Arm Lymphedema is a potential side effect of breast cancer surgery and radiation therapy that can appear in some people during the months or even years after treatment ends.
Lymph is a thin, clear fluid that circulates throughout the body to remove wastes, bacteria, and other substances from tissues. Edema is the buildup of excess fluid. So arm lymphedema occurs when too much lymph collects in any area of the body. If lymphedema develops in people who’ve been treated for breast cancer, it usually occurs in the arm and hand, but sometimes it affects the breast, underarm, chest, trunk, and/or back.
Why does lymphedema happen?
As part of their surgery, many people with breast cancer have at least two or three lymph nodes removed from under the arm (sentinel lymph node biopsy), and sometimes many more nodes (axillary lymph node dissection). If cancer has spread, it has most likely moved into to those underarm lymph nodes first because they drain lymph from the breast. Many people also need radiation therapy to the chest area and/or underarm. Surgery and radiation can cut off or damage some of the nodes and vessels through which lymph moves. Over time, the flow of lymph can overwhelm the remaining pathways, resulting in a backup of fluid into the body’s tissues. This causes lymphedema.
If you already have lymphedema but don’t remember hearing much about it during breast cancer treatment, you’re not alone, says Dr. Marisa Weiss, chief medical officer of Breastcancer.org. “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.”
Although there’s no way to know for sure whether you’ll develop lymphedema after breast cancer, you can help yourself by learning more about it. Know your risk factors, take steps to reduce your risk, and be aware of early symptoms. Left untreated, lymphedema can worsen and cause severe swelling and permanent changes to the tissues under the skin, such as thickening and scarring.
Adding to the frustration some people feel is the conflicting advice about how to prevent and manage lymphedema — perhaps you’ve encountered some of it! There’s still much more research to be done before we fully understand this condition. Also, many doctors don’t have a great deal of experience with lymphedema.Usually, before a patient has breast cancer surgery, there are things you should know to assist in the prevention or management of lymphedema.
Prior to surgery, you should receive exercises from your doctor, nurse or physical therapist. These exercises will help regain shoulder and arm range of motion.You can usually begin 1 day to 1 week after surgery. Of course, check with your doctor or nurse beforehand. Holding your arm higher than your heart, open and close your hand 15-25 times. Try to do this 3 or 4 times a day. This exercise helps push lymph fluid out of the arm through the lymph vessels that are still there. This will help prevent lymphedema.
Avoid burns and infections. If you have a burn or infection your body makes extra fluid to fight it. If you’ve had lymph nodes removed, it can be harder for your body to transport this extra fluid and this can cause lymphedema.
If possible, have blood drawn, injections, IVs, and vaccinations given in your unaffected arm. You also can have vaccinations or flu shots given in another area on your body, such as your hip. Tell your doctor or nurse that you’re at risk for lymphedema.
Moisturize your hands and cuticles regularly with lotion or cream. Push your cuticles back with a stick rather than cutting them with scissors. Avoid professional manicures.Keep your hand and arm clean as well.Don’t use harsh soaps that can dry out your skin. Wash and protect any cuts, scrapes, insect bites, or hangnails. Use antibacterial cream on any wounds and cover them with a bandage.
Wear protective gloves when doing your household chores such as washing dishes, general cleaning, or yard work.
Use an electric shaver instead of a razor on your affected arm or armpit.
Always Use a thimble while sewing.When you sew to avoid pricking yourself.
Protect your arm from sunburn with sunscreen. Use a product with a minimum SPF of 30.
Always wear oven mitts when handling hot dishes.
Avoid extreme hot- to cold-water temperature changes when you bathe or wash dishes.
Don’t use heating pads or hot compresses on the arm, neck, shoulder, or back on the affected side. Also, be cautious of other heat-producing treatments provided by physical, occupational, or massage therapists, such as ultrasound, whirlpool, fluidotherapy, or deep tissue massage. Heat and vigorous massage encourage the body to send extra fluid into the compromised area.
Avoid tight clothes and jewelry that restrict your movement.
Don’t carry heavy objects
with your at-risk arm, especially with the arm hanging downward. Talk with your doctor or physical therapist about how to gradually increase the amount of weight you are able to lift. A physical therapist may start you on a weight-training program using 1- to 2-pound weights, slowly increasing the weight over time as your arm is able to handle it.
Have your blood pressure taken on the unaffected arm.
If both arms are affected, have your blood pressure taken on your thigh. Tell your healthcare provider that you’re at risk for lymphedema.