The 411: What is Lymphedema?
Emmanuelle Ravez Gomez, RMT
What is lymphedema?
Lymphedema is an accumulation of fluid (lymph) in soft body tissues, due to impairment of the lymphatic vessels. This build up of lymph causes swelling called lymphedema.
The lymphatic system carries a clear fluid called lymph, which drains out from tiny blood capillaries to lymphatic vessels throughout the body. Lymph contains water, fats, white blood cells and other components.
Lymph from tissues and organs drains into the lymph vessels and is carried to the lymph nodes where it is filtered.
The collected lymphatic fluid is eventually returned to the blood stream via the subclavian vein.
For breast cancer patients, lymphedema might occur in the arm of the affected breast, hand, trunk, back or chest wall.
How do I get lymphedema?
Cancer treatment can affect the fluid drainage channels of the lymphatic system.
When axillary lymph nodes are removed during breast cancer surgery (with sentinel node biopsy or axillary dissection), or are treated with radiation, some of the lymph vessels can become blocked or can disappear altogether.
This blockage may prevent lymph from leaving the area and will overwhelm the remaining pathways, resulting in a backup of fluid into the tissues.
Lymphedema is a chronic condition. It does not get better with time unless detected and treated early.
The swelling might be so subtle that you can not see it but it might change overtime, possibly leading to a larger limb/fingers.
When does lymphedema appear post treatment?
Lymphedema can appear immediately after treatment but it generally appears months or even years after the end of treatment.
Statistics on breast cancer patients getting lymphedema, average onset of lymphedema:
It is estimated that 20 to 30% of people will have lymphedema in the arm after breast cancer treatment that include lymph node surgery and radiation to the lymph nodes.
The 411: Can Lymphedema Be Prevented?
Can lymphedema be prevented?
Yes and No…
Lymphedema could be avoided if lymph node dissections and radiation did not happen, but thankfully treating the cancer is the priority.
Lymphedema is not a given from these treatments. However, it can develop very soon after surgery or radiation or it can develop months or even years after these treatments.
How do I know if you have lymphedema?
Lymphedema is often diagnosed by one of your doctors but proactive care is better than reactive care if you know you are at risk. In this case there are benefits to early detection and I recommend taking baseline measurements so that you can take notes of subtle changes in circumference on both the affected and non-affected side. Get a tape measure and measure the hand, wrist, forearm and upper arm at regular intervals (for example 3 cm). Make sure to keep track of those measurements and repeat the process every 2 weeks.
Common symptoms of lymphedema include:
- Swelling of part or all of your arm, back, chest wall
- A feeling of heaviness or tightness
- Restricted range of motion
- Recurring infections
- Hardening and thickening of the skin
Benefits of proactive lymphedema care
Lymphedema is a chronic condition but you can help to better control it when it is detected and treated early reducing the impact on your quality of life.
Here are factors that may exacerbate Lymphedema:
Weight/Body Mass Index
Studies have provided evidence that obesity and postoperative weight gain are significant risk factors for the development of lymphedema. Several studies have shown that obesity can increase the risk of secondary lymphedema following damage to the lymphatics.
Other studies have shown that the greater the BMI at the time of diagnosis, the higher the frequency of lymphedema in a 5 year period following the end of treatment. It is best to keep your weight in check with a healthy diet and regular exercise.
A quick reminder about the role lymph nodes:
Lymph nodes take note of foreign particles entering specific body regions and signal the body to produce an immune response. Imagine you get a manicure and your cuticles are cut with non-clean tools. Debris and bacteria will get into your body. The lymph will typically carry those debris/bacteria to the axillary lymph nodes where they would be destroyed and removed. A signal would be then sent to the immune system to stop the infection. If your lymph nodes have been surgically removed or radiated, a cut that would otherwise be harmless might become a serious infection that might spread to your entire body.
The more lymph nodes have been removed or radiated, the harder it is for your body to fight off minor infections.
Whether or not you are exhibiting symptoms of lymphedema, an infection in the body is a potential concern. It is important to check with your doctor if you suspect an infection of any kind.
If you notice a cut or break in the skin on the affected side, it is recommended to:
- Clean the area with soap and water
- Apply an over the counter antibiotic cream (eg. polysporin)
- Cover with a dry bandage until it has healed
- Check for signs of infection (redness, swelling, heat)
Please seek medical attention immediately if signs of redness, swelling, heat, pain or fever occur. An antibiotics treatment might be necessary to prevent further spreading of the infection.
Other Risk Reduction Strategies
- Blood pressure should be taken on the non-affected side
- Avoid sunburns as your body will make extra fluid to fight it
- If possible, have blood drawn, injections and vaccines on the non-affected side
- Don’t wear tight clothing/bras and jewellery/watches
- Limit the exposure to high temperatures (no whirlpool, saunas, steam rooms)
- Keep on exercising but monitor your arm for any changes!
- Be careful when getting a manicure to not get the cuticles cut
- Moisturize your skin
- Watch for cracks in the skin
Posted in: In Treatment, Post Treatment, Side Effects