Lymphedema in Breast Cancer: What You Need to Know
By SUSAN GILCHRIST, M.D., M.S.
Lymphedema is swelling that occurs when fluid accumulates in the soft tissue, usually in the upper extremities in women after breast cancer surgery due to an interruption of the lymphatic system (a network of lymph nodes) that carries protein-rich fluid back into the bloodstream.
Common factors that place women at higher risk for lymphedema:
Surgery involving axillary lymph nodes
How to recognize lymephedema:
Sensation of arm fullness of affected arm
Discomfort or pain
Difficulty with range of motion
What should you do if you suspect lymphedema?
A detailed medical history and physical exam by your physician is critical. Once there is suspicion of lymphedema your physician may obtain one or more tests to diagnose lymphedema (e.g. imaging tests and measurements of affected limb) and then refer you to a lymphedema specialist within your institution. Below is a link to a network of lymphedema specialists in case you are not referred.
What are common treatments for lymphedema?
Compression garments or bandages to enhance drainage
Massage to manually improve lymph drainage (MLD)
Pneumatic compression devices which consists of intermittent inflation of a sleeve worn to improve lymph drainage
Carefully controlled exercise
Skin and nail maintenance
Complete decongestive therapy which is an intensive program comprised of all of the above therapies
After talking with a lymphedema specialist, make sure you wear a fitted compression garment during exercise. Start at a low level and increase weight slowly over time. Exercises should be done with the correct form (examples in link below).
What surgical procedures are available for lymphedema?
Lymph node transfer – microsurgery to transfer lymph nodes from one area of your body to the affected limb
Liposuction – to remove excess tissue preventing fluid drainage
Lympovenous bypass – procedure with a microscope to redirect blocked lymphatic vessels to small veins to improve lymph drainage
I have enjoyed seeing several of my patients benefit from surgery, and in particular, lymph node transfer, when appropriate. After recovery, this has allowed my patients to train up to a higher level of aerobic capacity and maintain resistance training goals.
Are there any new medical therapies available for lymphedema?
In 2018, there was a pilot study of a small number of patients with lymphedema who received 75mg of ketoprofen, an NSAID, by mouth 3 times a day for 4 months. The study showed a reduction in skin thickness, though no reduction in limb volume. Importantly, excluded from the trial were those with cardiovascular disease, diabetes, hypertension, kidney or liver disease, and those with active cancer. In addition, the majority of patients had lymphedema of the lower extremity.
Bottom line – read the fine print before determining whether a certain treatment is applicable to YOU.
Want to contribute to research in lymphedema?
Click the link below to clinical trials testing novel therapies for the treatment of lymphedema.
Be smart. Be informed. Hope this post has been helpful.