Lymph is a milky 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’s filtered.
Lymph nodes are found throughout the body. The ones near the breast (see image below) are those that can be 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 they contain cancer cells. When axillary lymph nodes are removed during breast surgery (with sentinel node biopsy or axillary dissection) or are treated with radiation therapy, some of the lymph vessels 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), causing it to swell (edema).
The swelling may be so slight it’s barely seen or felt. Or, it may be so great the arm grows very large.
In severe cases, lymphedema can cause pain and limit movement. Also, it can be quite upsetting to have one arm become larger than the other, even if the change is small.
Learn about sentinel node biopsy, axillary dissection and the risk of lymphedema.
For a picture of lymphedema, visit the Society for Vascular Surgery website.
Lymphedema is related to axillary lymph node surgery and radiation therapy, but it’s not clear why some people get lymphedema and others don’t.
Some factors that increase risk include [35-38,188,193-194]:
The risk of lymphedema doesn’t seem to be impacted by [41,188-189]:
Today, most people don’t get lymphedema since modern surgery removes fewer axillary lymph nodes than in the past. Typically, the cases that do occur now are less severe in terms of the impact on movement and the way the arm looks than cases that occurred in the past.
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’s less risk of lymphedema [35-38,40-42].
Women who have sentinel node biopsy are about 4 times less likely to develop lymphedema than those who have an axillary dissection .
One year after breast surgery [40-42]:
Learn more about sentinel node biopsy and axillary dissection.
Lymphedema usually develops within 3 years of breast surgery . Sometimes, it occurs many years after treatment ends .
Although not common, if lymphedema occurs right after surgery, it can usually be reversed.
If you notice early signs or symptoms of lymphedema, talk with your health care provider.
Although there’s no cure for lymphedema, when it’s caught early, treatment can reduce some signs and symptoms and stop them from getting worse.
Signs and symptoms of lymphedema include [35-36]:
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 perometers, bioimpedance measures, water displacement, photography, asking patients about symptoms and special imaging called lymphoscintigraphy [36,42-43].
Although there’s 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 through a combination of [35,44-45]:
Other treatments may include [36,43,46-48,195]:
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.
Other treatments for lymphedema, such as lymph node transfer and lymphovenous bypass, are under study [196-197].
In the past, there was some concern exercise might increase the risk of lymphedema in people treated for breast cancer and worsen symptoms in those who developed the condition.
However, after recovery from breast surgery, arm exercises (such as weight-lifting) don’t appear to increase the risk of lymphedema [47,49-51]. (It's best to avoid strenuous exercise right after breast surgery.)
Studies also 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 [47,51-53].
Talk with your health care provider before starting an exercise program to manage lymphedema.
Learn more about the benefits of exercise for breast cancer survivors and find guidelines on physical activity for survivors.
Although there’s no proven way to prevent lymphedema, you can:
Injury or infection to the arm may trigger lymphedema . So it’s best to take steps to reduce the risk of injury or infection.
Although the tips below haven’t been proven in clinical trials, they may work for some people (especially those who had axillary node dissection).
Tips to reduce 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 [36,54].
Air travel and duration of flights do not appear to increase the risk of lymphedema . However, if you have a long flight, it may be helpful to wear a compression sleeve and to massage the arm during the flight .
A note if you are traveling by air
Susan G. Komen® wants to ensure people who have breast cancer are treated with respect and dignity.
When you travel by air, these steps may be helpful:
Learn about TSA screening if you wear a breast prosthesis.
Learn about TSA screening if you wear a wig, scarf or other head covering.
If you have concerns about airline security screening, visit the TSA website.
Many people don’t know lymphedema is a possible side effect of treatment, but it can be a lifelong concern once it develops.
It’s important to take steps to try to reduce your risk and seek care if it does develop.
If you have any signs or symptoms of lymphedema, see your health care provider.
One organization working to increase awareness of lymphedema is the National Lymphedema Network.
Komen Treatment Assistance Program Provides financial assistance for lymphedema care and supplies, as well as other treatment expenses. www.cancercare.org/financial
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 compression garments and information on lymphedema. www.lymphnet.org
*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.
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