Lymphoedema can be an uncomfortable complication following breast cancer surgery and treatment, affecting around 20% of patients. It’s important for people to understand what it is and what their risks are, as whilst there is no known cure, early diagnosis and treatment can make it easier to manage.
What is Lymphoedema:
The lymphatic system is important to rid the body of toxins and transport lymphatic fluid that fights infection. It plays an important role in the body’s immune system. Lymph nodes are glands that filter and drain fluid that circulates around the body. They are located throughout the body, including in the breast and armpit. Lymph nodes are often removed during surgery. They can also be damaged by radiotherapy.
When lymph nodes are removed or damaged, the natural flow of fluid from your breast and arm can be restricted, lymph fluid builds up in tissues under the skin causing swelling. This swelling is lymphoedema.
Lymphoedema can affect people at any time. Whilst it’s more common in the first 1-2 years after diagnosis it can occur months or years after treatment. Many people diagnosed with lymphoedema have a mild and even a transient presentation that may resolve fully. There is always however a lifelong risk of developing lymphoedema, so it is important to reduce your risk and know what to look for, as early detection and treatment makes it easier to manage.
What are the risks:
Whether or not you develop lymphoedema after treatment for cancer depends on the location of the cancer, its stage and the type of treatment. While the risk is lifelong, most people who are at risk never develop lymphoedema.
Some factors increase the risk:
- surgery to remove lymph nodes – the more nodes removed, the greater the risk of developing lymphoedema; having a sentinel lymph node biopsy reduces the chance of getting lymphoedema but it can still occur in a small number of people
- radiation therapy that causes scarring and thickening of the tissues and often the lymph nodes and lymph vessels
- taxane-based chemotherapy drugs (talk to your oncologist if you are concerned)
- an infection in the limb at risk of developing lymphoedema (i.e. the arm or leg on the side where the lymph nodes were removed)
- injury of the lymphatic system – for example, a tumour growing near a lymph node or vessel can block the flow of lymph fluid
- an existing problem with the lymphatic system (underlying primary lymphoedema)
- rheumatoid arthritis
- being overweight or obese
- not being able to move around easily.
What are the early warning signs:
Early symptoms include:
- swelling of the arm, breast or hand (your rings, sleeves or wristbands may feel tight)
- feelings of discomfort, heaviness or fullness in the arm or breast
- aching, pain, tension in the arm, shoulder, hand, chest or breast area.
If you have any of these symptoms, consult your doctor right away.
Treatment for lymphoedema usually required care from a range of health professionals including a lymphoedema practitioner (occupational therapist, physiotherapist or specialist nurse), your GP and a dietician.
Treatments are designed to reduce and control swelling, improve your range of movement and prevent infections. Options include good skin care, gentle exercise, lymphatic drainage massage and the use of compression garments on the affected arm. Lymph Physiotherapist Petrina Burnett, of BGAL Physiotherapy, says,
“Treatment may also include management of scar tissue, use of compression pumps, laser and bandaging. Your therapist can also provide education regarding activities or procedures to avoid or be cautious about.”
How to reduce your risk:
There are several things you can do to reduce your risk of developing lymphoedema after treatment:
- Use the affected area normally.
- Look after your skin – there is an increased risk of small infections becoming more serious. You can look after your skin yourself by applying non perfumed skin emollients, which will improve the skin elasticity. Please talk to your local pharmacist for recommendations.
- Keep active – regular exercise increases lymph flow and reduces the risk of fluid accumulating.
- Maintain a healthy body weight – being overweight increases your risk of developing lymphoedema.
Where to find help:
If you are concerned about lymphoedema your Breast Care Nurses, GP or treating specialist who can refer you to services to manage your lymphoedema.
For more information you may like:
- Download the Cancer Council’s fact sheet Understanding Lymphoedema
- Search the Australasian Lymphology Association’s National Lymphoedema Practitioners Register (NLPR) for a lymphoedema practitioner in your local area.
- Read the Australasian Lymphology Association’s position statement on monitoring for the early detection of breast cancer related lymphoedema.
- Read Cancer Australia’s Guide for women with early breast cancer, which includes useful information on lymphoedema.
Lymphoedema and Resistance Exercise
Resistance exercise is most effective when load and complexity is gradually increased. Research has been positive for over a decade in the lymph world, but as with all things, the data needs to be blended with good clinical judgment and individualised to the person’s unique needs and preferences. Lymph practitioners assess, provide exercise interventions and reassess to determine if a program is effective and optimal. Some resistance exercise types may be better than others. Additionally, wearing compression may be preferred and give better outcomes for some. Stretching is best delivered alongside the program to ensure optimal muscle length and tissue extensibility to enhance lymphatic drainage.