limit movement. And, it can be a source of distress due to the cosmetic look of the affected arm. For a picture of lymphedema, 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, although a few survivors get symptoms much later on [42]. At this time, there are no standard criteria for diagnosing the condition.
Why Does Lymphedema Occur?
Breast cancer survivors usually get lymphedema as a result of treatment to the lymph nodes in the armpit. Having a larger number of lymph nodes removed during breast cancer surgery and radiation to the armpit increase the risk of lymphedema [42-44]. Being overweight, being younger and having high blood pressure may also increase the risk of lymphedema [44,47]. However, it is still not clear why some breast cancer survivors get lymphedema and others do not.
How Often Does Lymphedema Occur?
The use of sentinel node biopsy appears to lower rates of lymphedema after treatment [42,44-47]. Sentinel node biopsy is less invasive and removes fewer lymph nodes compared to standard lymph node surgery. Before widespread use of sentinel node biopsy, about 26 percent of breast cancer survivors got lymphedema [43]. A recent study found that five percent of women who had sentinel node biopsy alone had lymphedema five years after surgery compared to 16 percent of women who had standard lymph node surgery [44]. With increasing use of sentinel node biopsy, lymphedema should become less common and the cases that do occur should be less severe in terms of functional and cosmetic impact.
Symptoms of Lymphedema
Early signs of lymphedema should be discussed with your health care provider right away. These may include:
- Swelling in the arm
- Feeling of tightness, heaviness or fullness in the arm
- Pain or redness in the arm
- Tight fit of rings, watches or bracelets
For a picture of lymphedema, visit the Society for Vascular Surgery website.
Treating Lymphedema
Although there is no cure for lymphedema, several treatments can restore some movement and reduce pain and swelling in the affected arm. Compression bandages or sleeves that apply pressure around the arm can help push the lymph fluid out of the arm. Exercises (closing and opening a fist, for example), massage therapy, physical therapy and elevation of the arm can also help get rid of extra fluid. Before starting any of these types of therapy, you should discuss them with your health care provider. Most of these therapies are done by a physical therapist. Your health care provider may recommend a physical therapist or you can find one through the National Lymphedema Network or the Lymphedema Association of North America.
One lymphedema treatment that is becoming more common is complete decongestive therapy. This approach uses nail/skin care, manual lymphatic drainage (a special type of massage), bandage compression and physical therapy and has shown success in decreasing swelling and lymphedema-related infection [48-51].
Reducing the Risk of Lymphedema
It is still not clear which strategies may prevent lymphedema. However, injury or infection to the arm may trigger lymphedema [47]. 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 affected arm and hand right away.
- Wear gloves when doing house or garden work.
- Keep the affected hand well moisturized.
- Use the unaffected arm 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.
- Keep skin clean and well-moisturized.
- Avoid wearing tight jewelry or clothing and wear a padded bra strap.
- Use an electric razor, not a blade, to shave the underarm.
- Avoid any type of injury, including scratches and bruises, to the at-risk arm.
- When flying in an airplane, wear a compression sleeve and drink lots of fluids during the flight.
- Rest the at-risk arm in an elevated position (above the heart or shoulder).
If you have an infection or injury or any of the symptoms listed above, see your health care provider right away.
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 arm width. Measurements may be taken before surgery to give a baseline comparison for measures taken after surgery. Other screening methods under study include water displacement, infrared scans and bioimpedance measures, but these are not widely used [42,52-56].
Calling Attention to Lymphedema
Although lymphedema can be a lifelong concern once it develops, many people do not know that it may be a side effect of treatment. Because of this, survivors may be less likely to take steps to try to reduce their risk of lymphedema—or to seek care if it develops. Though most health care providers understand the impact of lymphedema health and quality of life, there is room for improvement. One organization working to increase awareness of lymphedema is the National Lymphedema Network.
Lymphedema Resources
Living Beyond Breast CancerFind information on lymphedema.
http://www.livingbeyondbreastcancer.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
Susan G. Komen for the Cure® and CancerCare’s Linking A.R.M.S.(TM)
Financial assistance for lymphedema supplies.
http://www.cancercare.org/
Updated 08/13/09
