Lymphedema is a potential side effect of breast cancer surgery, radiation therapy, and sometimes chemotherapy that can appear in some people during the months or even years after treatment ends.
Lymph is a thin, clear fluid that circulates throughout the body to remove wastes, bacteria, and other substances from tissues. Edema is the buildup of excess fluid. So, lymphedema occurs when too much lymph collects in any area of the body. If lymphedema develops in people who’ve been treated for breast cancer, it usually occurs in the arm and hand, but sometimes it affects the breast, underarm, chest, trunk, and/or back.
Breast cancer surgery, especially when several lymph nodes are removed, 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.
While lymphedema can affect the breast, chest, and underarm areas, it’s more common in the arm or hand on the same side as breast cancer surgery. Because early swelling in the arm can be hard to notice, treatment guidelines recommend taking baseline measurements before surgery and then at regular intervals afterward.
A small study suggests that conducting baseline measurements with bioimpedance spectroscopy, followed by regular measurements with the same technique, can identify lymphedema very early. This early detection allowed the lymphedema to be successfully treated with self-massage and a compression sleeve.
The research was presented on May 8, 2018 at the 2018 American Society of Breast Surgeons Annual Meeting. Read the abstract of “Reducing breast cancer-related lymphedema (BCRL) through prospective surveillance monitoring using bioimpedance spectroscopy (BIS) and patient-directed self-interventions” (PDF; scroll to page 47 of the PDF).
Bioimpedance spectroscopy, also called BIS, is a newer non-invasive technique to measure the volume of fluid in various parts of the body. BIS involves passing an extremely low-strength electrical current through the area and measuring how the flow of the current is slowed by the fluid in the body. It’s important to know that BIS measurements are NOT available everywhere.
The researchers wanted to see if BIS could detect small changes in arm volume that likely would not be seen by measuring the arm with a tape measure and before the women themselves reported any lymphedema symptoms. The goal was to then treat any early lymphedema with more conservative therapies that the women could do at home.
Lyndsey Kilgore, M.D., of the University of Kansas Cancer Center, said at a media briefing about the research that it is critical to detect patients at risk for lymphedema before they present with symptoms that are so severe it requires the use of complex, costly interventions or even results in a condition that can’t be reversed.
The study included 146 women diagnosed with breast cancer in one breast between November 2014 and December 2017. All the women had surgery to remove the breast cancer and treatments considered to put them at a high risk of lymphedema, including:
- axillary lymph node surgery
- taxane chemotherapy
- radiation to the lymph nodes near the breast cancer
All the women had the arm on the same side as the breast cancer measured with BIS before surgery and then had their arms regularly measured with BIS after surgery. The women were followed for at least 1 year.
During follow-up, BIS measurements found that 49 women (34%) had what is called subclinical lymphedema, meaning the increase in arm volume could not be seen with the eye and the women reported no symptoms.
These 49 women began self-care to treat the subclinical lymphedema, which involved wearing a compression sleeve and being taught how to massage their arms, which they did for 4 to 6 weeks.
Of the 49 women with subclinical lymphedema, 40 (82%) had their BIS measurements return to pre-surgery levels after the self-care. The other 9 women with persistent lymphedema were referred to a lymphedema specialist for complete decongestive therapy, an intensive program that combines many different treatment approaches, including bandaging, compression garments, manual lymphatic drainage, exercise, and self-care. Of these 9 women, 8 had cancer in four or more lymph nodes and all were obese.
"Early detection using BIS with easy patient self-directed interventions for early-stage lymphedema can significantly improve patient outcomes and decrease the development of persistent lymphedema," said Kilgore.
While BIS isn’t common yet, if you’ve been diagnosed with breast cancer and know that you’ll be having surgery, radiation, or chemotherapy, there are other things you can do before treatment starts to reduce your risk of lymphedema, including scheduling an appointment with a medical professional who specializes in lymphedema management. This trained lymphedema therapist can take baseline measurements of your arm and hand, as well as assess the strength of your arm and upper body and then create a tailored post-surgery exercise and rehabilitation plan for you.
For more information, visit the Breastcancer.org pages on Reducing Risk of Lymphedema and Lymphedema Flare-Ups.