Breast Cancer: Lymphedema

Lymphedema following treatment for breast cancer is an abnormal swelling of the arm or hand. Some patients also report swelling in the breast or chest wall. It may occur following removal of some or all of the axillary (armpit) lymph nodes or after radiation treatments directly to those nodes.

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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 occurs when lymphatic vessels of the arm are no longer able to remove all the lymphatic fluid that is normally filtered from the tissue. Sometimes lymphedema is triggered by an injury, infection, burn, or other trauma to the arm. Studies have also shown that weight gain after treatment for breast cancer can strain the lymphatic system.

There have been many studies of arm lymphedema after lymph node removal for breast cancer. The risk of develop­ing lymphedema varies based on how the lymph nodes are removed.

  • Sentinel lymph node biopsy.
    Studies show the risk of developing lymphedema is very, very low. As few as 0 to 7 out of every 100 patients will develop lymphedema.
  • Axillary lymph node dissection.
    Studies show the risk of developing lymphedema is higher. About 15 to 25 out of every 100 patients will develop lymphedema.

It is difficult to determine the risk of developing lymphedema because:

  • There is no standard test for diagnosing lymphedema.
  • Disruption of lymph flow affects people differently.
  • Lymphedema can develop soon after surgery, or years later.
  • Current cases of lymphedema can be caused by older treatment methods.

Signs of lymphedema may include visible swelling in the arm, hand, breast, or chest wall; a sensation of heaviness, achiness, or tightness in the arm; easy fatigability of the arm; or pain in the arm. Occupational therapists and physical therapists can treat lymphedema using a variety of techniques, including compression garments, exercise, and/or gentle massage.

If you notice arm swelling, redness, or pain, it is very important to consult your doctor so that infection, if present, can be treated. Additional testing such as a Doppler ultrasound of the veins of the arm (to look for blood clots) or evaluation of other possible causes of arm swelling may be necessary.

We do not know whether any specific activities increase the risk of developing lymphedema after breast cancer. Here are some general guidelines that you can follow to reduce the chance of getting an infection that might lead to lymphedema:

  • Avoid getting breaks in the skin that can lead to infection of 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. Do not cut the cuticles.
  • Wear gloves when gardening, cleaning, or washing dishes.
  • Use care when removing hair under your arm. Do not use a straight razor or hair removal (depilatory) 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 the use of local heating and hot packs on the affected arm and shoulder.