Lymphedema: What, When, How?

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What...

...is the lymphatic system? The lymphatic ("lim-fat-ic") system is the waste removal system in your body. It removes waste material from cells and tissues: proteins, infections, viruses, cancer cells, and anything foreign, such as perfumes and dyes. An important trait of the system is its location within the skin, specifically the second layer called the dermis. Any interruption of the skin also interrupts the lymphatic system. Lymph fluid collects in clusters of lymph nodes found throughout the body—in the neck, underarm, groin, stomach, and tailbone region.

...is lymphedema? When fluid backs up in your lymphatic system and causes an area to swell, it is called lymphedema, a condition that can be very mild, moderate, or severe. The swelling from a sprained ankle is not lymphedema. Fluid in lymphedema has been present for more than 64 days, unlike that of regular edema (or swelling).

...causes lymphedema? In the United States, treatment from breast cancer, which may involve the removal of lymph nodes and radiation therapy, is the leading cause of lymphedema. The likelihood of developing lymphedema increases with the amount of breast tissue removed, the number of lymph nodes removed, and the amount and extent of radiation treatments. Other factors that increase the risk of lymphedema include obesity, lack of exercise, and previous problems in the cancer area. Water retention does not cause lymphedema.

...are the signs of lymphedema? The most common sign of lymphedema after breast cancer treatment is a heaviness or weighted feeling to the affected arm. Some patients may notice a color or temperature change in the arm. The arm may also be painful or achy.

When...

...does lymphedema develop? Lymphedema usually develops within 24 months after surgery or cancer treatment. However, in some cases a small incident can stimulate lymphedema several years later. Again, the swelling from a breast surgery is not considered lymphedema until it is persistent and not responding as time goes on.

...will lymphedema go away? Unfortunately, the lymphatic system does not have the ability to repair.  Once an area has been damaged from surgery, radiation, or trauma, it does not heal or re-develop. If lymphedema occurs, it can be managed but it is a lifelong condition. If not treated, the protein-rich lymph fluid is a breeding ground for bacteria and infections that can be serious. Untreated, lymphedema tends to worsen over time.

How...

...is lymphedema treated? Lymphedema is commonly treated by a physical or occupational therapist certified in lymphedema care. Depending on the severity of edema present, the treatment can involve manual drainage techniques, compression bandaging, and a daily compression garment. These treatments are covered by all major insurance companies, including Medicare and Medicaid. The most important thing is to seek treatment early—at the first sensation of "fullness."

...is lymphedema avoided? To decrease the chances of developing lymphedema, after breast cancer treatment a patient should

  • Avoid trauma to the breast and arm on the affected side.
  • Avoid needle sticks and blood pressures on the treated side while you are undergoing your initial breast cancer treatment
  • Avoid rose pruning, which can lead to scratches and a particular type of infection.
  • Avoid saunas, or other extreme heat.
  • Avoid carrying heavy shoulder-strapped handbags on the treated side.
  • Limit sun exposure and minor cuts/abrasions by using sunscreen and gloves.
  • Maintain a normal weight, which will also decrease the chances of the breast cancer’s recurrence.
  • Exercise. (Patients should first check with their surgeons about possible restrictions.)

More information can be found at http://www.lymphnet.org/pdfDocs/Healthy_Habits_at-Risk_LE.pdf.