By Mei R.
Fu, PhD, RN, ACNS-BC
WHAT
IS LYMPHEDEMA?
LYMPHEDEMA (LIMF-eh-DEE-ma)
following
breast cancer treatment is an abnormal
accumulation of lymph fluid in the
affected arm, hand, fingers, wrist,
elbow, shoulder, neck, breast, chest
area, or any combination of these areas.
The word “affected” means the same body
side on which you received breast
surgery or radiation. The excess fluid
build-up leads to persistent swelling
and other distressing symptoms,
including pain, heaviness, firmness,
tightness, and numbness.
Lymphedema
usually develops slowly over time but it
can also develop soon after surgery or
radiation or even years later after
breast cancer treatment. Not everyone
who has been treated for breast cancer
will develop lymphedema, but many will.
During surgery for breast
cancer, the doctor usually removes part
or the whole breast and at least one of
the lymph nodes and some connected lymph
vessels from the underarm or chest area
to see if the cancer has spread. This
changes the flow of lymph fluid in your
affected body side and leads to the
excess fluid build-up. Radiation can
also affect the flow of lymph fluid in
your affected body side in a similar
way.
Please call your doctor if you notice
the following symptoms as they may indicate
an early onset of lymphedema:
-
Your affected
arm, hand,
or breast
feels full or heavy.
-
Skin in your affected arm or body
side feels tight or firm.
-
Swelling in
the affected body side (including
breast, hand, fingers, elbow,
shoulder, neck, breast, or chest
area).
-
Less movement or flexibility in your
affected hand, fingers, wrist or
arm.
ONSET OF
LYMPHEDEMA
Onset of
lymphedema following breast cancer
treatment can be gradual or sudden. It
is still not fully understood why some
patients are more prone to fluid
build-up than others even with
similarity in surgical treatment,
numbers of lymph nodes removed, and
radiotherapy. Noticeable swelling is
often absent during the initial
development of lymphedema, but patients
may report feelings of tightness and
heaviness. With gradual onset,
lymphedema typically occurs two to five
years after treatment, but it can also
happen as many as 15 to 30 years later.
With
sudden onset, swelling develops rapidly,
usually within 24 hours and often
individuals are able to identify the
triggers, such as air travel, infection,
or injuries (e.g., cuts, insect bites,
pinpricks, burns). Usually, immediate
administration of antibiotics can clear
the infection, while elevation of the
limb helps to reduce the swelling. To
reduce the risk of injury-triggered
lymphedema, it is important to treat
cuts, insect bites, pinpricks, or burns
immediately with antibiotic cream to
prevent infections.
It is
also important to follow appropriate
risk reduction behaviors.
For
further information:
The
Lance Armstrong Foundation,
Lymphedema: Detailed Information
Also see:
What
does Lymphedema look like?
Short Video on Lymphatic
System
References:
Armer, J., Fu, M. R.,
Wainstock, J. M., Zagar, E., Jacobs, L.
K. (2004).
Lymphedema following breast cancer
treatment, including sentinel lymph node
biopsy. Lymphology 37,
73-91.
Armer,
J., & Fu, M. R. (2005).
Age differences
in post-breast lymphedema signs and
symptoms.
Cancer Nursing, 28(3),
200-207.
Armer,
J.M., Radina, M.E., Porock, D., &
Culbertson, S.D. (2003).
Predicting
breast cancer-related lymphedema using
self-reported symptoms.
Nursing
Research, 52(6), 370-379.
Fu, M.R.,
Axelrod, D. & Haber, J. (2008).
Breast
Cancer-Related Lymphedema: Information,
Symptoms, and Risk Reduction Behaviors.
Journal of Nursing Scholarship, 40(4),
341-348.
Fu, M.R.,
Haber, J., Guth, A. & Axelrod, D.
(2008).
Lymphedema Education among
Breast Cancer Survivors undergoing
Radiotherapy.
National Lymphedema
Network LymphLink, 20(3),
pp. 8-9.
Fu, M.R.
(2008).
Women at
Work with Breast Cancer-related
Lympheodema.
Journal of
Lymphedema, 3(1), 30-36.
Fu, M.R. (2005).
Breast Cancer Survivors’ Intentions of
Managing Lymphedema.
Cancer Nursing, 28(6),
446-457.
Johansson, K., Ohlsson, K., Ingvar C.,
Albertsson M., & Ekdahl C. (2002).
Factors
associated with the development of arm
lymphedema
following breast cancer treatment: A
match pair case-control study.
Lymphology. 35(2),
59-71.
Mak,
S.S., Yeo, W., Lee, Y.M., Mo, K.F., Tse,
K.Y., Tse, S.M., Ho, F.P., Kwan., W.H.
(2008)
Predictors of lymphedema in
patients with breast cancer undergoing
axillary lymph node dissection in Hong
Kong. Nursing Research, 57(6),
416-25.
Petrek, J.A., Senie,
R.T., Peters, M., Rosen, P.P. (2001).
Lymphedema in a cohort of
breast carcinoma survivors 20 years
after diagnosis.
Cancer, 92(6):1368-77.
