Understanding 

Lymphedema

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. Let's start with the basics:  

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.

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

Get Survivingbreastcancer.org tips, recommendations and support delivered to your inbox every Monday! 

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 lymphdema. 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 lymphdema therapist. If caught early, the better. 

Common symptoms include:

  • Swelling in the arm, typically visible compared to the unaffected arm

  • Felling heavy or tight

  • Aching or pain which can cause limited range of motion

  • Swelling in the fingers and hand; trouble bending or moving your fingers

  • Rings or watching suddenly feel too right

 

How to Treat Lymphedema

If you develop lymphedema, your doctor may suggest that you see a lymphedema therapist. Lymphedema therapists are trained specialist who can help manage your diagnosis and prescribe a number of recommendations and treatments depending on the severity of the lymphedema. 

  • Your therapist may recommend a compression garment or compression sleeve. Compression can help move lymph fluid throughout your arm and control swelling

  • A lymphedema specialist may also have you come in person for Manual Lymphatic Drainage (MLD). This is a very light form of massage that gently moves the lymph from the swollen area to areas with functional lymph vessels. The technique involves a light pulling and pushing (or circular motions). MLD is not painful and Patients can be taught how to do MLD on their own at home. 

  • Bandaging is another technique that can be utilized to reduce lymphedema. Usually bandaging is done with multiple layers of compression that are applied with some pressure to help move the fluid from swollen areas to other parts of the body. 

 

In addition to the above treatments, there are some other techniques but they can be more expensive. It's important to check with your insurance provide to see what may be covered. 

 

Compression devices are another option for people managing lymphdema. These devices act like a pump can be worn at home to imitate the manual lymphatic drainage technique

 

There are also surgical options for lymphedema such as lymphatic bypass or lymph node transfers. Lymphatic bypass is a process in which the lymphatic vessels and veins are re-routed around the obstruction and reconnected to functional lymph vessels so that the fluid can drain.  Lymph node transfer on the other hand is a process by which lymph nodes from other parts of the body are removed and placed into the impaired area. This technique helps to restore the flow of lymph fluid back into the region. 

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