Breast cancer – related Lymphedema
Breast cancer related Lymphedema
Source: National Cancer Institute
If you have breast cancer, no matter which type of surgery you have, you will likely have one or more lymph nodes removed from under your arm. This is not the case if you have DCIS, since cells in DCIS will not travel to other parts of the body.
Lymph nodes are part of the immune system, which protects your body against infection and disease. Lymph nodes are small, round organs that are clustered in many areas of the body, such as the underarm. They are connected to one another by lymph vessels, which carry a clear fluid, called lymph. Cancer cells can spread to lymph nodes and other parts of the body through lymph vessels.
Once lymph nodes are removed, they will be checked for cancer. Knowing whether cancer is in the underarm lymph nodes can help the doctor decide if you need any treatment in addition to surgery. And, if so, what type you might need.
Lymphedema is swelling caused by a build-up of lymph. You may have this type of swelling in the hand, arm, chest, or back on the side of your body where lymph nodes were removed by breast cancer surgery or damaged by radiation therapy.
Some important facts to know about lymphedema are:
- Lymphedema can show up soon after surgery.
- Sometimes, lymphedema can last for years.
- Lymphedema can show up months or years after cancer treatment is over.
- Lymphedema might develop after an insect bite, minor injury, or burn on the arm where lymph nodes were removed or damaged.
- Lymphedema can cause pain and other problems. To help with these problems, some people find it helpful to work with a physical therapist or doctor who specializes in rehabilitation and has special lymphedema training.
Sentinel Lymph Node Biopsy is a type of surgery in which the surgeon removes a few lymph nodes for testing. First, the surgeon injects a dye, a radioactive tracer, or both into the breast near the tumor. This helps the surgeon see which lymph nodes the lymph from that area of the breast flows to first. Then, he or she removes the node or nodes that contain the dye or radioactive tracer to see if they have cancer. If they do not contain cancer, it is not likely that the other nodes under the arm have cancer. This means that the surgeon usually doesn’t have to remove any other lymph nodes.
Fewer lymph nodes are removed with sentinel lymph node biopsy than with standard lymph node surgery. Having fewer lymph nodes removed helps lower the chances that you will develop lymphedema and other problems caused by damage to lymph vessels and lymph nodes.
Treatment
This Review article says:
Breast cancer–related lymphedema (BCRL) is a potentially debilitating and often irreversible complication of breast cancer treatment. Risk of BCRL is proportional to the extent of axillary surgery and radiation. Other risk factors include obesity and infections.
Compression bandages or garments.
A repetitively applied, multilayered padding alone or in combination with manual lymphatic drainage is used to reduce ultrafiltration. A Kinesio tape is an alternative to the compressive bandage. Compression garments—lymphedema sleeve and gauntlet and hosiery—can be applied after the lymphedema reaches its nadir to prevent reaccumulation. Garments must be fitted by an experienced physical therapist and replaced every 6 months as they can lose elasticity.
Intermittent pneumatic compression.
Intermittent pneumatic compression. An intermittent pneumatic compression pump is a device that uses a stocking that is intermittently inflated over the arm. Most of the intermittent pneumatic compression pumps sequentially inflate a series of chambers in a distal to proximal fashion. It is usually applied daily or five times per week, although the optimal duration is unknown.
Massage therapy
Source: National Cancer Institute
Massage therapy (manual therapy) for lymphedema should begin with someone specially trained in treating lymphedema. In this type of massage, the soft tissues of the body are lightly rubbed, tapped, and stroked. It is a very light touch, almost like a brushing. Massage may help move lymph out of the swollen area into an area with working lymph vessels. Patients can be taught to do this type of massage therapy themselves.
When done correctly, massage therapy does not cause medical problems. Massage should not be done on any of the following:
- Open wounds, bruises, or areas of broken skin.
- Tumors that can be seen on the skin surface.
- Areas with deep vein thrombosis (blood clot in a vein).
- Sensitive soft tissue where the skin was treated with radiation therapy.
Infection Prevention
This study says: Infection prevention and treatment is another important aspect of lymphedema management. Infection is the most common lymphedema complication[43]. Lymph stasis, decreased local immune response, tissue congestion, and accumulated proteins and other debris foster infection[43]. Patients and health care professionals should be vigilant about any signs and symptoms of infection, such as fever, malaise, lethargy, and nausea. Prompt oral antibiotics are the first line of treatment for acute infection to prevent the need for intravenous therapy and hospitalization
Learn about other treatments at
Lymphoedema.ie
Lymphoedema Support Network
Updated 2024