Jeannette Zucker, a physical therapist and lymphedema specialist at Memorial Sloan Kettering Cancer Center, discusses how cancer treatment can lead to lymphedema and ways to reduce the risk and better manage lymphedema following cancer treatment.
Lymphedema, swelling in your limbs that can be very uncomfortable, can occur when some or all of the axillary (underarm) lymph nodes are removed as part of treatment for breast cancer. It can also happen after the axillary lymph nodes have received radiation because they aren’t able to remove all the lymphatic fluid that’s normally filtered from the tissue. In both instances, the fluid collects, and swelling occurs in the arm or hand and sometimes in the breast or chest wall.
Signs of lymphedema include:
- visible swelling in the arm, hand, breast, or chest wall
- a sensation of heaviness, achiness, or tightness in the arm
- easy tiring (fatigue) of the arm
- pain in the arm
If you notice arm swelling, redness, or pain, it’s very important to tell your doctor so he or she can treat any infection that may be present. We may also recommend additional testing to look for blood clots or evaluate other possible causes of arm swelling. MSK specialists in occupational and physical therapy can treat lymphedema using a variety of techniques, including compression garments, exercise, and gentle massage.
Sometimes an injury, infection, burn, or other trauma to the arm triggers lymphedema. Studies have also shown that gaining weight after breast cancer treatment can strain the lymphatic system. Many studies indicate that the risk for developing lymphedema varies based on how the lymph nodes are taken out.
It’s difficult to determine the risk of developing lymphedema because there’s no standard test for diagnosing it. Disruption of lymph flow affects people differently, and lymphedema can develop soon after surgery or even years later.
While we don’t know whether specific activities increase the risk of developing lymphedema after treatment for breast cancer, there are some general guidelines that you can follow to reduce the chance of getting an infection that might lead to the condition:
Avoid cuts or breaks in the skin that can lead to infection on the affected arm. If you do get a cut, clean the area well and apply antibacterial ointment and a bandage. Watch the area for signs of infection until it heals.
- Use a moisturizer daily to help protect the skin of your arm and hand.
- Manicure your nails carefully. Don’t cut the cuticles.
- Wear gloves when gardening, cleaning, or washing dishes.
- Use care when removing the hair under your arm. Do not use a straight razor or hair removal cream, as they can cause skin breaks.
- Use insect repellent to avoid stings.
- Avoid tight jewelry, clothing, or anything that can cause a tourniquet effect (such as blood drawing or the taking of blood pressures) on the affected arm. If both arms are involved, ask your doctor how to proceed.
- Take care not to get sunburned. Use sunscreen with an SPF of at least 15.
- Avoid using heating and hot packs on the affected arm and shoulder.