Lymphedema is swelling of the arm, hand, trunk, or breast caused by a build-up of lymph fluid in those tissues after breast cancer surgery or radiation therapy. Lymph is a thin, clear fluid that circulates through your body to remove waste, bacteria, and other substances from tissues. Edema is the medical term for swelling. Lymphedema can develop soon after treatment, or months or even years later. Studies have reported that as few as 10% and up to as many as 90% of women develop lymphedema after breast cancer surgery and radiation therapy. Such a wide range of results may be due to the fact that: (a) researchers have used different ways of defining and then measuring lymphedema, (b) many of these studies have involved small numbers of patients, and/or (c) many studies were done with women who had a large number of underarm lymph nodes removed, which used to be standard practice. Today, many experts estimate that the range is probably close to 20-30%.
A study that reviewed published research on lymphedema suggests that full-body exercise and complete decongestive therapy (CDT), also called complex decongestive therapy, are the best ways to minimize lymphedema symptoms and maintain good quality of life. Jane Armer, director of nursing research at the Ellis Fischel Cancer Center and noted lymphedema researcher, was one of the scientists who did the study.
The research was published in the July/August 2012 issue of Nursing Research. Read “Self-Management of Lymphedema: A Systematic Review of the Literature From 2004 to 2011.”
As part of their surgery, many people with breast cancer have at least two or three lymph nodes removed from under the arm (sentinel lymph node biopsy), and sometimes many more nodes (axillary lymph node dissection). If the cancer has spread, it’s most likely moved into those underarm lymph nodes first because they drain lymph from the breast. Many people also need radiation therapy to the chest area and/or underarm. Surgery and radiation can cut off or damage some of the nodes and vessels through which lymph moves. Over time, the flow of lymph can overwhelm the remaining pathways, resulting in a backup of fluid into the body’s tissues.
Because there is no cure for lymphedema, people diagnosed with the condition have to manage the symptoms daily. Still, it’s not clear how effective these self-management techniques are, which is why the researchers did this study.
The literature review found that full-body exercise, which includes weight lifting, stretching, and aerobic exercise such as walking or dancing, was likely to be effective in managing lymphedema. The studies reviewed found that full-body exercise wasn’t associated with an increase in arm volume and may have helped stabilize arm volume. In people who were diagnosed with lymphedema, full-body exercise also may have stopped lymphedema from getting worse and when done with supervision, it didn’t make the lymphedema worse.
The researchers also found that CDT, an intensive program that combines a number of treatment approaches, including bandaging, compression garments, manual lymphatic drainage, exercise, and skin care, also helps people effectively manage lymphedema.
The researchers pointed out that research suggests that the earlier patients start managing lymphedema successfully, the better the outcome will be.
The researchers also noted that more studies on lymphedema self-care need to be done so that all symptoms of lymphedema, including:
- altered sensations
- reduced function
- emotional distress
- poor body image
- social isolation
are addressed, rather than only arm volume.
If you’re scheduled to have breast cancer surgery, be sure to ask your doctor about your risk of lymphedema and any steps you can take to lower that risk. If you’ve already had surgery and have been diagnosed with lymphedema, it’s a good idea to talk to your lymphedema therapist about a self-management routine that treats all the symptoms you’re experiencing. Together you can develop a plan that is effective and makes the most sense for your unique situation.
You can learn much more about how lymphedema happens, the risk factors for lymphedema, steps you can take to minimize that risk, and lymphedema treatments in the Breastcancer.org Lymphedema section.
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