Lymphoedema is the abnormal accumulation of the protein rich, lymph fluid that constantly circulates throughout the tissues of the body. If it develops in people who have been treated for breast cancer, it may occur in the arm, hand, breast, underarm, chest, trunk and or back. It may occur a few months post treatment or years later.
The nodes in the armpit drain lymph fluid from the arm and breast on that side. At least one or more lymph nodes may be removed from the armpit (sentinel lymph node biopsy). This will assist the medical team in staging and determining the type of cancer. If the cancer has spread, axillary lymph node dissection may also be performed. If the patient is treated with radiation therapy to the chest, breast and or the areas where breast draining nodes are found, the lymphatic drainage vessels and nodes found in these areas are obliterated. Over time the lymph fluid is not able to flow normally, the remaining pathways become fatigued and a backup of fluid in this region of the body results in lymphedema of the area.
Other risk factors for developing lymphedema after the treatment for breast cancer are:
- Chemotherapy. When receiving chemotherapy, cortisone is administered. Hormonal changes occur as well, due to being thrown into menopause. Both these factors may result in weight gain.
- Being overweight or obese. This implies a BMI greater than 25. You can calculate your BMI online.
- The presence of a seroma. A ball like postsurgical pocket of accumulated fluid.
- Being exposed to extreme temperatures in the affected areas. Too hot or too cold, but more so temperatures greater than 27degrees Celsius.
- Any injury or trauma to the affected area. NO blood should be taken on the affected side as well as no infusions or injections.
- No constriction should be placed on the affected areas. NO blood pressure should be measured on the arm of the breast cancer side. No ill-fitting/tight bra, jewelry or clothing should be donned, in the affected areas.
- Infection affecting the arm, hand, or upper body on the same side as your surgery, should be prevented. Your lymph system acts as an alarm system for your immunity, and, your lymph nodes filter the draining lymph fluid. Avoid mosquito or spider bites to these areas.
- Travel by rail, road or by aircraft greater than four hours. Wear a compression sleeve, drink lots of water and avoid salty snacks.
- Salty food and the intake of natural diuretics e.g. tea, coffee, alcohol and fizzy drinks. Do not partake in more than a combination of three per day. Drink six to eight glasses of water a day.
Common signs and symptoms of lympoedema are:
- Clothes, jewelry or a bra beginning to feel tighter or leaving indentations on your skin.
- An achiness, tingling, discomfort or increased warmth of the potential areas. A bursting feeling with or without pins and needles or pain.
- A feeling of heaviness or fullness.
- Slight puffiness or swelling of the possible areas together with a temporary indentation remaining in the areas if you press on it with your finger.
- Loss of the normal anatomical look of the potential areas together with asymmetry between the two sides.
- Fever or flu like symptoms.
- Changes in skin texture or appearance such as tightness, redness or hardening.
Lymphoedema is treated with manual lymph drainage (gentle massage). Compression is employed (multilayer bandaging and/or a compression garment). Meticulous skin and nail care is mandatory. Appropriate exercises to suit the patient’s requirements are taught as well as modifications being made to their daily and work activities.
The most efficient way to jumpstart your lymphatic system is:
- Deep abdominal breathing.
- Ensuring that your tummy works daily.
- Walking, with hands not hanging down.
- Drinking 6 to 8 glasses of water per day.
- Dry Brushing/gentle massage performed in the correct sequence.
What can you do if you think that you have developed Lymphoedema?
Seek an evaluation by a certified Lymphoedema therapist. Education and early intervention results in a faster response and better outcome.
Always remember that there is no cure for Lymphoedema. It is not life threatening and can be treated and managed.