“I fought breast cancer, I’m a fighter! I am cancer free, so what is this about lymphedema after breast cancer? Why was I never told that I could end up with a chronic disease as a complication of my cancer treatments? This lymphedema sucks!” It does suck, yet there are ways of reducing your risk of lymphedema after breast cancer.
While working in a durable medical supply store that catered to breast cancer patients seeking bras and prosthesis, this or a similar sentiment was often heard. It was heartbreaking to me and so frustrating. Going through cancer treatment and receiving a lymphedema diagnosis can be devastating. Were they told, and didn’t remember? Had they never been told and their doctors just hoped for the best? Were their doctors unaware or did they just not want to deal with it?
Dr. Marisa Weiss, chief medical officer of breastcancer.org says, “I can say from experience that the time right after diagnosis, when you are considering options and planning treatment, is a blur. When you are feeling so anxious and overwhelmed, it is hard to listen, understand, and decide. So even if lymphedema gets mentioned during this time, you may not remember it. Or it may not come up because the focus is really on getting you well. So if lymphedema does develop later on, it can feel like yet another insult to the body, one that many women weren’t fully prepared for. The good news is that women can learn how to manage it and lead normal lives.“
WHAT IS LYMPHEDEMA?
Lymphedema is a problem that may occur after surgery when lymph nodes are removed. It can also be caused from radiation therapy, which can damage lymph nodes. It is an accumulation of lymph fluid which causes abnormal swelling usually in the area of the arm after breast surgery. However, it can also develop in the hand, breast, or torso. Lymphedema doesn’t always appear right away. It usually develops gradually and can appear during the months or even years that follow the breast surgery.
WHAT ARE MY CHANCES OF GETTING LYMPHEDEMA AFTER CANCER?
There is no way to know for sure what your chances are of developing lymphedema. However, the good news is they are continually developing new and better surgical treatments. Therefore, the chances of lymphedema today are greatly reduced. Most people do not get lymphedema since modern surgery removes fewer axillary lymph nodes than in the past. The more nodes removed the greater the risk. Axillary node dissection, which removes more lymph nodes, gives you a 15% to 25% chance of developing lymphedema. Sentinel lymph node biopsy, which removes only a few lymph nodes to check for cancer, gives you less than a 5% chance of developing lymphedema. When lymph nodes are removed, you will always be at higher risk for lymphedema.
SIGNS AND SYMPTOMS OF LYMPHEDEMA
The main symptom of lymphedema after breast cancer is swelling in the arm on the affected side. The amount of swelling can vary. A feeling of fullness, heaviness, or tightness, in the arm, armpit or chest may also occur. Clothing feeling tight or jewelry that doesn’t fit may also indicate the development of lymphedema. Do you have trouble bending or moving your joints? Does your arm feel weak or heavy? Do you have aching or pain in your arm that was not there before? All are signs to look for when you are at risk for lymphedema. If you do notice any of these conditions you should seek medical attention as soon as possible. The sooner lymphedema is diagnosed and treated, the easier it is to manage.
TREATMENT OF LYMPHEDEMA
Typically, lymphedema treatment is broken down into four components which include manual lymphatic drainage, skin and nail care, compression and exercise. Manual lymphatic drainage is a gentle form of massage, which helps to redirect lymph fluid to move it out of the affected area. Skin care includes keeping skin clean and moisturized along with protecting the skin from injury and infection. Compression helps prevent more fluid build up and can include multi-layer bandaging and compression garments. Finally, exercises help to stimulate your lymph vessels and move lymph fluid out of the body. Your therapist may incorporate other treatments such as Kinesio tape, aquatic therapy and pneumatic pumps.
REDUCING YOUR RISK OF LYMPHEDEMA AFTER BREAST CANCER
Although there is no proven way to prevent lymphedema, there are some things you can do to reduce your risk after breast cancer. First of all, it’s important to be aware of the risk and seek care if you notice any signs or symptoms. Maintain a healthy body weight and eat a low-sodium diet. Take steps to reduce the risk of infection or injury that can trigger lymphedema. Here are some suggestions to help prevent injuries and infections:
- Wear gloves when doing work around the yard or in the house.
- Keep skin clean and well moisturized.
- Be very careful with shaving. Be sure to use a clean sharp razor. If the area is swollen, it may be better to avoid shaving.
- Avoid sunburn and excessive heat from saunas or hot baths.
- Use insect repellent when outdoors.
- Treat infections of the at-risk arm and hand immediately.
- Do not use the at-risk arm when having blood drawn, getting injections or having blood pressure taken if possible.
- Don’t cut nail cuticles. Instead, gently push back when they are soft.
- Wear compression sleeves and gloves on long airplane flights.
- Try to avoid bruises and scratches to the at risk arm.
- Do not wear clothing that is tight or restrictive.
- Carry handbags or heavy packages with the unaffected arm.
- Avoid vigorous, repetitive movements against resistance, such as scrubbing, pulling or pushing with the affected arm.
- Seek medical attention right away if you see signs of infection, such as redness, pain, heat, increased swelling or fever.
KNOWLEDGE IS POWER
Talk with your healthcare provider about ways to help prevent lymphedema. Make these precautions a part of your life. Compare your hands and arms on a regular basis. Learn what is normal for you so that if you see changes you can seek medical help as soon as possible. There is no way to know whether or not you will develop lymphedema after breast cancer, but early detection is key to the treatment and management of lymphedema. Be aware, knowledge is power.