- What is lymphedema?
- Who is at risk for developing lymphedema?
- What happens after my breast cancer surgery?
- What are lymphedema symptoms and signs?
- How is lymphedema diagnosed?
- What is the treatment for lymphedema?
- How can I help prevent lymphedema?
- What can I do if I already have lymphedema?
- What is the prognosis for lymphedema?
The term lymphadema comes from the lymphatic system, which helps coordinate the immune system's function to protect the body from foreign substances and includes an extensive network of lymph vessels and lymph nodes. Here's how the lymphatic system works:
- Excess fluid is collected from the space between tissues in the body and moves through the lymph vessels. The fluid (now called lymph) isn't pumped through the body like blood, but instead is "pushed" through the lymph system as the vessels are compressed by surrounding muscles.
- Filters called lymph nodes remove certain harmful substances from the lymph fluid, such as bacteria and debris. The fluid from most tissues or organs is filtered through one or more lymph nodes before draining into the bloodstream.
What Is Lymphedema?
Lymphedema is an abnormal buildup of fluid that causes swelling, most often in the arms or legs. The condition develops when lymph vessels or lymph nodes are missing, impaired, damaged, or removed.
There are two types of lymphedema: primary and secondary.
Primary lymphedema is rare and is caused by the absence of, or abnormalities in, certain lymph vessels at birth.
Secondary lymphedema occurs as a result of a blockage or interruption that alters the flow of lymph through the lymphatic system and can develop from an infection, cancer, surgery, scar tissue formation, trauma, deep vein thrombosis (a blood clot in a vein), radiation, or other cancer treatment.
Who Is at Risk for Developing Lymphedema?
People who have had any of the following procedures may be at risk for developing lymphedema:
- Simple mastectomy in combination with axillary (arm pit) lymph node removal.
- Lumpectomy in combination with axillary lymph node removal.
- Modified radical mastectomy in combination with axillary lymph node removal.
- Combined cancer surgery and radiation therapy to a lymph node region (such as the neck, armpit, groin, pelvis or abdomen).
- Radiation therapy to a lymph node region.
Lymphedema can occur within a few days, months, or years after surgery. A small amount of swelling is normal for the first four to six weeks after surgery.
What Happens After My Breast Cancer Surgery?
Lymphedema develops after breast surgery because there is an alteration in the pathway that drains the fluids involved in the immune system. It can occur at any time after the surgery. If untreated, it can become worse.
Following surgery, a physician will examine you and take arm measurements. Sometimes, there may be redness or pain in the arm, which may be a sign of inflammation. Depending on your symptoms, your physician will then consider the best treatment options for you.
What Are the Signs and Symptoms of Lymphedema?
If you suspect any of the symptoms of lymphedema listed below, call your health care provider right away. Prompt treatment can help get the condition under control.
- Swelling in the arms, hands, fingers, shoulders, chest, or legs. The swelling may occur for the first time after a traumatic event (such as bruises, cuts, sunburn, and sports injuries), after an infection in the part of the body that was treated for cancer, or after an airplane trip lasting more than three hours.
- A "full" or heavy sensation in the arms or legs.
- Skin tightness.
- Decreased flexibility in the hand, wrist, or ankle.
- Difficulty fitting into clothing in one specific area.
- Tight-fitting bracelet, watch, or ring that wasn't tight before.
How Is Lymphedema Treated?
Lymphedema treatments vary, depending on the stage and cause of the illness. The most important aspect of treatment is learning how to care for your health. Your doctor or nurse will teach you and your family how to follow your prescribed treatment.
If the initial signs and symptoms of swelling are caused by infection, antibiotics may be prescribed. Other treatments may include bandaging, proper skin care and diet, compression garments, exercises, and manual lymphatic drainage, a gentle form of skin stretching/massage.
How Can I Help Prevent Lymphedema?
Lymphedema can be prevented or controlled if it develops by following the recommendations below.
Maintain good nutrition
- Reduce foods high in salt and fat.
- Include at least two to four servings of fruits and three to five servings of vegetables in your daily meal plan.
- Eat a variety of foods to get all the nutrients you need.
- Use the package label information to help you to make the best selections for a healthy lifestyle.
- Eat foods high in fiber such as whole-grain breads, cereals, pasta, rice, fresh fruits, and vegetables.
- Drink plenty of water.
- Maintain your ideal body weight. A registered dietitian or your health care provider can help calculate your ideal body weight.
- Avoid alcoholic beverages.
- Always check with your doctor first before starting a new exercise program.
- To improve cardiovascular fitness, you should perform aerobic activities (including walking, swimming, low-impact aerobics or specially prescribed exercises) for 20 to 30 minutes at least three times a week.
- Take time to include a five-minute warm-up, including stretching exercises, before any aerobic activity and include a five to 10-minute cool down after the activity.
- If your normal exercise routine includes weight lifting with your arms, check with your doctor about the best time to resume this activity and if there are any weight restrictions.
- Discontinue any exercise that causes unexpected pain. If your arm or leg (on the side where you had surgery) becomes tired during exercise, cool down, then rest and elevate it.
- Wear gloves while doing housework or gardening.
- Avoid cutting your cuticles when manicuring your nails. Use care when cutting your toenails.
- Frequently wash your hands with soap and warm water, especially before preparing food, and after using the bathroom or after touching soiled linens or clothes.
- Protect your skin from scratches, sores, burns and other irritations that might lead to infection. Use electric razors to remove hair and replace the razor head frequently.
- Use insect repellents to prevent bug bites.
- Immediately report any signs of infection to your physician.
Stay alert for signs of infection
- Fever over 100 degrees F (38 degrees C)
- Sweats or chills
- Skin rash
- Pain, tenderness, redness or swelling
- Wound or cut that won't heal
- Red, warm or draining sore
- Sore throat, scratchy throat or pain when swallowing
- Sinus drainage, nasal congestion, headaches or tenderness along upper cheekbones
- Persistent dry or moist cough that lasts more than two days
- White patches in your mouth or on your tongue
- Nausea, vomiting or diarrhea
- Flu-like symptoms (chills, aches, headache or fatigue) or generally feeling "lousy"
- Trouble urinating: pain or burning, constant urge, or frequent urination
- Bloody, cloudy, or foul-smelling urine
Avoid tight clothing, shoes or jewelry
- Women should wear well-fitted bras; bra straps should not be too tight, avoid underwire styles, and wear pads under the bra straps if necessary. Wear comfortable, closed-toe shoes and avoid tight hosiery. Wear watches or jewelry loosely, if at all, on the affected arm.
Avoid heavy lifting with the affected arm (even a purse or bag)
- Also avoid repetitive movements of the affected arm (such as scrubbing, pushing or pulling). Do not carry a purse or bag on your shoulder (the side where you had surgery).
Keep your skin meticulously clean
- Dry your skin thoroughly (including creases and between fingers and toes) and apply lotion.
Take precautions during visits to your doctor
- Ask to have your blood pressure checked on the unaffected arm. And avoid injections or blood drawing on the surgical side if possible.
Inform your doctor of any symptoms
- Notify your doctor if you have redness, swelling, a skin rash or blistering on the side of your body where you had surgery, or if you have a temperature over 100 degrees F (38 degrees C). These warning signs of infection could be an early sign of lymphedema and should be treated immediately.
What Can I Do if I Already Have Lymphedema?
To help decrease the risk of further swelling, continue following the recommendations for preventing lymphedema listed above. In addition:
- Avoid extreme temperature changes. Do not use hot tubs, whirlpools, saunas or steam baths. Use warm, rather than very hot, water when bathing or washing dishes. Always wear sun protection (at least SPF 15) when going outdoors.
- When traveling by air, ask your health care provider if you should wear a compression sleeve on your affected arm or a stocking on your affected leg. For long flights, additional bandages may be needed. Talk to your health care provider before traveling.
- When sitting or sleeping, elevate your affected arm or leg on pillows. Avoid prolonged lying on your affected side.
- Your doctor may refer you to an occupational therapist who specializes in managing lymphedema. The therapist will assess your condition and develop an individual treatment plan to manage your lymphedema.
- Therapy may include specific exercises or a complete exercise program, limitation of certain activities that are vigorous or repetitive, and recommendations for a compression sleeve, bandages, manual lymph drainage and possibly a pump.
- Continue to see your health-care provider for frequent follow-up visits, as recommended.
What Is the Outlook for Lymphedema?
Lymphedema cannot be cured. However, with proper care and treatment, the affected limb can be restored to a normal size and shape. In addition, lymphedema can be treated and controlled so that it does not progress further.
If left untreated, lymphedema can lead to increased swelling and a hardening of the tissue, resulting in decreased function and mobility in the affected limb. It can also lead to chronic infections and other illnesses.
It is important to receive treatment promptly if you recognize symptoms of lymphedema.
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Reviewed by Arnold Wax, MD, on June 20, 2009