Breast Cancer-Related Lymphedema

Anyone who has been treated for breast cancer is at risk for developing breast cancer-related lymphedema or BCRL , a side effect that causes uncomfortable swelling in arms, breast and chest. However, women who’ve had surgery and radiation therapy are at the greatest risk.

Our bodies contain a network of lymph nodes and vessels that collect watery, clear lymph fluid similar to the way veins collect and transport blood to all parts of the body. Lymph fluids are necessary to fight off infection and help the body muscles to move fluid throughout the body.

Typically during breast cancer surgery, the doctor removes at least one lymph node from the underarm to determine if the cancer has spread. Sometimes it is necessary for doctors remove more than one. When the lymph nodes are removed, the lymph vessels are also removed. Lymph vessels are responsible for carrying fluid from the arm to the rest of the body and because they are intertwined with lymph nodes it is impossible to remove one without the other.

Extraction of the nodes and vessels changes the way the lymph fluid normally moves within the upper body. The fluid can be restricted to the point where excess fluids build up in the fatty tissues just under the skin and cause swelling, known as BCRL. Radiation treatment can affect the flow of lymph fluids in the arm and breast area in the same way, further increasing the risk.

Not everyone undergoing breast cancer treatment will experience lymphedema, but many women do. It usually develops slowly over time after treatment and can take months, even years to be noticeable. However, some breast cancer patients experience it immediately after surgery or radiation treatment. Currently, there is no cure for lymphedema, but it can be controlled.

Doctors still do not fully understand why some patients are more prone to BCRL than others. As breast cancer surgery and treatments improve and become less invasive, doctors are optimistic that fewer women will develop lymphedema. Newer studies are investigating techniques that can preserve the most active lymph nodes and vessels whenever possible.

Breast cancer patients should follow their doctor’s advice to prevent short-term swelling after surgery or radiation. While current scientific studies show breast cancer patients can’t prevent lymphedema, experts generally agree that by following basic guidelines, patients can reduce the risk or slow the onset of BCRL:

• Good hygiene and careful skin care may reduce the risk of lymphedema by helping you avoid infections. Remember that your body responds to infections by increasing lymph fluid production. Whenever undergoing a medical procedure (including IV, blood draw, etc.) tell your health care provider you are at risk for BCRL.
• Avoid burns. Like infections, burns can cause the body to make extra fluid that may build up and cause swelling after cancer treatment. Use oven mitts that cover your arms, and avoid sunburns, high heat from hot tubs and saunas, steam or hot foods from microwave ovens and hot oils.
• It's important to use your affected arm for normal everyday activities to help you to heal properly and regain strength. This includes doing things like brushing your hair and bathing. Using your muscles also helps drain lymph fluid from the limbs. If you’ve had surgery or radiation treatment, ask your doctor or nurse when you can begin to exercise and what type of exercises you can do.
• Avoid constriction or squeezing of the arm as it may increase the pressure in nearby blood vessels. This may lead to increased fluid and swelling (think of water building up behind a dam). Some women have linked this with the start of BCRL. Lymphedema has also been linked with air travel, possibly because of the low cabin pressure. Well-fitted compression garments may make frequent or long trips more comfortable.

More information about lymphedema can be found through these organizations:
Lymphedema Network, National Lymphology Association of North America, Breast Cancer Network of Strength , Susan G. Komen for the Cure, American Cancer Society, BreastCancer.org

Lynette Summerill is an award-winning writer who lives in Scottsdale, Arizona.
In addition to writing about cancer-related issues, she writes a blog, Nonsmoking Nation, which follows global tobacco news and events.