Lymphedema — a buildup of fluid under the skin that causes swelling — is a potential risk and fear for some women undergoing surgical treatment for breast cancer. But the good news is that changes in treatment have helped to lower that risk tremendously in recent years, affecting far fewer women.
“With the move away from radical mastectomies 40 plus years ago and removing less lymph nodes with a procedure called sentinel lymph node biopsy, we are seeing much lower rates of lymphedema,” explained Endeavor Health nurse practitioner Sarah Anzevino, DNP, APN-BC, who cares for patients in partnership with breast cancer medical oncologists.
Vital patient education
Clinicians like Anzevino are working to improve education for patients to help them better understand their lifetime risk of developing lymphedema, as well as ways to modify their risk and symptoms to watch for.
It’s important for people to be aware of potential signs of lymphedema and to reach out to their clinical team as soon as they have concerns, said Anzevino.
Lymphedema is a result of the lymph channel being interrupted (due to the lymph node biopsy or dissection) which then can impact normal lymphatic drainage. While the risk of lymphedema is small, it lasts for life and can develop at any time after treatment, often not right after surgery.
Common lymphedema symptoms include:
- Visible swelling, typically in the hand and arm (side of the breast cancer surgery with lymph node biopsy)
- Discomfort in the arm, or a feeling of tightness, fullness or achiness
- Red or irritated skin
Cellulitis, an infection to the skin, can elevate the risk of lymphedema and even a bug bite can stimulate cellulitis or trigger a negative reaction.
“We advise patients to use insect repellant to avoid bug bites and to be extra careful with activities like gardening/yardwork by wearing gloves to help avoid cuts to the hands and toxins in the soil,” said Anzevino.
While swelling is among the most common symptoms, lymphedema does not always present with obvious swelling.
“We tell patients to be mindful of how their arm feels, as they can experience a heaviness or fullness on the same side as their surgery,” explained Anzevino. Lymph node biopsy with breast surgery does not cause swelling to lower extremities.
Specially trained therapists are key
For patients who do experience symptoms, it’s extremely important to work with a specially trained, certified lymphedema therapist (CLT) like Endeavor Health’s occupational therapist Amanda Schell, MS, OTR/L, CLT-LANA.
“Our main goal is to help people better understand lymphedema and feel empowered in self-management strategies to prevent progression of the diagnosis. While we can’t eliminate the condition, we can help people regain and maintain function to participate in their meaningful daily activities and prevent worsening swelling or pain in the affected arm or breast,” said Schell.
Maintenance therapy for lymphedema includes:
- Appropriate exercise
- Manual lymphatic drainage
- Patient education
- Compression garments
- Monitoring for skin infection
A landmark study more than a decade ago demonstrated that exercise stimulates lymphatic drainage and circulation, contradicting years of belief that exercise made the condition worse. However, it’s vital to follow safe exercise protocols as overloading your system can cause more inflammation, said Schell.
“There is mounting evidence that progressive resistance training can help prevent progression of lymphedema,” said Schell. Supervised and slowly progressive resistance training that becomes a program an individual can do at home is the goal, she added.
Taking control of the condition
Specialized lymphedema therapists also do manual lymphatic drainage and give patients the education and tools to perform it on themselves, or teach friends or family members how to help.
Patient education includes teaching people to understand and look for signs of infection and minimize cuts and scrapes.
“We don’t want people living in a bubble or fearing daily activities,” said Schell. “I tell people to treat themselves with extra care. If you scrape your hand, clean it and cover it and keep exposure to bacteria at a minimum.”
Wearing compression garments like sleeves can be a major component of controlling swelling and managing symptoms of lymphedema, explained Schell.
Again, professional therapists have resources and recommendations to help pick the optimal garment for individual patients. They can also help with insurance coverage for medical-grade compression garments.
“We’re here to empower our patients so they don’t feel controlled by this condition,” said Schell. “It will take a commitment and requires maintenance that becomes part of your daily lifestyle, but it doesn’t have to take over your life.”
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