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 carrying 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.
Image source: National Cancer Institute (http://www.cancer.gov)
During surgery (mastectomy or lumpectomy) for breast cancer, some of the lymph nodes in the underarm (called axillary lymph nodes) are removed and checked to see if the cancer has spread to these lymph nodes. When axillary lymph nodes are removed 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 occurs when lymph fluid collects in the arm (or other area such as the hand, fingers, chest or back) and causes swelling (edema). This swelling may be so slight it is barely noticed or it may be so great the arm grows large. In severe cases, lymphedema can cause pain and limit movement.
Who gets lymphedema? Lymphedema is related to breast 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:1-4
When does lymphedema occur? Lymphedema usually occurs within three years of breast surgery.2 Sometimes it occurs immediately after surgery and sometimes it can take many years to develop.How often does lymphedema occur?The good news is that most breast cancer survivors don’t get lymphedema. And, because modern surgery removes fewer lymph nodes, lymphedema has become less common and the cases that do occur are less severe. In the past, most people had a procedure called axillary dissection to remove axillary lymph nodes. Now, most people have a sentinel node biopsy (SNB), which removes fewer lymph nodes than axillary dissection and thus, lowers the risk of lymphedema.1-9 A recent study found that 10 years after breast surgery, only about five percent of survivors who had SNB had developed lymphedema versus about 35 percent of those who had axillary dissection.9
For women who choose breast reconstruction after a mastectomy, the type of reconstruction does not appear to affect the risk of lymphedema.4
Breast cancer survivors who have symptoms of lymphedema should see their health care provider if they notice any of the following:
Symptoms of lymphedema1-2
There are no standard screening tools for lymphedema and there is no standard way to diagnose lymphedema.
The most common way for providers to check for lymphedema is by measuring upper and lower arm widths. These 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).2,10-15
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. The goal of this therapy is to decrease swelling and infection related to lymphedema through a combination of: 1,14-19
Other treatments include exercise, weight loss, surgery and use of a compression device (a pump connected to a sleeve that inflates and deflates to apply pressure to the arm).1,14-15,19-20 New treatments for lymphedema, such as laser therapy, are under study.15Does exercise cause 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.19,21-23 And, for those who develop lymphedema, studies now show weight-lifting (in a supervised setting) can reduce symptoms and improve body image, sexuality and physical strength.19,22-24
There is no proven way to prevent lymphedema. However, injury or infection to the arm may trigger it,6 so taking steps to reduce these risks may be helpful for some people. It is important to note the tips listed below have not been proven in clinical trials.
Tips on reducing the risk of injury or infection to the arm2,25
Lymphedema occurs less often today than in the past thanks to the increased use of sentinel node biopsy. According to Dr. Terry Mamounas, Director, Comprehensive Breast Center, MD Anderson Cancer Center, Orlando, "the adoption and widespread use of sentinel lymph node biopsy over axillary lymph node dissection has resulted in a dramatic decrease in the risk for lymphedema over the past several years. Further improvements in our understanding of lymphedema risk factors and newer management approaches provide patients with additional options for lymphedema prevention and management.We are optimistic that in the years to come the incidence of lymphedema among breast cancer survivors will continue to decline as surgical and radiation therapy interventions will be further minimized. Some of the factors contributing to this trend will include the increasing use of neoadjuvant (preoperative) chemotherapy, improvements in patient selection with novel biomarkers and continuing refinements in surgical and radiation therapy techniques."Although there is no proven way to prevent lymphedema, survivors can:
And although there is no cure for lymphedema, when it is caught early, treatment can reduce some symptoms and stop them from getting worse. If you are a breast cancer survivor and have concerns about lymphedema, talk to your provider.
Living Beyond Breast CancerFind information on lymphedema.http://www.lbbc.org/ Lymphatic Research FoundationFind information on lymphedema and clinical trials on lymphedema.http://www.lymphaticresearch.orgLymphology Association of North America (LANA)Find a list of physical therapists. http://www.clt-lana.orgNational Cancer Institute—LymphedemaFind information on lymphedema.http://www.cancer.govNational Lymphedema NetworkFind a support group, physical therapist, financial assistance for garments and information on lymphedema. http://www.lymphnet.orgCancerCare’s Linking A.R.M.S.TMFinancial assistance for lymphedema supplies.http://www.cancercare.org/
Through a partnership between CancerCare and Susan G. Komen for the Cure®, Linking A.R.M.S.™ (http://www.cancercare.org/) provides financial assistance for lymphedema supplies and other breast cancer treatment-related needs. Last year, Komen awarded $500,000 to this program. Also, Susan G. Komen’s Research, Evaluation & Scientific Programs have provided more than $2.6 million in funding for research grants studying various aspects of lymphedema. Examples of Komen-supported research include: