Breast Cancer: Lymphedema After Treatment
Lymphedema is a problem that may occur after cancer surgery when lymph nodes are removed.
Lymphedema can occur months or years after treatment. It’s a chronic (ongoing) condition
that has no cure. But steps can be taken to help keep it from starting, and to reduce
or relieve symptoms. If left untreated, lymphedema can get worse. Getting treatment
right away can lower your risk of infections and complications.
What is the lymphatic system?
The lymphatic system is a network of tiny vessels and small, bean-shaped organs called
lymph nodes that carry lymph throughout the body. Lymph is a clear, colorless fluid
that contains a few blood cells. It starts in many organs and tissues. The lymphatic
system is part of your immune system. It helps protect and maintain the fluid balance
of your body by filtering and draining lymph and waste products away from each body
region. The lymphatic system also helps the body fight infection.
How lymphedema happens
During surgery for cancer, nearby lymph nodes are often removed. This disrupts the
flow of lymph, which can lead to swelling. This is lymphedema. Lymphedema can affect
one or both arm, the head and neck, the belly, the genitals, or the legs. Swelling
can worsen and become severe. Skin sores or other problems can develop. Affected areas
are also more likely to become infected.
Often during breast cancer treatment, some or all of the lymph nodes under the arm
are treated with radiation. The lymph nodes under the arm are also called the axillary
lymph nodes. They drain the lymphatic vessels from the upper arms, from most of the
breast, and from the chest, neck, and underarm area.
When many lymph nodes under the arm have been removed, a woman is at higher risk of
lymphedema for the rest of her life. Radiation treatments to the under arm lymph nodes
can cause scarring and blockages that further increase the risk of lymphedema. Lymphedema
may occur right after surgery or radiation, or months or even years later.
Types of lymphedema
There are several types of lymphedema:
A mild type of lymphedema can occur within a few days after surgery and usually lasts
a short time.
Lymphedema can also occur about 4 to 6 weeks after surgery or radiation and then go
away over time.
The most common type of lymphedema is painless and may slowly develop 18 to 24 months
or more after surgery. It does not get better without treatment.
Lymphedema can happen any time after surgery or radiation to the lymph nodes. The
risk continues for the rest of the person's life. Lymphedema can’t be cured, but it
can be managed. Any swelling should be checked by a healthcare provider right away.
There's no way to know who will and won't get lymphedema, but there are things that
can be done to help prevent it.
Can lymphedema be prevented?
Women treated for breast cancer who have good skin care and who exercise after treatment are
less likely to develop lymphedema. Newer types of lymph node surgery have also helped
decrease lymphedema risk. But there is no sure way to prevent lymphedema.
Symptoms of lymphedema
The main symptom of lymphedema after breast cancer treatment is swelling of the arm
on the side where lymph nodes have been removed. The amount of swelling may vary.
Some people may have severe swelling (edema) with the affected arm being several inches
larger than the other arm. Others will have a milder form of edema with the affected
arm being slightly larger than the other arm.
Other symptoms of lymphedema may include:
Feeling of fullness, heaviness, or tightness in the arm, chest, or armpit area
Bra, clothing, or jewelry don't fit as normal
Aching or new pain in the arm
Trouble bending or moving a joint, such as the fingers, wrist, elbow, or shoulder
Swelling in the hand
Thickening of or changes in the skin
Weakness in the arm
If you notice any of these symptoms, see your healthcare provider right away. Treatment
needs to be started right away to keep lymphedema from getting worse.
How is lymphedema diagnosed?
There are no tests for lymphedema. Instead, your healthcare provider will ask about
your medical history and give you a physical exam. You’ll be asked about:
Past surgeries you’ve had
Any problems after your surgeries
When the swelling started
If you’ve had severe swelling (edema) in the past
What medicines you’re taking
What other health conditions you have, such as high blood pressure, heart disease,
Imaging tests, measures of volume, blood tests, and other tests may be used to diagnose
Treatment for lymphedema
Treatment depends on how severe the problem is. Treatment includes ways to help prevent
and manage the condition, and may include:
Exercise. Exercise helps improve lymph drainage. Specific exercises will be advised
by your doctor or physical therapist.
Bandages. Wearing a compression sleeve or elastic bandage may help to move fluid,
and prevent the buildup of fluid.
Diet and weight management. Eating a healthy diet and controlling body weight is an
important part of treatment.
Keeping the arm raised. Raising the arm above the level of the heart when possible
lets gravity help drain the fluid.
Preventing infection. It’s important to protect the skin in the affected area from drying,
cracking, infection and skin breakdown. Your healthcare provider will advise you about
how to care for your skin and nails to help prevent problems.
Massage therapy. Massage by someone trained in lymphedema treatment can help move
fluid out of the swollen area.
Preventing infection and injury
Protecting the arm on the side of the surgery is very important after breast surgery.
Poor drainage of the lymphatic system can cause that arm to be more at risk of infection
and less sensitive to extreme temperature. Be aware of activities that put too much
pressure on the affected arm. To protect your arm from injury and infection, make
sure to do the following:
Ask for injections and blood draws to be done on the unaffected arm.
Ask for all blood pressure tests to be done on the unaffected arm.
Don't wear nightgowns or clothing with elastic cuffs or tight bands.
Carry your handbag or heavy packages with the unaffected arm.
Be very careful and use a clean razor when shaving underarms.
Prevent sunburns and other burns to the affected arm.
Wear gloves when gardening and when using strong household cleaners.
Clean the skin of the affected arm daily, gently dry well, and apply lotion.
Do approved exercises regularly to improve drainage.
Eat a healthy, low-sodium diet.
Avoid extreme hot or cold temperatures on the affected arm, such as hot tubs, saunas,
and heating pads or ice packs.
Take good care of your fingernails and don’t cut or bite your cuticles.
Clean all cuts with soap and water, and then apply antibacterial ointment and a sterile
Protect your fingers from needle pricks and sharp objects. Use a thimble when sewing.
Avoid vigorous, repetitive movements against resistance, such as scrubbing, pulling,
or pushing with the affected arm.
Tell your doctor right away if you have any signs of infection, such as redness, pain,
heat, increased swelling, or fever.
Working with your healthcare provider
Talk with your doctor about what you can do to try to prevent lymphedema from happening
to you. Make these precautions part of your daily habits and plan to follow them for
the rest of your life.
Compare your hands and arms. Look at them in the mirror. Learn what's normal for you
so you can notice changes right away. If lymphedema does develop, let your doctor
know right away. There are things you can do to try to keep it from getting worse.