Lymphoedema
Life after Breast Cancer. Managing Lymphedema
What is the Lymphatic system?
The Lymph system is a one way drainage route designed to rid the “tissues” of unwanted material and excess fluid. This unwanted material includes fat, bacteria viruses, cancer cells and proteins and is called “lymph”. Normally, lymph flows through the lymphatic vessels and eventually re-enters the blood stream. It is an integral part of the immune system of the body.
What is Lymphedema?
Lymphedema is the swelling that occurs when this is protein rich fluid called “lymph” collects in parts of the body.
What causes lymphedema?
Lymphedema is caused when this drainage system is compromised i.e. the flow of lymph is interrupted by damage to the vessels and/or the lymph nodes that are located along the vessels.
In cancer Patients, damage to the lymphatic system can be caused from the cancer itself, infection or certain cancer treatments such as radiation.
What are the risk factors for developing Lymphedema?
1. Removal of more than 5 lymph nodes. 22% risk for lymphedema after axillary lymphadenectomy.
2. Radiation and surgery combination (9-44%).
3. Post-operative axillary trauma, infection or haematoma.
4. Increased body weight
What are the symptoms?
Usually there is a substantial delay between the initial treatment of Breast Cancer and the clinical appearance of Lymphedema. The symptoms are commonly
1. Self-reported feeling of arm “heaviness”.
2. Sensation of arm fullness or mild discomfort. Jewellery or clothing too tight.
3. Joint stiffness, pain or skin changes.
4. Restricted range of motion and swelling.
Lymphedema patients do not usually present with severe pain
What is the management of Lymphedema?
Treatment should occur as soon as possible. If neglected, lymphedema will slowly progress. According to literature, no curative treatments for lymphedema are currently available, however the goal of treatment is to decrease the excess volume and maintain the limb at its smallest size.
Physiotherapy involves nonsurgical techniques such as complete decongestive therapy which is a combination of manual lymph drainage, compression bandaging and therapeutic exercises.
References
Harris et al (2001) Question and answers on the management of lymphedema related to breast cancer. Canadian medical Association Journal 164 (2):198-199
RM Morrell, MY Halyard, SE Schild, MS Ali, LL Gunderson, BA Pockaj (2005). Breast Cancer-Related Lymphedema. Mayo clinic proceedings 80(11): 1480 – 1484
BD Lawenda, TE Mondry, PAS Johnstone (2009). Lymphedema: A primer on the Identification and Management of a Chronic Condition in Oncology Treatment. A cancer Journal for clinicians 59(1): 8-24
EU Cidon, C Perea, F Lopez-Lara (2011). Life after Breast Cancer: Dealing with Lymphoedema. Clinical Medicine Insights: Oncology 5: 9-14