Dr. MJ Bazos MD,
Lymphedema related to
What is lymphedema?
Lymphedema is the swelling that occurs when a
protein-rich fluid called “lymph” collects in part of the body. In
lymphedema related to breast cancer, this pooling of fluid usually occurs in the
upper arm, where it can lead to pain, tightness and heaviness, and recurrent
What causes lymphedema?
Normally lymph flows through the lymphatic
vessels and eventually enters the blood stream. Sometimes the flow of lymph is
interrupted by damage to the vessels and the ovalshaped structures called
“lymph nodes” that are located along the vessels. In breast cancer
patients, damage to the lymphatic pathways can be caused by the cancer itself,
infection or certain breast cancer treatments. For instance, lymphedema can
occur following removal of the lymph nodes in the armpit or “axilla”
(called “axillary lymph node dissection”).
Lymphedema can also occur when radiation therapy
to the armpit causes scarring and blocks or slows the flow of lymph. In many
cases, lymphedema develops within the first year after surgery or radiation
therapy, but it can develop at any time. It can be a temporary or a long-term
How is lymphedema
If you or your doctor suspect that you have
developed lymphedema after surgery or radiation therapy, you will need to be
assessed. Your doctor may use a tape measure to compare the distance around each
of your arms at different points and around your wrists and hands. A difference
of 2 cm at any of these measurement points may require treatment.Your doctor
will also check for tightness and feelings of heaviness in your arms. This
assessment will allow your doctor to determine whether your lymphedema is mild,
moderate or severe (severe lymphedema rarely occurs following breast cancer
treatments). There are other methods of measuring lymphedema, such as water
displacement, but they are used less often.
My doctor says I have lymphedema. What are my
Before you begin treatment for lymphedema, you
will want to make sure that you do not have any other problems related to your
original breast cancer. Your doctor will check for infection in your arm and
tumours in your armpit. Your doctor will also check for blood clots in your
armpit (called “axillary vein thrombosis”). Once your doctor has
ruled out these problems, you can begin treatment for lymphedema. Usually you
will be offered treatment that involves wearing a compression garment. Other
treatments, such as using a pneumatic compression pump or undergoing massage and
physical therapies, are sometimes offered in addition to, or instead of, a
compression garment. However, you should keep in mind that, at this time, the
only treatment that can be recommended on the basis of scientific evidence
— information from studies involving large numbers of women — is the
use of a compression garment.
A compression garment (sometimes called a
“compression sleeve”) is a tight-fitting piece of elastic clothing
that covers all or part of the arm. It may also cover the wrist or part of the
shoulder. Good compression garments are usually custommade. They should be
replaced every 4 to 6 months or when they begin to lose their elasticity.
Ideally, trained personnel should fit the garment for you. A compression garment
works by putting pressure on your swollen arm and stopping the collection of
lymph in any one area. Your doctor may recommend that you wear the garment 24
hours a day or that you wear it only during waking hours. Whatever your doctor
recommends, you should keep in mind that research shows that the long-term and
consistent use of compression garments for lymphedema will result
A pneumatic compression pump is a device with a
sleeve that can be inflated with compressed air in order to massage the arm. The
device squeezes the lymph away from the hand and arm and toward the body. There
are several commercially available pumps, ranging in complexity and cost. Most
pumps used by therapists, clinics and patients are complex and cost several
thousand dollars. Unfortunately, no studies have been published regarding the
most effective kind of pump, the most desirable pumping time or the best
pressure levels. One thing that is known, though, is that you should not use
pump therapy if you have an active infection or problems with blood clots
(called “deep vein thrombosis”).
Massage and physical
Massage and physical therapies are used to help
the fluid drain from the affected area. Manual lymph drainage is a massage
technique that involves the skin surface only. The therapist tries to improve
drainage from the arm by clearing out the main lymphatic pathways of the body,
starting in the neck and moving to the main part of the body. Complex Management
of lymphedema related to breast cancer, also called complex decongestive
physiotherapy, is a treatment routine that involves manual lymph drainage, skin
care, bandaging, exercises and the use of compression garments. In one study,
the use of a compression garment combined with manual lymph drainage was
compared with the use of a compression garment alone. Women in both groups had
reduced arm volume and improvement in symptoms. However, manual lymph drainage
did not provide additional benefit over the compression garment
There are other therapies for lymphedema that
you may hear about: laser treatment, electrical stimulation, transcutaneous
electrical nerve stimulation (TENS), cryotherapy, microwave therapy, thermal
therapy, surgery, and drug therapy with diuretics or benzopyrones. There is no
research that indicates whether these therapies are useful. These therapies
require further study and are not recommended at this time.
What should I do if I am having
You must tell your doctor if you are having
pain. Most often, the best way to control the pain is to control the lymphedema.
You may need to change your treatment in some way. If changing your treatment
does not help the pain, your doctor may prescribe an anti-pain medication
What can I do to help
There are several things you can do to manage
your lymphedema and prevent complications:
• Look after your skin. Avoid cuts,
pinpricks, hangnails, insect bites, pet scratches and burns to the affected arm.
If your skin is injured, be sure to clean and protect the wound immediately.
Stay away from substances that you are allergic to or that you find irritate
your skin. Whenever possible, avoid blood pressure monitoring in the
arm and avoid medical procedures that require
pricking the skin in the affected arm (vaccination, blood drawing, insertion of
an intravenous needle, acupuncture, and venography or lymphangiography [x-ray
assessments that involve injections]).
• Treat skin infections promptly. Usually
skin infections are streptococcal — that is, they are caused by bacteria
called “streptococci.” On rare occasions an infection may be
staphylococcal — caused by bacteria called “staphylococci.” In
either case, the infection should be treated immediately with antibiotics such
as penicillin. If you have recurrent infections, you may want to take regular
preventive doses of antibiotics or receive monthly injections of penicillin.
Your doctor may want you to have an emergency home supply of an antibiotic, to
be taken at the first sign of infection. If you are visiting a remote area, be
sure to take along a supply of antibiotics.
• Use saunas, steam baths and hot tubs
with care. Heat can make your lymphedema worse. Be cautious about exposing
yourself to hot environments.
• Travel with care. Some patients report
that their lymphedema is worse when they travel to places with a hot climate.
Some also report that their lymphedema is worse during flights. If you have a
compression garment, you should wear it when travelling by air.
• Exercise your arms. Activities that
exercise your arms may help control your lymphedema. Although some doctors say
you should avoid activities such as rowing, tennis, golf, skiing, squash and
racquetball, there is no research to suggest that these sports promote or worsen
lymphedema. In fact, in one study, 20 women with breast cancer competed in the
strenuous sport of dragon boat racing and found that the activity did not
promote or worsen lymphedema. Some experts recommend that you wear a compression
garment during exercise.
• Maintain an ideal body weight. Being
overweight can contribute to the development of lymphedema and may make the use
of compression garments or pneumatic compression pumps less