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Lymphedema

Lymphedema is a health condition that can result from breast cancer treatment following the surgical removal of lymph nodesLymph nodes:
Small structures that filter lymph fluid for harmful substances. They contain immune cells that can help fight infection by attacking and destroying germs. Cancer can travel through the lymphatic system spread to the lymph nodes.
from the underarm area or radiation treatmentRadiation therapy (Sometimes called radiotherapy):
A treatment method that uses a high energy beam to destroy cancer cells by damaging the DNA of cancer cells so that they can’t continue to grow.
to this area. When lymph nodes are removed or damaged, the lymphatic systemLymphatic system:
A network of vessels that transports lymph fluid, a clear fluid that comes from your blood and bathes the tissues. It contains water, protein and minerals and white blood cells. The lymph passes through a series of filters, the lymph nodes, before rejoining the bloodstream.
is unable to work as effectively in that area and lymph fluid can build up, causing swelling in the arm, hand or chest area. Not everyone who has had lymph nodes removed or radiation to the underarm area develops lymphedema. For those who do develop it, lymphedema can occur immediately after surgery, or months, even years later, and remain a life-long risk. It can be temporary, with mild discomfort, or become life-long condition that requires treatment to control the swelling. The best defense against lymphedema is detecting and treating it early.

The risk of developing lymphedema depends on a number of factors including the extent of your breast cancer surgery, the number of lymph nodes removed, the extent of radiation therapy, and your weight.

There are many steps you can take to help reduce your risk of developing lymphedema, some of which are discussed below.

What is the Lymphatic System?

The lymphatic system is a network of vessels that run through the body, in parallel to the arteries and veins. It is part of the circulatory system, as well as an important part of the body’s immune system. The lymphatic vessels carry lymph, a clear fluid that contains white blood cells, and collect fluid, debris, and other substances found in the body’s tissues. Lymph fluid is filtered through small bean shaped glands called lymph nodes, which are located in clusters in several places in your body, including the armpits, groin, neck, abdomen and chest.

Lymph nodes contain immune cells that detect, attack and destroy harmful substances like bacteria. If cancer cellsCell:
The basic structural and functional unit of all organisms.
break away from a tumourTumour:
An abnormal mass of tissue that occurs when cells divide more than they should or do not die when they should. Tumours may be benign (not cancer) or malignant (cancer). A tumour is also called a neoplasm.
, they sometimes travel to the nearest lymph node(s), and can be detected there. In some cases, they can spread to other parts of the body through the lymphatic vesselsLymph vessels:
Ducts that carry lymph fluid through the lymphatic system.
(metastasisMetastatic (metastases):
The spread of cancer from its original (primary) location to another part of the body. A tumour that is formed by cancer cells that have spread to another part of the body is called a “metastatic tumour” or a “metastasis.”
). This is why your doctor will check your lymph nodes in the area of the affected breast for the presence of cancer cells, to see if breast cancer has spread from the original tumour. If cancer cells are found, the affected lymph nodes will likely be removed.

Signs and Symptoms of Lymphedema

The best defense against lymphedema is detecting and treating it early. Watch out for these early warning signs and speak to your health care provider for advice if you notice them:

  • A feeling of tightness in the skin of your arm, armpit, shoulder and/or chest

  • A feeling of heaviness in your arm

  • Swelling/increase in the size of your arm, shoulder, breast, chest, armpit, back, hand or fingers

  • Clothing or jewelry feeling tight on the affected side

  • Aching or stiffness in the arm on the side of your surgery

  • A feeling of congestion or blockage in your arm

  • Swelling or discomfort that has not gone away 6 to 12 weeks after surgery

Reduce Your Risk

Here are some things you can do that may lower your risk of developing lymphedema:

  • Look after your skin. Use a moisturizer daily. Where possible, try to avoid any injury to the skin on your affected side(s), including cuts, burns, sunburns and insect bites, by wearing protective clothing and gloves. Apply antibiotic cream immediately to any areas where the skin is broken (e.g. cuts and scrapes).

  • Avoid constricting your arm. Try to avoid having blood drawn or blood pressure monitoring on the affected side(s). Avoid tight-fitting jewelry or restrictive clothing on your arm. Avoid carrying a heavy bag on your affected side(s).  If you need to carry something heavier, try using a bag or basket with wheels to lighten the load on your shoulder.

  • Do the follow-up exercises that you receive after surgery. After your operation you will be shown exercises that are intended to help restore your upper body mobility. The movements are believed to reduce the risk for lymphedema.

  • Maintain a healthy body weight. If you are overweight, you have a greater chance of developing lymphedem.

  • Look out for signs of infection. Infection can lead to lymphedema in those at risk for developing it. If you notice skin redness, swelling or heat on your affected side(s), contact your health care provider immediately.

  • Maintain a healthy level of physical activity. Movement is beneficial for lymphedema risk reduction and management, but too much exercise too quickly can overload the lymphatic system and may be a trigger for lymphedema. Exercise carefully, increasing your level of activity gradually, resting frequently and paying attention to your body's response.

Diagnosis and Treatment

If you think you may have signs of lymphedema, speak to your health care provider or a member of your health care team at the hospital where you received your cancer treatment.

If you are diagnosed with lymphedema, ask your health care provider to refer you to a therapist with training in treating lymphedema, if one is available. The treatment will focus on therapies to decrease or contain the swelling, including skin care, gentle massage to encourage lymph fluid to drain from the area (Manual Lymphatic Drainage), compression bandaging and compression garment fitting. Physical activity is another aspect of lymphedema treatment—to help improve flexibility and lymph circulation.

There is no cure for lymphedema. However, it can be managed with appropriate treatment and self-care. Detecting and treating lymphedema early is key and can lessen its impact.

If you have been diagnosed with lymphedema, there are a number of resources available to support you as you learn more about the condition and how to manage it, including:

Many provinces in Canada have lymphedema associations that provide information, support, and services for people who are living with lymphedema. If your province or territory does not have an association, you can visit Lymphedema Canada for more information on support services in your area. You can also ask your health care team for information about support services.

Lymphedema associations across Canada:

B.C. Lymphedema Association (BCLA)

Alberta Lymphedema Association (ALA)

Lymphedema Association of Saskatchewan (LAS)

Lymphedema Association of Manitoba (LAM)

Lymphedema Association of Ontario (LAO)

Association Québécoise du Lymphoedème/ The Lymphedema Association of Quebec (LAQ)

 

Sources:

American Cancer Society. Lymph Nodes and Cancer. Accessed January 23, 2013.

Canadian Breast Cancer Foundation-Ontario Region & Princess Margaret Hospital. (2010). Getting Back on Track. Life after breast cancer treatment. Toronto, ON: Canadian Breast Cancer Foundation.

Cancer Research UK. The lymphatic system. Accessed January 23, 2013