Treatment options for breast cancer continue to evolve, including targeted drug therapies and other non-invasive choices that don't require surgical treatment, such as a mastectomy.
Patients diagnosed with breast cancer understandably have many questions around their condition and treatment options. One question that comes up frequently is the risk of developing lymphedema during or after treatment.
What is lymphedema after breast cancer treatment?
Lymphedema is a swelling condition that happens after injury or damage to the lymphatic system, caused by the build-up of lymph fluid in the fatty tissue under the skin. The lymphatic system works in conjunction with the circulatory system, helping to maintain healthy fluid levels within the system as well as providing a first line of defense against infection. Normally, lymph fluid is circulated throughout the body and merged back into the blood vessels in the subclavian veins, right beneath the collar bones. Unlike the cardiovascular system, which has the heart to pump blood through the system, the lymphatic system does not have a muscle that pumps the lymph through the body. When the lymphatic system is damaged, lymphedema can occur.
The most common cause of secondary lymphedema in the United States is surgery, trauma, or radiation therapy, most often associated with breast cancer treatment. This connection is a result of lymph node removal and damage during surgery, radiation or taxane-based chemotherapy.
What causes lymphedema after treatment for breast cancer?
Lymphedema can occur after any cancer, but is most common in those that more greatly impact the lymph system. Breast cancer is one of those types of cancer. There are numerous lymph nodes near the breast tissue, and as the lymphatic system can move infected, damaged, or mutated cells—such as cancer cells—through the body, they may be impacted by the cancer. During a mastectomy, some lymph nodes may be damaged or removed, which can create difficulties in moving lymph fluid throughout the body, leading to the pooling of fluid within the chest.
Surgery as part of breast cancer treatment
Lymph nodes can be damaged or removed as part of a mastectomy, including segmental mastectomies. Other surgical treatments that may affect the lymph nodes include:
- Sentinel lymph node biopsy, in which one or more lymph nodes are removed and tested for cancer. This is generally recommended for early-stage breast cancer.
- Axillary lymph node dissection, in which five to 30 lymph nodes are removed. This is performed when there is a higher risk of lymph node involvement or if the sentinel lymph node biopsy comes back with results that determine that there is more lymph node involvement.
Radiation
Radiation therapy can damage the lymph nodes and lymphatic vessels, causing an increased risk of lymphedema, especially in the trunk region.
Chemotherapy
Patients who undergo taxane-based chemotherapy are likely to have an increased risk of fluid retention, which in turn can increase the risk of lymphedema.
Infection
Having an infection of cellulitis after surgery may increase lymphatic system damage.
What are the symptoms of lymphedema?
Research has shown that symptoms of lymphedema in the arm, trunk or breast can happen before visible swelling. Common symptoms of lymphedema include:
- mild to severe swelling, often starting in the hand or arm of the side of the surgery
- seroma formation (a pocket of fluid that develops in the body after surgery)
- a tight or heavy sensation in the affected limb, usually the arm
- pain or discomfort in the swollen area
- difficulty moving the joints or limited finger movement
- tight, hard, or red-looking skin
- breast fullness
Knowing what to look for is key to getting treated for lymphedema early.
Can lymphedema be prevented?
Early diagnosis and education are key to good long-term management of lymphedema. Brown University Health Cancer Institute’s Early Surveillance Program helps to monitor at-risk patients and diagnose lymphedema early, leading to best case management.
Prior to surgery, at-risk patients are seen by a physical therapist as part of their care team. Volume measurements are taken and followed-up at post-surgical visits two weeks, one month, and then every three months for the first year. The frequency of these checkups is increased if needed based on assessment. This monitoring is critical to help prevent the progression of the lymphedema to a more severe and chronic condition.
Preventive compression therapy can promote lymphatic drainage if lymph nodes are removed during surgery. Make sure to be properly fitted for a compression sleeve to ensure optimal pressure. This sleeve should be worn when exercising or flying on an airplane, with any new strenuous activity, or if you feel a heaviness in your affected arm.
What treatment options are available for lymphedema?
Lymphedema is a chronic condition, as there is currently no cure, but there are a variety of options to help manage the symptoms and improve the quality of life for anyone affected.
Compression therapy or bandaging helps to promote lymphatic drainage. This can be as simple as compression sleeves or gloves, or multi-layered bandaging to provide more intense compression. Manual lymphatic drainage (MLD) is a specialized massage performed by a trained therapist. This massage simulates lymph flow and reduces swelling. Gentle movement, such as swimming, yoga, and light weightlifting, can help stimulate lymphatic flow and reduce the buildup of lymph fluid.
Pneumatic compression devices can be another option. A sleeve is worn over the affected limb, and an air pump inflates and deflates the sleeve to help move lymph fluid.
In some cases, surgery may be an option. A lymph node transfer moves healthy lymph nodes to one part of the body to replace the damaged lymph nodes. Another surgical option, lymphaticovenous anastomosis, reroutes lymph vessels to nearby veins in the affected limb.
In addition to physical treatments, patients experiencing lymphedema after breast cancer treatment may feel emotionally and mentally drained from managing another health condition after dealing with cancer treatments. A cancer survivorship group can help provide emotional support and connect people with shared experiences to provide comfort and practical advice.
Lymphedema is a manageable condition. If you or a loved one are experiencing the signs of lymphedema, speak with a healthcare provider to determine how to best treat your condition.
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