WHAT IS LYMPHEDEMA?
What every woman facing breast cancer should know about Lymphedema: Hand and Arm care following surgery or radiation therapy for Breast Cancer.
Woman who have been treated for breast cancer may be at risk for lymphedema, or arm swelling. Most women who have had breast cancer will not develop this side effect, but many will. This information will describe what lymphedema is, the steps you can take to lower your risk, and what signs to look for. It is not possible to predict who will get lymphedema, but recognizing it early and treating it promptly is the best way to manage it.
what is lymphedema?
Our bodies have a network of lymph nodes and lymph vessels that carry and remove lymph fluid, similar to the way blood vessels circulate blood to all parts of the body. The lymph fluid contains white blood cells, which help us fight infections. During surgery for breast cancer, the doctor usually removes some of the lymph nodes from the underarm area to see if the cancer has spread. Some lymph vessels that carry fluid from the arm to the rest of the body are removed also, because they are intertwined with the nodes.
The removal of lymph nodes and vessels changes the way the lymph fluid flows within that side of your upper body, making it more difficult for fluid in the arm to circulate to other parts of the body. If the remaining lymph vessels cannot remove enough of the fluid in the breast and underarm area, the excess fluid builds up and causes swelling, or lymphedema. Radiation treatment can affect the flow of lymph fluid in the arm and breast area in the same way, putting the patient at increased risk for lymphedema.
Lymphedema usually develops slowly over time. The swelling can range from mild to severe, and it can develop soon after surgery or radiation treatment or many months or even years later. Women who have many lymph nodes removed and radiation therapy may have a higher risk of developing lymphedema, but doctors do not fully understand why some patients are more likely to have problems with fluid build-up than others. As breast surgery and treatment continue to become more conservative (that is,as more women are treated with lumpectomy) and as research advances are made with procedures such as the sentinel lymph node biopsy (a new procedure which allows the surgeon to remove only one or two lymph nodes), doctors expect that fewer woman will develop lymphedema. Although much remains to be learned about this condition, there are ways that you can care for the arm and breast area to reduce your chances of having future problems.
How to reduce swelling after surgery or radiation
Immediately after surgery, some swelling may occur in the affected arm or breast area. this swelling is usually temporary and will gradually disappear over the next six to twelve weeks. The following suggestions may help relieve the swelling:
- Use your affected arm as you normally do when combing your hair, bathing, dressing, and eating.
- Elevate your affected arm above the level of your heart for 45 minutes, two or three times a day, while lying down. Position your arm on pillows so that your hand is higher than your wrist and your elbow is slightly higher than your shoulder.
- Exercise your affected arm while it is elevated above the level of the heart by opening and closing your hand 15 to 25 times. Repeat this three to four times a day. This exercise helps to reduce swelling by pumping lymph fluid out of the arm through the undamaged lymph vessels.
- To regain your normal range of shoulder and arm movement, begin exercising your affected arm about a week after your surgery as directed by your doctor, nurse, or physical therapist. Generally, normal range of motion returns within four to six weeks.
- If you have radiation therapy after surgery, it may cause or prolong the swelling in the arm or cause some swelling in the breast toward the end of the treatment. This swelling is temporary and will gradually disappear. During treatment and up to 18 months afterward, you should do simple stretching exercises daily to maintain your shoulder range of motion.
How to help prevent and control Lymphedema
Although there are no scientific studies to show that woman can prevent lymphedema, most experts recommend following these basic guidelines, which may lower your risk of developing lymphedema or delay its onset:
Try to avoid infection
Your body responds to infection by making extra fluid to fight the infection, Removal of or damage lymph nodes and vessels makes it more difficult to transport this extra fluid, and this can trigger lymphedema. Good hygiene and careful skin care may reduce the risk of lymphedema by helping you to avoid infections. Follow these suggestions to help you care for your hand and arm on the side of your surgery:
- Whenever possible, have your blood drawn, and IV's and injections given in your unaffected arm. Also have flu shots and vaccinations in your unaffected arm or somewhere else, such as the hip. Let your health provider know that you are at risk for lymphedema.
- Keep your hands and cuticles soft and moist regularly applying moisturizing lotion or cream. Push cuticles back with a cuticle stick rather than cutting them with scissors.
- Keep your arm clean. Clean and protect any skin openings caused by cuts, abrasions, insect bites, hangnail or torn cuticles. Use an over-the counter antibacterial cream on any openings once they are cleaned, and then cover with a bandage.
- Wear protective gloves when doing household chores involving chemical cleansers or steel wool, gardening or yard work, and perhaps while washing dishes.
- Use and electric shaver for removing underarm hair, these may be less likely to cut or break the skin than straight razors or hair removal creams.
- If necessary, use an insect repellent when outdoors to avoid bug bites. If you get stung by a bee in the affected arm, clean and elevate the arm, apply ice, and contact your health care provider if it becomes infected.
Try to avoid burns
Like infections, burns can lead the body to make extra fluid that my build and cause swelling in women whose lymph nodes have been removed or damaged. Suggestions for avoiding burns include:
- Protect your arm from sunburn. Use sunscreen that is labeled "SPF15 or higher and try to stay out of the sun during the hottest part of the day.
- Use oven mitts.
- Avoid oil splash burns from frying and steam burns from microwaved foods or boiling liquids.
- Avoid excessive heat, such as from hot tubs and saunas, since heat can increase fluid build-up.
Try to avoid constriction
Constriction or squeezing of the arm may increase the pressure in nearby blood vessels, which may lead to increased fluid and swelling. Some women have associated this with the onset of lymphedema. Lymphedema onset also been associated with air travel, possibly because of the low cabin pressure. Suggested precautions include:
- Wear jewelry, clothing, and gloves that are not too tight.
- Avoid shoulder straps when carrying brief cases and purses.
- Wear loose-fitting bra so that the straps do not dig into your shoulder. Following mastectomy, use a light weight prosthesis.
- Have your blood pressure routinely taken on the unaffected arm or, if both arms are affected, on your thigh.
- Wear a compression sleeve when traveling by air if you fly frequently or for long flights. If possible, try to keep the arm elevated above the level of your heart and flex it frequently during the trip. A well-fitted compression sleeve may help prevent swelling. Talk to your doctor or physical therapist about whether you should be fitted for a sleeve to wear during air travel.
Try to avoid muscle strain
It is important to use your affected arm for normal everyday activities, such as brushing your hair and bathing, for you to heal properly and regain strength. However, overuse has been associated to onset lymphedema in some women. It's a good idea to follow these suggestions whenever possible:
- Use your affected arm as normally as possible. Continue to do the activities you did before your surgery once you are fully healed, about four to six weeks after surgery or radiation treatment.
- Exercise regularly but try not to over-tire your arm. Before doing any strenuous exercise, such as weightlifting or tennis, talk with your doctor nurse, or physical therapist about your specific goals and limitations so that you can decide what level of activity is right for you. Ask your doctor or physical therapist if you should be fitted for a sleeve to wear during strenuous activities.
- Use your unaffected arm or both arms as much as possible to carry heavy packages such as groceries or handbags, or children.
How to care for cuts, scratches, or burns
- Wash the area with soap and water.
- Apply an antibiotic cream or ointment to the area.
- Cover with a clean, dry gauze or bandage.
- For burns, apply a cold pack or cold water for 15 minutes, then wash with soap and water and apply a clean, dry dressing.
- Watch for early signs of infection: rash, red blotches, swelling, increased heat, tenderness, fever. Call your doctor right away if you develop an infection.
Signs of lymphedema may include:
- Arm feels full or heavy
- Skin feels tight
- Less movement or flexibility in the hand or wrist
- Difficulty fitting the arm into jacket or shirt sleeves
- Ring,watch, and/or bracelet feels tight but you have not gained weight
If you have had lymph nodes removed or radiation treatment, you may want to examine your upper body in front of a mirror. If you notice any of the signs listed above, and if they last for one to two weeks, call your doctor or health care provider.
When to call your health care provider
- If you notice any swelling, with or without pain, that lasts for one to two weeks.
- If any part of your affected arm or underarm area (axilla) feel hot, is red or has sudden swelling. These symptoms could signal an infection and may require antibiotics.
- If you develop a temperature over 100.5 F that is not related to a cold or flu.
Lymphedema Treatment
If you are diagnosed with lymphedema, there is effective treatment to reduce the swelling, prevent it from getting worse, and limit the risk of infection. Typically, the therapy is prescribed by your doctor and should be given by an experienced therapist. Mild lymphedema should be treated by a physical therapist or other health care professional who has gone through special training. Moderate or severe lymphedema is most often treated by a therapist with specialized training and expertise who will provide skin care, massage, special bandaging, exercise, and fitting for a compression sleeve. Seeking and getting treatment early should lead to a shorter course of treatment to get your lymphedema under control.
For more information
For more information about lymphedema or other issues related to breast cancer, contact the following organizations:
Y-ME National Breast cancer Organization
24-Hour National Breast Cancer Hotline 1-800-221-2141 (English): 1-800-986-9505 (Spanish)
This information is by the:
American Cancer Society
National Alliance of Breast Cancer Organizations