Breast cancer survivors unsuspectingly may face another challenge: a disorder that is called lymphedema. It is estimated that over three million women who currently have breast cancer will develop this disorder. But what is it and what can be done to manage this condition?
Lymphedema comes from two words: lymph, a natural body fluid, and edema, meaning swelling. Not the same as swelling seen with injury, arthritis, fluid retention, or vascular problems, lymphedema is a chronic condition in which an arm or a leg swells due to interruption of the normal lymphatic circulation. This disorder may be present at birth, or occur following surgery, radiation treatment, or after an accident.
The lymphatic circulation is different from the circulatory system which includes the heart and blood vessels. The lymphatic system consists of the lymph (a syrupy, protein-rich fluid), the lymphatic vessels, and the lymph nodes. The lymphatic vessels remove excess fluid and proteins from the spaces between the body’s cells and return them to the blood circulatory system. More numerous in the neck, the armpit, the groin, in front of the elbow, and behind the knee, the lymph nodes lie along the lymphatic vessels through which the lymph passes. They have two main functions:
1. the production of the white blood cells that combat bacterial and viral infections, (lymphocytes), and
2. the removal of waste products and potentially harmful bacteria and other germs.
If the lymphatic vessels are damaged, they lose their effectiveness in returning the lymph to the bloodstream. Fluid and protein accumulate in the tissues, causing mild swelling. If aggressive corrective action is not taken immediately, the condition progresses, and the limb may continue to swell. The tissues are deprived of the supply of nutrients brought by the circulatory system, and cannot get rid of their metabolic waste products. The skin loses its normal elasticity and hardens. Chronic swelling occurs and the arm or leg loses its normal mobility. The immune response may be impaired due to lymph node damage, and lymph fluid may ooze through the skin, altering its acidity (pH). These factors create an environment ripe for infections and skin ulcerations. Pain may vary from a feeling of heaviness in the arm or leg to being constant and severe.
The onset of lymphedema may be sudden, occurring immediately after cancer treatment, or it may develop years later. It is not known which women who have had breast cancer will develop this disorder, but we do know that lymph node removal and radiation therapy puts these individuals at risk, whether they have had a lumpectomy or a mastectomy.
There is no cure for lymphedema; prevention and proper management are extremely important. A lymphedema specialist is an essential part of the healthcare team.
Preventative measures are a lifelong necessity to prevent/manage lymphedema. In addition to adaptation of a healthy lifestyle, specifics for the involved arm or leg include:
-Modification of daily tasks to prevent even minor injury.
-Avoidance of tight or restrictive clothing.
-Avoidance of undue pressure or strain.
-Aggressive treatment of any signs or symptoms of lymphedema or injury.
-Moisturize the skin with a quality pH-balanced lotion, such as Nivea or Eucerin.
Specialized treatment by a certified lymphedema specialist is an important aspect of management. A specialized treatment program includes:
-Manual lymphatic drainage, a specialized massage technique. CAUTION: Vigorous and deep massage is contraindicated. DEEP MASSAGE MAY FRACTURE LYMPHATIC VESSELS.
-Consistent use of compression bandages or a properly fitting compression garment.
-Specific lymphedema exercises.