A breast cancer diagnosis is difficult for many reasons. In addition to dealing with the emotional impact, the patient has to learn a lot of new information quickly. This information can be overwhelming.
However, knowing the stages of the disease, its subtypes, and the available treatment options helps empower a patient to make an informed decision. It’s also critical to know the potential complications of treatment, such as lymphedema.
The lymph system is a network of lymph nodes, vessels, and ducts that move lymph fluid from tissues to the bloodstream, removing waste from the body. It plays a central role in the body’s immune system.
Lymph nodes have an important purpose in breast cancer: they indicate whether cancer is trying to move, or metastasize. Looking for cancer cells in the nodes is something a doctor will do during breast surgery.
Lymph Node Removal
When cancer is found, you’ll have surgery to remove the tumor,
and will typically have a sentinel node biopsy at the same time. The sentinel
nodes are the first nodes of the lymph system that fluid from the breast drains
into. When cancer cells are found in the sentinel nodes, doctors will continue
to remove more nodes (called axillary dissection) until they find no more
cancer cells. Many lymph nodes may be removed under these conditions.
Unfortunately, removing lymph nodes isn’t always without consequence. A condition called lymphedema is side effect of node removal. It commonly occurs in the arm on the side of the body with cancer, but can also occasionally manifest in the trunk of the body.
Women who have had radiation therapy are at risk for the condition because radiation can scar the lymph nodes. While not everybody gets lymphedema, the risk of developing it increases as more nodes are removed.
Causes and Signs of Lymphedema
Removal of nodes can leave the body without a way to drain off lymph fluid. This fluid can back up into the fatty tissues of the skin with nowhere to go, and infection can form as a result.
Lymphedema can occur immediately after treatment or sometimes years later, although it is rarer after the first two years. When it occurs, it’s a lifelong condition. Possible signs and symptoms of lymphedema include:
- swelling in the breast, arm, or hand on the surgery side
- a feeling of fullness or heaviness
- skin texture changes, such as tightness
- aching or pain in the affected area
- difficulty moving the joints
- decreased flexibility
- tightness around rings, watches, and bracelets
- hot and red skin
Minimizing the Chances of Lymphedema
You’ll normally experience swelling immediately after breast surgery, which should go away in six to 12 weeks. Minor exercises may be effective in helping to prevent lymphedema during this period.
To restore proper arm function, the American Cancer Society suggests that a patient hold the affected arm over the head two to three times a day, opening and closing their hand a few times. Another method is to lie down three times a day with your arm propped above your heart, your wrist higher than your elbow, and your elbow higher than your shoulder. Of course, it’s important to talk over any exercise regimen with your doctor before beginning—especially after surgery.
It’s also very important to avoid having your blood pressure measured or blood drawn from the affected arm. Be sure to tell your healthcare providers that you’ve had a node removed. Ask your doctor which side is best for needle sticks if you’ve had nodes removed on both sides. You can buy medical alert bracelets to warn an EMT not to use that arm in an emergency.
Other preventive measures include the following:
- Don’t wear tight clothing or anything that can restrict the movement of lymph fluid.
- Keep the arm from getting infected.
- Prevent any bug bites and try not to cut yourself.
- Maintain a healthy body weight.
If you develop lymphedema, there are methods for decreasing the risk of infection and prevent the swelling from getting worse. A physical therapist can help. Along with protecting the arm against needle sticks and blood pressure cuffs, there are special massage methods designed to move the fluid through the body. Compression garments can be used to apply pressure to the arm and prevent fluid from collecting.
Minimizing airline travel is also advised, although not always practical for patients. You should also avoid extreme temperature changes, including steam baths and hot tubs. Weightlifting is not advised.
While there are currently no effective cures for lymphedema, the condition isn’t hopeless. Clinical trials are underway to see if certain forms of exercise may help improve the condition. Laser therapies are also being studied, and node transplants are being tested as well.
Lymphedema is a problem that can be managed with care. A lymphedema therapist can help you understand how to minimize the problems posed by this condition, and help you live as well as you can.