Lymphoedema

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Lymphoedema

If you have lymph nodes removed from your armpit or if you have radiation treatment to that area , you are at some risk of developing lymphoedema.

Lymphoedema occurs when an excessive amount of protein-rich fluid (lymph) accumulates in the tissues.Impairment of the lymphatic drainage system ( usually due to surgery or radiation treatment) means it is unable to transport the fluid out of the tissues and return it to the bloodstream. This causes swelling which can become permanent if left untreated. The fluid also provides an ideal medium for bacterial growth, increasing the risk of infections such as cellulitis.

After breast cancer treatment lymphoedema can occur in the arm, hand , breast or trunk and might develop within months of treatment or years later.The onset is usually gradual.

It’s important to know the early signs of lymphoedema as according to the Australasian Lymphology Association (ALA), around one in five breast cancer patients are at risk of developing the condition.

Signs and Symptoms of Lymphoedema

  • The warning signs (published by the ALA) may include;
  • transient swelling of a limb or other region of the body
  • infection (due to lymph stasis)
  • feelings of aching, heaviness, stiffness in the affected body part or limitation of movement
  • tightness or temperature changes to areas of the body. Jewellery or clothing may feel tighter than usual
  • The swelling may be aggravated by heat, overuse, sustained positions and prolonged inactivity and be more obvious at the end of the day

Lymphoedema is a progressive,chronic condition and develops in stages so early detection and intervention is important to prevent it becoming severe.

  • Stage 0 A latent stage where swelling is not obvious despite the lymph transport system being damaged
  • Stage I In this early stage of the condition , high protein lymph fluid accumulates in the tissues, causing swelling which subsides with elevation.There may be some "pitting" at this stage ( an indentation remains after pressure is applied to a small area)
  • Stage II Elevating the area doesn't reduce the swelling and pitting is obvious
  • Stage III The tissue has become hard (fibrotic) and no longer pits. The overlying skin thickens and gradually becomes discoloured. Increased fat deposits develop. At this stage the affected area is usually grossly swollen and the swelling is irreversible
  • Download this helpful PDF Lymphoedema After Breast Cancer
  • Risk factors:
  • The extent of surgery, lymph node dissection, radiation treatment
  • Obesity
  • Injury and trauma e.g. sprains, fractures, wounds or skin punctures
  • Infections in the skin on the susceptible area
  • Burdening the limb by carrying heavy bags on the susceptible hand or arm.
  • Exposure to excessive heat including sunburn
  • Constriction on the limb from blood pressure tests, tight clothes, and jewellery or sleep position.

It is preferable to use the unaffected limb for blood pressure recording, blood tests, injections and IV drips if possible. However, the limited amount of research conducted in this area has not proven any increased risk.

Treatment

In New Zealand the current treatment for lymphoedema is based on the five “cornerstones” of care:

  • Light touch massage
  • Compression bandages or garments
  • Extra special care of the limb / area
  • Paced exercise
  • Medical taping

You will most likely have to make some changes to your day to day life to help accommodate this diagnosis, such as:

  • Adjust clothing to accommodate the swelling or the compression garments
  • Get used to wearing compression garments
  • Consider the extra costs for compression garments and massage therapy
  • Change the way you do household tasks or work
  • Work out ways to fit in time for exercise and massage
  • Learn to take extra special care with your limb and treat cuts and burns promptly.

If diagnosed and treated early, this distressing and debilitating swelling can be controlled and reduced, infection prevented, the range of movement of the affected area can be improved, and the quality of life for people with the disorder can be greatly enhanced.

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