What Is Breast Cancer Related Lymphedema?
Breast cancer-related lymphedema is abnormal swelling that can develop in the arm, hand, breast or torso on the side treated for breast cancer due to build-up of protein rich fluid in tissue spaces. What are the symptoms of Breast Cancer Related To Lymphedema (BCRL)?
Feeling of fullness, heaviness or tightness in arm or armpit area. Pain / aching in the arm & shoulder region.
Weakness in the arm on the operated side.
Swelling of arm on the side where lymph nodes have been removed.
Trouble bending or moving joints such as the fingers, wrist, elbow or shoulder.
Anterior chest wall swelling that is most commonly located in the affected breast, or chest wall, over the collarbone (area of neck), underarm, along scar lines.
Swelling of the back usually appears as extra rolls of fat along the side of trunk, fullness over the shoulder blades and fullness across the waistline on the affected side of trunk.
If breast reconstruction has been done, the reconstructed breast appears too large, misshapen & uncomfortable during daily activities.
Bra, clothing, jewelery & wrist watches don’t fit as normal.
Bra belt digs in the shoulder.
Dryness or thickening of arm skin on affected side.
Is the swelling appearing after Breast Cancer surgery - Lymphedema?
No, the swelling immediately after breast cancer surgery is not necessarily lymphedema. This can happen as part of the healing process and should go away within 4-6weeks. Lymphedema can develop suddenly or gradually. It can happen soon after surgery or can develop months or years later. When in doubt please consult a lymphedema therapist.
What is the Lymphatic System?
The lymphatic system is a vast network of tubes (vessels) and grapelike clusters called lymph nodes. The lymphatic system is responsible for absorbing and filtering fluid surrounding the cells and tissues of the body.
What is Lymph? Lymph is a colorless protein-rich fluid containing cell debris, waste products and pathogens. It is present in tissue and transported through the lymphatic system to regional lymph-nodes. What causes Breast Cancer Related Lymphedema? Lymphedema usually develops when lymph nodes or vessels are blocked, damaged, or removed. During breast cancer treatment a patient undergoes surgical procedures either modified radical mastectomy or lumpectomy which may be combined with axillary lymph node dissection (ALND) or sentinel lymph node biopsy (SLNB), radiation and chemotherapy. The surgical procedures cause disruption of lymphatic flow whereas radiation treatment to axillary area, chest & breast causes scarring and blockage of lymph vessels as well as lymph nodes. These changes increase the risk of BCRL. It can also be caused by spreading of breast cancer to axillary area and blocking the lymph nodes. Will radiation increase the risk?
The risk of lymphedema will increases with radiation treatment. Radiation causes scarring of the lymph nodes and lymph vessels there by disrupting the lymph channels leading to accumulation of lymph. Is it safe to exercise with lymphedema? Will the swelling increase if I exercise? Yes, exercise is safe with lymphedema as long as you pay attention to a few basic principles. If you have lymphedema you should exercise wearing your compression bandages or your compression garments. Why should I exercise?
Muscle contraction during the exercise stimulates the flow of lymph. Muscle contraction and changes in pressure in the chest from deep breathing cause changes in pressure on the lymphatic vessels which in-turn increases the lymphatic flow through the vessel .
Will exercise make my Lymphedema worse?
No. Research has shown that in women with breast cancer related lymphedema, exercise is safe. In fact, women who participated in a supervised, slowly progressive weight lifting program had a 50% reduction in the likelihood of lymphedema flare ups.
Why should I wear compression when I exercise?
When an individual has lymphedema, the pressure of the edema stretches out the skin so that it no longer provides a firm surface for the muscles to contract against. Exercise causes increased blood flow which caused an increase in lymph load in an already compromised limb. The compression of the garment/bandage provides a "new firm skin" for the muscles to contract against so that the pressure will be exerted on the lymph vessels and the fluid will move. Without the garment/bandage, the skin will just stretch and the force of the muscle contraction will not be translated to the lymph vessels. The involved limb could swell more if you exercise without compression.
How And When Do I Begin To Exercise? After healing of surgical wound and the removal of drains, when your surgeons says it’s ok to start exercise you should begin exercising. The exercise should be :
Low intensity. Pain free.
Within the guidelines for the surgical procedures you may have had.
Done while wearing compression bandages or garments.
Enjoyable!
What Kind of Exercises Should I Do?
Your exercise program should include the following:
Stretching – to increase the range of motion at joints that are tight.
Strengthening – to improve muscle performance and strength.
Endurance – to improve the efficiency of the heart, lungs, and muscles.
Is Lymphedema cured?
Lymphedema cannot be cured but it can be managed and the condition can be reversed near to normal.
Can the Lymphatic fluid be drained off?
The fluid in lymphedema doesn't collect as a single pool of fluid. Instead it is spread throughout the tissues, making the drainage impossible.
Do diuretics help reducing Lymphedema?
No, diuretics are not recommended for treating lymphedema.
How is Lymphedema managed? The gold standard management for lymphedema is Complete Decongestive Therapy (CDT) which is multicomponent treatment system carried out by certified lymphedema therapist (CLT).
It includes:
Manual lymphatic drainage
Compression therapy
Decongestive & breathing exercises
Skin and nail care
Should I change my compression garment throughout the day? Compression garments are made of elastic materials that stretch out after wearing for about 12 hours.
The areas where a limb bends (knee, elbow) stretch out more than the rest of the garment and then those areas do not receive the correct amount of compression which can allow pooling of edema fluid that can cause constriction at those areas. Some individuals can wear compression garments day and night and do not need to bandage their involved limb at night. These individuals should change their garments in the morning and again in the evening. Why should I wash my garment every time I change it? Compression garments are made of elastic materials that stretch out after wearing. Washing them daily helps them to retain their elasticity as well as removes perspiration, bacteria and dead skin that accumulate inside the garment from normal wear. Why should I moisturize the affected limb?
Moisturizing the skin helps to retain the elasticity of the skin which helps to avoid cracks/breaks in the skin. This is important because any break in the skin allows bacteria to enter the limb which is at risk for infection because of the lymphedema.
How Long After Treatment Will I Have To Wear The Garment?
Generally, for as long as the lymphatic impairment lasts. The short answer is until someone finds a way to reverse that impairment. Right now that means forever as there is no cure for lymphedema.
Can I swim? Do I have to wear the garment in water?
Swimming is one of the best exercises for lymphedema. If the affected limb is submerged in the water, then you do not have to wear your garment because the hydrostatic pressure of the water is providing the compression on your limb.
Can I put my garment in the dryer after washing? The heat will ruin the elasticity of the garment and perhaps shrink it. Some manufacturers say that you can put them in the dryer, but that will wear them out faster and they are costly to replace. Garments are best air dried - out of direct sunlight.
Why should I avoid manicures?
The skin is a very porous organ. It absorbs chemicals. Acetone and other nail polish removers are chemicals. The solvents that are used to remove artificial nails are strong chemicals. Cutting cuticles too close can allow bacteria that are always on the skin to enter and possibly trigger an infection. Nail salons are public places and instruments are not sterile. People who wear artificial nails are more prone to develop fungal infections. Infection triggers development of lymphedema.
Is There Any Surgical Management Of Lymphedema?
There are two surgical procedures for risk reduction and treatment of lymphedema:
Lymph venous bypass
Vascularized lymph node transfer/ transplant
In Lymph venous bypass we see quick results as it involves creating a shunt to another vessel in which the fluid can travel as the normal lymphatic channel is blocked or disrupted.
Results with lymph node transfer are not as quick as with the bypass procedure. The nodes have to make their own connections, which takes about three months.
The surgical procedure reduces the risk of lymphedema but does not completely eliminate it hence one has to vigilant about early signs and symptoms of lymphedema.
What happens if lymphedema is left untreated?
If lymphedema isn’t well managed, it can lead to complications.
Lymphangiosarcoma: Rare but the most serious complication. It’s a type of cancer which is result of prolonged poorly managed lymphedema.
Cellulitis: It is a severe skin infection.
Lymphorrhea: It is leak of lymph from the skin. Insect bites, abrasion, cuts, wounds, cracks - no matter how small, any break in the skin has the potential to allow lymph to weep through.
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