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How to tell normal swelling from lymphedema?

Page last modified on: August 25, 2008

Question from Lyd: How can I tell the difference between the swelling in my arm and breast from radiation (I am 2 months out of treatment) and the signs of lymphedema?: Answers —Nicole Gergich, M.P.T., C.L.T.-L.A.N.A. : I would say the hallmark sign of lymphedema is an asymmetrical swelling in the tissue that persists over time. We also need to understand that skin changes and tissue changes related to radiation can persist for a long period of time. In fact, inflammation is high in that tissue for up to a minimum of 4 months, and longer term changes can happen for up to 5 years. So to tell the difference in the early stages I agree is difficult, and there's not a specific percent of difference we would say is accurate. But the question I would ask is does the swelling change over time? Do you see the swelling in your arm or breast change from week to week or day to day? Month to month even? Is it gradually improving over time? If it is, I'd say it's related more so to the radiation.; Jennifer Sabol, M.D., F.A.C.S.: I tend to agree. I think it's very difficult to decide what is simply treatment radiation change and going to get better. Traditionally, we think of radiation swelling as being within the radiated field, meaning the breast; however, treatment's effect can also impact the lymphatics as they come out of the arm, and during radiation treatment some patients may experience more arm swelling. Again, these changes do subside slowly over time. I think while it's impossible to specifically treat lymphedema during radiation (and Nicole may have a comment about that), symptoms that persist after treatment should be managed aggressively.; Nicole Gergich, M.P.T., C.L.T.-L.A.N.A. : I think we can certainly treat someone during radiation therapy, although it becomes very difficult. I think the program, though, becomes slightly modified depending on how the tissue is responding to radiation. Certainly, we can stimulate the lymphatic system in its proximal and central and healthy areas, but we would tend to avoid massaging over the radiated field. So it does limit the treatment to some degree. Compression would also be limited during radiation treatment as we need to protect tissue. I think we need to remember that the lymphatics in the underarm drain the tissue of breasts, the chest wall, and the arm on the same side. So even if we don't directly damage the arm or the underarm with radiation, there still can be damage done that impacts the drainage of that entire quadrant.

On Wednesday, April 16, 2008, our Ask-the-Expert Online Conference was called Preventing and Treating Arm Lymphedema. Kathryn Schmitz, Ph.D., M.P.H., F.A.C.S.M.,Nicole Stout Gergich, M.P.T. C.L.T.-L.A.N.A., and moderator Jennifer Sabol, M.D., F.A.S.C. answered your questions about ways to prevent and manage lymphedema.

The materials presented in these conferences do not necessarily reflect the views of breastcancer.org. A qualified healthcare professional should be consulted before using any therapeutic product or regimen discussed. All readers should verify all information and data before employing any therapies described here.

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Meet the Experts

Kathryn Schmitz, Ph.D., M.P.H., F.A.C.S.M. is assistant professor in the Division of Clinical Epidemiology at the University of Pennsylvania and adjunct associate professor in the Division of Epidemiology at the University of Minnesota.

Nicole Stout Gergich, M.P.T., C.L.T.-L.A.N.A.

Nicole Stout Gergich M.P.T., C.L.T.-L.A.N.A. is a physical therapist and lymphedema specialist at the Breast Care Center at the National Naval Medical Center. She is also the president of the Oncology Section of the American Physical Therapy Association, and has previously served on the Medical Advisory Board and research committee for the National Lymphedema Network.

Jennifer Sabol, M.D., F.A.C.S. is a breast surgeon who directs the newly developed Breast Care Center at Lankenau Hospital in Wynnewood, Pa. Among her many interests, Dr. Sabol spearheads several research initiatives to advance the care for women with breast cancer and improve methods of breast cancer detection and treatment.