Understanding 

Lymphedema

What is the Lymphatic System?

Our bodies have a network of lymph nodes and lymph vessels. This system collects and carries a watery, clear lymph fluid, much like how veins collect blood from distant parts of the body and carry it back to the heart.  This fluid consists of proteins, salts, and water, as well as white blood cells, which help fight infection.

What Is Lymphedema?

Lymphedema is most commonly caused by the removal of, or damage to, your lymph nodes as a part of cancer treatments. It results from a blockage in your lymphatic system, which is part of your immune system. The blockage prevents lymph fluid from draining well, and the fluid buildup leads to swelling.

 

According to the National Cancer Institute, anywhere from 5-17% of women who have sentinel lymph node biopsy develop lymphedema.  Among women who have axillary lymph node dissection, the percentage is higher — from 20-53% — and the risk increases with the number of nodes taken out.  Not surprisingly the risk is even higher if you receive radiation to the breast, chest, and under the arm area.

Lymphedema is the build up of lymph fluid within the lymphatic system.  The buildup can be caused by a number of factors which we will get into below. Lymphedema can occur in the limbs and extremity such as the arms and legs. As it relates to breast cancer, the most common occurrence of lymphedema occurs in the arm, chest, or back. 

Lymphedema is something that can be managed so you never get it, or, it is something you manage on a continual basis to avoid flareups and progression as there is no cure for lymphedema.  Although there is no official cure, there are plenty of beneficial treatment plans that help mitigate side effects. 

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How To Prevent Lymphemdema

After Surgery, your surgeon may recommend specific exercises to increase mobility and prevent lymphedema. They may also recommend seeing a physical therapist. With approval of your medical care team (and feel free to ask them!) you may start exercises to prevent cording. Cording, which is also known as axillary web syndrome (AWS)  which refers to a long line of "cord" that develops under the armpit and axilla area and can happen after someone undergoes a sentinel lymph node biopsy (SLNB) or a full axillary lymph node dissection (ALND). 

One of the most common exercises to prevent cording and/or axillary web syndrome is the activity of "walking the walk". This is an excellent exercise:

 

1. Stand perpendicular to the wall

2. With the affected arm, using your fingers to start crawling up the wall (think itsy bitsy spider). 

3. As your arm makes it way up the wall, lean in to the highest point you are able to achieve without causing harm or pain, and hold for 10 seconds. 

Repeat this process several times throughout the day. 

Your doctor may also recommend specific exercises utilizing weights and limits on the number of pounds or kilos you should lift. It's always better to start off light, never over do it, and increase weight slowly and gradually, over time.

10 Recommendations To Prevent Lymphedema:

  1. Avoid tight clothing and jewelry on the arm and wrists

  2. Avoid cutting your cuticles

  3. Use insect repellent when outdoors

  4. Avoid sunburn and excessive amounts of heat from saunas and baths

  5. Avoid having IV's or blood pressure taken in the at-risk arm. 

  6. Wear a compression sleeve when traveling on air planes or carrying a lot of heavy luggage. 

  7. Keep your arm elevated whenever possible

  8. Engage in activities that help promote the movement of your lymph fluid such as yoga and swimming

  9. Nutrition plays an important role in life after a breast cancer diagnosis; maintain a healthy weight and a low sodium diet

  10. Carry handbags and purses on the unaffected arm

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What Are The Signs and Symptoms of Lymphedema

After a cancer diagnosis it is common to feel that every ache, pain, or twitch is a sign that the cancer has returned or is spreading. Similarly, it is common to feel that after a sentinel node biopsy or an axillary node dissection, any change to your arm is lymphedema. If you follow the recommendations above, you are already on the right track of decreasing your change of developing lymphedema. Below are some of the symptoms you should be aware of and if you start to develop any of these symptoms, speak withyour medical care team and look into scheduling an appointment with a lymphedema therapist. If caught early, the better. 

Common symptoms include: