What is Lymphedema?
Lymphedema is an abnormal accumulation of high protein fluid in the arm following removal of the under arm (axillary) lymph nodes. The initial symptoms are usually hand and arm swelling. Other symptoms may include a feeling of tightness, heaviness or burning. In most cases the swelling is painless. However, sometimes the hand or even the entire arm can be become red, swollen and painful. This condition requires immediate medical attention, and usually responds dramatically to antibiotic treatment.
What causes Lymphedema?
Lymphedema is caused by obstruction to lymphatic flow. The lymphatic system is designed to return protein rich fluid back to the general circulation. Along the course of the lymphatic channels are lymph nodes which filter out products (including cancer cells) from the lymph fluid. In breast cancer treatment the lymph nodes under the arm are frequently removed to determine if the cancer has spread (see link to Treatment and reconstruction surgery).
The removal of these under arm (axillary) lymph nodes may cause obstruction to the lymphatic channels. As a result protein rich fluids leaks out into the surrounding tissues which can eventually lead to hand and arm swelling. Radiation therapy done to reduce the risk of cancer recurrence can increase the potential for developing lymphedema.
Fortunately, lymphedema is becoming less common because lymph node removal is becoming less traumatic. In the past all of the lymph nodes were removed from under the arm to determine the extent of the spread of a breast cancer. Now we only remove the first draining node(s). There are still patients who require removal of all their under arm lymph nodes, and these patients can develop lymphedema even several years following lymph node surgery.
What is the Treatment?
If a woman notes hand or arm swelling following lymph node surgery for breast cancer, she should first be seen by her physician to make sure she does not have a recurrence. If the physician’s examination is negative (which it usually is) she should then be referred to a lymphedema treatment center.
Proper treatment includes a form of massage therapy called Manual Lymph Drainage (MLD). Following massage, the therapist wraps the affected extremity in bandages to maintain the reduction obtained with massage. Exercises and skin care instructions are included in a comprehensive treatment program.
During the course of treatment, the patient and a partner are trained in self-care. There is no cure for this condition so lifelong maintenance is important to control the symptoms of lymphedema. Patients with lymphedema are at an increased risk of infection because of the high protein content of the fluid provides the perfect media for bacteria to flourish. It is important for patients to recognize any signs of infection and to start antibiotic treatment as soon as possible.
Other Sources of information:
The National Lymphedema Network (800-541-3259) provides a newsletter that enables patients and healthcare providers to share experiences and information about lymphedema.
National Lymphedema Network
Living with Lymphedema: www.cancersupportivecare.com/lymphlive.html
Lymphatic Research Foundation: www.lymphaticresearch.org
Academy of Lymphatic Studies: http://www.acols.com