MANAGEMENT OF LYMPHEDEMA
Lymph is a colourless fluid formed in the body and drains into the blood through a network of vessels and lymph nodes. Swelling because of overloading of the surrounding tissues with lymph fluid is called lymphedema.
Why is lymphedema associated with breast cancer?
Cancer cells travel through the body through the lymph nodes. During surgery these nodes are tested for malignancy and if positive theneither some or all of the remaining nodes are removed. The surgical removal of these nodes causes an obstruction to the natural flow of lymph resulting in swelling in the arm. Radiation to the armpit is another risk factor in the development of lymphedema.
Swelling and “odd sensations” soon after surgery are not lymphedema.After surgery, it is normal for there to be some numbness in the armpit, upper arm and the breast or chest wall and there is often some swelling. As the nerves begin to repair, it is also normal to experience a number of odd and uncomfortable sensations, often described as tingling. These sensations can occur in the breast or chest wall, armpit, upper arm and upper back. The swelling and odd sensations usually settle down during the weeks or months after surgery.
Lymphedema can occur at any time after surgery - even many years later. Knowing the signs and symptoms allows you to take control of it and manage it at its onset with better results.
Early symptoms of lymphedema are:
Swelling of the arm, breast or hand.
Feelings of discomfort, heaviness, tightness or fullness in the arm or breast.
Aching, pain or tension in the arm, shoulder, hand, chest or breast area.
What can trigger lymphedema?
- Infections in your arm - infections can start from cuts, scratches, injections, insect bites, burns or sunburn,
- However, the cost of a year long treatment adds up to Rs. 9-10 lakhs, an amount unaffordable by many. At Nag Foundation we have made it our mission to make Herceptin more accessible.
- Being overweight
- Overheating your arm - avoid sun, hot baths and showers, spas, saunas and excessive exercising in hot weather
- Injuries to your arm
- Carrying or holding heavy parcels/bags
- Restricting circulation to your upper body or arm - blood pressure cuffs, tourniquets, bras with narrow straps, clothes which are tight around your chest or arm, and tight jewellery or watches may reduce lymph flow
- Travelling - sitting still during long flights, car or bus trips, and pressure variations in planes may reduce lymph flow.
You can reduce the risk of developing lymphedema by:
- Taking good care of your skin
- Keep your skin moist and supple using a moisturising cream
- Protect your skin from the sun with clothing and sunscreen
- Avoid waxing your arms
- If shaving your armpit, use an electric razor instead of a wet razor
- Use insect repellent and, if bitten, use a product to reduce the itchiness of the bite
- Protect your hands with gloves while washing dishes or gardening
- Treat any cuts or breaks to the skin with antiseptic
- If a cut, bite or break to the skin becomes red or inflamed, or your arm swells quickly or becomes red and warm, see your doctor as soon as possible as you may have an infection that requires antibiotics
- Keeping active and exercise daily
- Avoiding using the arm on the side of your surgery for blood pressure measurements, injections, blood samples or intravenous drips
- Even though there is not enough evidence to whether these procedures can trigger lymphoedema, these precautions are recommended.
How is lymphoedema managed?
There is no known cure for lymphoedema but there are ways to manage
- a) Good skin care,
- b) Gentle exercise,
- c) Lymphatic drainage massage
- d) Use of compression garments on the affected arm.
These treatments help reduce and/or control swelling, improve the range of movement of the affected area and prevent infections.
Things to remember
- Not all women with breast cancer will develop lymphoedema
- Early diagnosis and treatment of lymphoedema
- makes it easier to manage
- reduces the amount of swelling
- improves arm function
- Take precautions to reduce your risk of developing or triggering lymphoedema
- Observe your arm for any changes
- Seek prompt medical advice if you are concerned
- If you have had breast cancer surgery and are subsequently admitted to hospital for any reason, let the nursing staff know of your surgery so they can be sure to use the other arm for any procedures