How to Deal with Lymphedema During Breast Cancer.

You may have heard of a condition called lymphedema, which occurs after removal of the armpit (or axillary) lymph nodes.

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You may have heard of a condition called lymphedema, which occurs after removal of the armpit (or axillary) lymph nodes.

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Learning more about the signs of lymphedema can help you identify it as early as possible. Read on to learn more about this condition, some of the risk factors and symptoms, and some treatment methods that can help you cope with lymphedema.

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What is lymphedema?

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Lymphedema is a condition in which parts of the body swell due to a buildup of lymph in the tissues. ²

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Lymph is a watery fluid that flows through our body tissues and then into our blood.³

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Lymph vessels help carry our lymph away from our tissues and toward lymph nodes.³

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Lymph nodes are glands that filter our lymph, removing damaged cells and cancer cells. We have lymph nodes in our armpits, groin, neck, and throughout our bodies.³

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When someone has lymphedema, lymph stays in the tissues instead of returning to the bloodstream, causing fluid to build up under the skin. We see this fluid buildup as swelling (also known as edema). In people who have had surgery on the axilla, the swelling may occur in the hand, arm, breast, or chest wall. ⁴

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What causes breast cancer-related lymphedema?

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As with nearly all of your tissues, breast tissue has lymph fluid circulating through it. Near your armpits, you have lymph nodes called axillary lymph nodes. Normally, the lymph from breast tissue drains to vessels and then to the axillary lymph nodes. When someone has invasive breast cancer, the cancer can spread through lymph to the axillary or other nearby lymph nodes.² The removal of the lymph nodes and the disruption to the lymph system can prevent the lymph from draining. In addition, some treatments can increase the risk of lymphedema.

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Blockage

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In some cases, when cancer is present in the lymph nodes, the cancer itself can block the lymph vessels. This prevents the lymph from draining, which can cause swelling.²

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Lymph node removal surgery

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Lymph node removal surgery is a more common cause of lymphedema. When the cancer-containing nodes are removed, they are no longer available to drain the lymph, and swelling can occur. People who have this surgery need to know that lymphedema can develop at any time after surgery.⁵

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Radiation

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Finally, radiation treatment of the lymph nodes can cause scarring or blockage. This damage to the lymph nodes can prevent them from draining the lymph, leading to lymphedema.⁵

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Other risk factors

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Being overweight or obese has been identified as a risk factor for developing lymphedema after breast cancer treatment. ¹ Researchers found that hypertension (high blood pressure) also appeared to be a risk factor for people who had mastectomies. ⁶ Eating a healthy diet and managing your weight may help lower your risk of developing lymphedema. On the other hand, there are many people who are so-called normal weight who have lymphedema. It’s important not to blame yourself for this treatment side effect.

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What are the symptoms of lymphedema?

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People may begin to feel symptoms of lymphedema soon after surgery while others may not experience symptoms for months or years. ⁵

While some swelling is expected immediately following surgery or radiation (known as acute swelling), this swelling should subside over time.¹ If you’re not sure whether you’re experiencing acute swelling or the onset of lymphedema, consult your doctor.

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Symptoms of lymphedema include:

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• swelling of the arm, hand, shoulder, or chest wall on the side of your body that was treated ⁴
• a decrease in your ability to move your arm, shoulder, fingers, or wrist ⁴
• changes in your skin texture or skin feeling tight ⁴
• aching, tingling, or heaviness in your arm ⁴
• veins are harder to see ¹
• jewelry may feel tighter or harder to take off ¹
• clothing or undergarments may feel too tight or leave a mark on your skin ¹
• uneven shape of your back in the mirror ¹

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How long will symptoms last?

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There is currently no cure for lymphedema. The good news is that, while lymphedema may never completely go away, there are treatments that can help people manage it effectively.⁵ We will cover treatment more below.

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What are possible complications?

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Cellulitis

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People with lymphedema are at greater risk of infection of the skin’s tissues. Sometimes, if there is extensive soft tissue infection, this may be something called cellulitis.⁴

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According to the American Cancer Society, symptoms of cellulitis include:

• skin redness
• skin warmth
• pain in the affected area
• cracking of the skin
• fever or flu-like symptoms ⁴

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Let your doctor know right away if you experience any of these symptoms so you can receive treatment (usually with antibiotics) immediately.

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Johns Hopkins Medicine offers some suggestions to prevent infection for those with lymphedema, although none of these suggestions has been proven to be necessary:

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• wear gloves when working in the yard or cleaning
• ask for blood draws, injections, or blood pressure tests to be done on the other arm
• wear sunscreen to prevent sunburn
• take care to avoid needle pricks while doing activities like sewing
• take care when shaving underarms
• clean any cuts with soap and water, apply antibacterial ointment, and cover with a sterile bandage ⁵

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Angiosarcoma

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While the research is limited, some studies show that breast cancer-related lymphedema may be a risk factor for angiosarcoma. Angiosarcoma is a very rare tumor that can develop in the blood and lymph vessels, nearly always in someone who had radiation therapy. Only about 1% of breast cancer patients develop angiosarcoma 10-15 years after treatment with surgery and radiation. 7 Angiosarcoma appears as deep purple marks in or on the skin in the area where you received radiation therapy.

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How can we treat lymphedema?

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The earlier lymphedema is detected and treated, the better. Let your doctor know if you notice any symptoms right away even if they seem to go away on their own. Sometimes lymphedema symptoms can come and go. 1 Listening to your body can help you know when to contact your doctor. Even if you don’t notice any visible swelling but notice other symptoms of lymphedema, let your doctor know. ¹ Starting treatments early on can keep lymphedema from getting worse.

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Lymphedema specialists

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A lymphedema specialist can help you identify the most effective treatments for your situation. Your doctor, hospital, or cancer center can help connect you with a lymphedema specialist. ¹

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Physical or occupational therapy

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A physical or occupational therapist can show you some exercises that help you build up your strength and improve your range of motion in the area that’s been affected by lymphedema. Movement can help with lymph fluid drainage. ⁵

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Exercise

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Exercising on your own can also help with the movement of the lymph. Ask your doctor or a lymphedema specialist about what kind of exercises might be safe for you to try. ⁸ We used to tell people to limit weightlifting after breast cancer surgery, but an important study showed that lifting weights actually reduces the risk of lymphedema. ¹⁰

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Compression garments

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Compression garments apply pressure to the affected area. These garments might be a sleeve you put on your arm, a vest you wrap around your body, or something else, depending on which part of your body has been affected by lymphedema. This pressure applied by the garments can help the lymph fluid flow back to the lymph channels and out of the tissues. ⁸

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Intermittent pneumatic compression therapy

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This treatment is usually done in a doctor’s office. It involves placing your arm in a sleeve or wearing a vest-like garment connected to a pump. The pump inflates different parts of the sleeve or vest to help the lymph move along in the body. ⁸

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Manual lymphatic drainage

Manual lymphatic drainage is a type of massage given by a certified lymphedema therapist.² This helps the lymph drain into the lymph vessels.⁸

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Complete Decongestive Therapy

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Complete decongestive therapy is actually a combination of different types of therapies, including:

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• skincare
• manual lymphatic drainage
• compression garments
• exercise
• self-massage

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In a study of women with breast cancer-related lymphedema, complete decongestive therapy was found to improve the patients’ quality of life, reduce the fluid in the limbs, and improve limb function. ⁹

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Summary

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Lymphedema is a condition where a buildup of lymph causes parts of the body to swell. Cancer blocking the lymph flow, lymph node damage from radiation, or the surgical removal of the lymph nodes can cause lymphedema.^2,5 Breast cancer-related lymphedema may appear as swelling in the hands, arms, or chest wall. ⁴ Treatments, including physicalBreast cancer-related lymphedema may appear as swelling in the hands, arms, or chest wall. ⁴ Treatments, including physical therapy, massage, and compression garments, can help people manage lymphedema. ¹ Although lymphedema can be a lifelong condition, early diagnosis and intervention can keep lymphedema from progressing.⁵

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References

1. Lymphedema. Breastcancer.org. https://www.breastcancer.org/treatment-side-effects/lymphedema. Published July 30, 2022. Accessed September 7, 2022.

2. NCNN Guidelines for Patients: Invasive Breast Cancer. National Comprehensive Cancer Network. https://www.nccn.org/patients/guidelines/content/PDF/breast-invasive-patient.pdf. Published 2022. Accessed August 29, 2022

3. Lymphatic system: Parts & Common Problems. Cleveland Clinic. https://my.clevelandclinic.org/health/articles/21199-lymphatic-system. Published February 23, 2020. Accessed September 7, 2022.

4. What is lymphedema? American Cancer Society. https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/lymphedema/what-is-lymphedema. Published May 25, 2021. Accessed September 9, 2022.

5. Breast cancer: Lymphedema after treatment. Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/breast-cancer/breast-cancer-lymphedema-after-treatment. Published June 23, 2022.Accessed September 7, 2022.

6. Kuruvilla AS, Krajewski A, Li X, et al. Risk factors associated with postmastectomy breast cancer lymphedema. Annals of Plastic Surgery. 2022;88(3). doi:10.1097/sap.0000000000003107

7. Sato F, Yamamoto T. Breast angiosarcoma after Primary Breast Cancer Surgery: A systematic review. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2022. doi:10.1016/j.bjps.2022.06.046

8. Treatments for lymphedema. Breastcancer.org. https://www.breastcancer.org/treatmentsideeffects/lymphedema/treatments. Published July 27, 2022. Accessed September 9, 2022.

9. Breast cancer: Lymphedema after treatment. Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/breast-cancer/breast-cancer-lymphedema-after-treatment. Published June 23, 2022.Accessed September 7, 2022.

10. Schmitz KH, Ahmed RL, Troxel A, et al. Weight lifting in women with breast-cancer–related lymphedema. New England Journal of Medicine.2009;361(7):664-673. doi:10.1056/nejmoa0810118

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