After Breast Cancer: Preventing Lymphedema

October 17, 2011
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In this podcast, we talk about what lymphedema is and why it can occur after cancer treatment. We also review the signs and symptoms you should be aware of, as well as some practical steps to take to reduce your risk.

Transcript: 

You’re listening to a podcast from Cancer.Net. This cancer information website is produced by the American Society of Clinical Oncology, known as ASCO, the world’s leading professional organization for doctors that care for people with cancer.

Our topic today is preventing lymphedema after treatment for breast cancer.

In this podcast, we’ll talk about what lymphedema is and why it can occur after cancer treatment. We’ll also review what signs and symptoms you should be aware of, as well as some practical steps to take to reduce your risk.

Let’s begin with some basic definitions. Lymphedema is an abnormal buildup of fluid, called lymph, which causes swelling in a part of the body. Common locations are the arms or legs. Normally, lymph carries immune cells all around the body. It is like a highway for your immune system, and lymph nodes can be compared to “rest stops”. Lymph nodes are tiny, bean-shaped organs that fight infection. Cancer treatments, such as surgery and radiation therapy, can damage lymph nodes. This can slow down or stop the drainage of fluid from the lymph nodes, causing the swelling.

Specifically in breast cancer treatment, lymph nodes in the underarm are typically removed during surgery such as a mastectomy or lumpectomy. Women who have had radiation therapy to the same area may also be at risk for developing lymphedema. Lymphedema in the arms and hands is known to be a potential side effect of breast cancer treatment that involves lymph nodes, but experts disagree on how common since it is hard to measure.

Now, let’s talk about the symptoms and signs of lymphedema. They may be difficult to notice at first and can begin as a feeling of tightness around the shoulder, arm, or hand. The condition may develop within a few days, months, or occasionally years after breast cancer treatment. It’s important to talk with your doctor before treatment about whether you could experience lymphedema as a side effect and what physical changes to watch for. And, be sure to talk with your doctor as soon as possible if you experience any symptoms..

While it's not possible to predict who will develop lymphedema, here are seven steps that can help reduce your risk:

  • Step number one: Ask your doctor or nurse for suggestions on daily stretching exercises. These can begin a week after breast cancer surgery or radiation therapy and continue for up to 18 months to maintain your range of motion.

  • Step number two: Maintain a healthy body weight for your age and height.

  • Step number three: Exercise regularly. However, check with the doctor before starting or resuming an exercise program. Specifically, ask the doctor if there are any weight restrictions if you’d like to exercise with arm weights. At any time, if your arm becomes tired, cool down and elevate it. Stop exercising at the first sign of pain.

  • Step number four: Be careful not to overtax the side where you had treatment. For instance, avoid sudden increases in the work performed with the arm on the side where you had surgery, such as packing up or carrying boxes or a heavy purse or bag with that arm. Also, avoid clothing or jewelry that pinches or squeezes your arm or hand. And, have your blood pressure readings taken in the unaffected arm.

  • Step number five: Avoid extreme temperature changes, such as burns, hot baths, saunas, or using hot water to wash dishes.

  • Step number six: When traveling by air, ask the doctor if you should wear a compression sleeve on the airplane. If possible, keep your arm elevated and flex it frequently during each flight.

  • And step seven: Elevate your affected arm on a pillow when sitting or sleeping.

It is also important to note that the risk of infections also increases when more lymph nodes are removed during breast cancer treatment. This is because the lymph nodes help keep the immune system functioning properly by filtering out bacteria. Infections are a risk factor for lymphedema too, so women should take precautions to avoid infections. Wash your hands frequently and protect your skin by using daily moisturizer. Avoid needle sticks of any type in the affected arm, including getting blood taken at the doctor’s office. Wear gloves while doing housework or gardening, and use insect repellent and sunscreen when outdoors. Avoid having cuticles cut when getting a manicure, and try an electric shaver to remove underarm hair, as it may be less likely to break the skin.

If you notice any signs of an infection, such as a fever or rashes, redness, swelling, or wounds that won’t heal in your affected arm, it’s important to call your doctor right away.

If lymphedema develops, talk with your doctor as soon as possible. Ask for a recommendation of a therapist who specializes in managing this condition. The therapist will help you develop a treatment plan, which may include specific exercises, limitation of certain activities, and recommendations such as using a compression sleeve, bandaging, manual lymph drainage, education in self-care and possibly a drainage pump.

For more information on this topic, talk with your doctor or visit www.cancer.net. Thank you for listening to this Cancer.Net podcast.