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Post Date : Friday October 13 2006

Breast Cancer Survivors Preventing Lymphedema

The swelling in your arm that may follow breast cancer treatment can be minimized - and even prevented.
By Gina Shaw


Reviewed By Charlotte Grayson, MD

If you've had one or more lymph nodes removed during breast cancer treatment, you're at risk of swelling. Here's how to prevent and treat it.


Before you had breast cancer, you'd probably never heard of lymphedema, a painful swelling in the arms or legs caused by the buildup of lymphatic fluid. But once you've had lymph nodes removed from your armpit due to breast cancer, lymphedema becomes a new, unwelcome but important part of your vocabulary.

The lymph system is a key part of your immune system. Running parallel with the veins, it removes waste, bacteria, proteins, and excess water from the tissues. It also carries cells that fight disease and infection. Small bean-shaped structures called lymph nodes act as filters for the waste products in your lymphatic fluid. If one or more of these nodes are removed, there aren't as many channels available to help drain away the used lymphatic fluid, which can lead to fluid buildup under your arm.

Lymph nodes don't grow back, so if you've had even one underarm lymph node removed, you face at least some increased risk of arm lymphedema.

How big is this risk, and how do you prevent it? Doctors disagree about just how great a risk of lymphedema the typical breast cancer survivor faces. Overall, researchers estimate that a woman who's had lymph nodes removed faces anywhere between a 5% and 25% risk of developing lymphedema over her lifetime. The more nodes you've had removed, the greater the risk.

Managing Lymphedema within a Normal Lifestyle

However, they generally agree that survivors should manage their risk for lymphedema within the boundaries of a normal life.

"Any guidelines on how to prevent lymphedema have to be realistic and reasonable," says oncologist Marisa Weiss, MD, founder of Breastcancer.org and the author of Living Beyond Breast Cancer. "You have to respect the person's needs and desire to live a normal life and be physically active, but at the same time, make sure that they don't do anything to unduly jeopardize the arm's fluid drainage system."

"You need to live as you normally would," agrees Mary McCabe, RN, director of the Cancer Survivorship program at Memorial Sloan-Kettering Cancer Center in New York. "It's important to practice good health behaviors with respect to that arm, including making sure that you're careful about cuts and regularly checking the arm for any swelling or tight clothing. But you still need to be able to live a normal life."

Factors that increase the risk of lymphedema include:

Radiation to the underarm area
Being a heavy smoker
Having diabetes
Previous surgeries in the armpit area or on your arm
The good news: the risk of lymphedema is much less than it used to be. That's in part because of a relatively new procedure called a sentinel node biopsy. The surgeon locates the very first node draining lymphatic fluid away from the breast, and removes only that node -- the one most likely to have cancer. If it's clear (meaning there's no sign of cancer there), chances are the others are clear as well, so fewer nodes need to be removed.

Nonetheless, if you've had nodes removed, you still have to be careful with the affected arm. Anything that increases blood flow to that arm, such as an infection, a burn, a cut, or muscle overuse, can cause the fluid backup that leads to lymphedema.

To protect against lymphedema, take the following precautions:

Have blood drawn and blood pressure taken from the unaffected arm. You can order a lymphedema alert bracelet from the National Lymphedema Network (http://www.lymphnet.org or 1-800-541-3259) to make sure healthcare workers know to take care with that arm.
Keep that arm as clean as possible, and use lotion to keep skin from drying or cracking. Avoid picking at your nails and cuticles, and tell your manicurist not to cut your cuticles.
Do your best to avoid injury to or cuts on the affected arm. That means wearing gloves when gardening or doing housework, using plenty of sunscreen, and wearing insect repellent in buggy areas. Start antibiotics early if you have any sign of infection.
Don't overtire your arm. Some guidelines recommend never lifting more than 15 pounds with the affected arm, but for some women, those with toddlers, for example, that rule may be a difficult one to follow.
Should you worry if you just lifted 16 pounds with the arm where you had your surgery? McCabe says no. "There really aren't any specific, across the board exercise restrictions. Talk to your doctor about what our level of risk is, and use good judgment."

Realistically, Weiss says, we have to use our arms all the time. "It's not particularly reasonable to ask a woman never to carry bags of groceries or pick up her 4-year-old," she says. "On the other hand, you can avoid more unusual exertions, like carrying heavy boxes of books or lifting pieces of furniture."

Another often-identified risk: hot tubs. Overheating draws an increased flow of blood to the arm, which then needs to get back out. Does that mean your Jacuzzi days are over? It depends, says Weiss. "If you've had a moderate number of nodes removed, you can probably enjoy a hot tub every once in awhile. Just make sure it's not too hot -- probably warm-to-hot is better." You can also extend the affected arm out of the tub to keep it from overheating.

What about flying? Some women wear specially fitted compression sleeves on airplanes to prevent swelling. Even for people who don't have lymphedema, the low pressure in planes can sometimes cause feet, hands, or arms to swell. "If you've had a limited number of nodes taken out and it's a relatively short flight, I wouldn't worry about it," says Weiss. "But if you're taking a long transatlantic flight, you might want to get a compression sleeve."

Be sure to have your sleeve fitted by an expert. A badly fitted sleeve can do more harm than good.

How will you know if you're developing lymphedema? You should quickly get checked out by your doctor if you notice symptoms such as:

A full sensation in your affected arm
Decreased flexibility in your hand or wrist
Tight sleeves in clothing that otherwise fits
Tightness in rings, bracelets, or watches worn on that arm
Treatments for Lymphedema

Once you've been diagnosed with lymphedema, says Weiss, "It's a chronic problem that you'll have for a lifetime." It can vary in degree, and come and go over periods of time, but the sooner you seek treatment for it, the better you can control it.

There's no one-size-fits-all treatment for lymphedema. One of the most common treatments is manual lymphatic drainage, a gentle massage technique that's very different from traditional massage you might get at a spa. (If you do get a regular massage, tell the massage therapist to be very gentle with the affected arm.) This is done by a trained, certified therapist, and is designed to stimulate the lymphatic vessels.

This kind of treatment, while effective, can be expensive, and isn't always covered by insurance. Since lymphedema is a chronic condition, manual lymphatic drainage may be difficult to pursue off and on for the rest of your life.

"In general, all measures are temporary, and result in temporary relief of the problem," says McCabe. "Some people do have significant results from manual lymphatic drainage. But any solution that's going to work for you must be practical and easy to do."

Another treatment approach is the lymphedema pump. You place your arm in a plastic sleeve that fills with air, compressing the tissues and moving stagnant fluids out of the swollen arm. It can take a couple of hours a day, but you can do it at home while watching TV. "They are paid for by insurance, and can be a realistic long-term solution to a lifelong problem," says Weiss.

You can find out more about lymphedema and locate specialists in your area through the National Lymphedema Network at http://www.lymphnet.org.

Gina Shaw is a medical writer who was treated for breast cancer in 2004, and now calls herself a "joyful breast cancer survivor."

Published March 2005.

SOURCES: Marisa Weiss, MD, oncologist and founder, Breastcancer.org. Mary McCabe, RN, director, Cancer Survivorship program, Memorial Sloan-Kettering Cancer Center. Jami Bernard, author, Breast Cancer: There and Back. Melanie Polk, RD, Director of Nutrition Education, American Institute for Cancer Research. National Lymphedema Network. American Cancer Society. Breastcancer.org.