Let’s go with the bad news first. Lymphedema, a medical condition that refers to an excessive accumulation of fluid and subsequent swelling in parts of the body, has no cure, at least not after it’s progressed. For most people who are diagnosed with the condition, it has to be considered as a chronic, sometimes lifelong problem. Even if the arm or hand (the places where lymphedema is frequently found) return to looking and feeling normal, the need for concern and vigilance remains.
Now for the good news. While lymphedema in its later phases can’t be completely reversed, it can be effectively managed with a growing array of strategies and interventions – and with a high quality of life for the people who have it. With that information in mind, let’s look at the basics of why lymphedema can be a special concern for women who have had breast cancer surgery and related treatment.
Lymphedema and Breast Cancer
The build-up of fluid in cells, tissues or organs and the accompanying swelling that are associated with lymphedema can be caused by a variety of situations, including orthopedic surgery like hip and knee replacements, various cancer surgeries, trauma, infection and radiation. Some people also get lymphedema after being born with abnormalities in the lymphatic system, a condition called primary lymphedema. Because of the nature of the procedure and because radiation often accompanies it, lymphedema is most common in women who are being treated or have received treatment in the past, for breast cancer.
During surgical treatment, the surgeon might take out lymph nodes from under the arm to determine if the breast cancer has spread. When these nodes are removed, lymph vessels that carry fluid from the arm to the rest of the body are also removed, which can change the flow of lymph fluid in that part of the body. As a result, it’s more difficult for fluid in the chest, breast and arm to flow out. Radiation treatment can also affect lymph fluid flow which further increases the risk of lymphedema. Swelling can range from mild to severe and can start soon after surgery or radiation treatment – but it can also develop slowly over time and start months or even years later.
What many people experience
The signs and symptoms of lymphedema can vary but often include a sense of heaviness, noticeable swelling and changing skin texture in areas such as the breast, shoulder, arm and hand. Some people also notice some inflexibility in joints. People with lymphedema also report clothes or jewelry not fitting, even though they haven’t gained weight and there is sometimes redness and tingling in the skin.
Another potential symptom is related to the fact that when lymph fluid accumulates due to blockage, it can reduce the amount of nutrients that are normally transported to cells. The result is poor wound healing and increased risk of infection.
Just as there are various degrees of severity with lymphedema, as well as different areas of the body where it can occur, there are also multiple options for treatment. In particularly aggressive cases that don’t respond well to other approaches, surgery can be an option of last resort. Instead, most treatment centers on physical therapy, specific and carefully monitored exercises, specialized compression garments and bandaging, weight management and skin protection.
Brandy Glass, LPTA, CTL (physical therapist assistant) a certified lymphedema therapist at Riverside Physical Therapy in Tappahannock and Warsaw, describes the goal of these approaches as reducing pain and discomfort, improving movement, avoiding the complications that can be associated with lymphedema and increasing overall quality of life. “The combination of treatments just listed is really the gold standard for lymphedema. In most cases, and almost always when the lymphedema has progressed to the point of visible swelling, a lymphedema therapist will utilize what’s called ‘complete decongestive therapy’ or CDT. The idea behind CDT is to get the excess lymphatic fluid out of the affected area and back into the body – and then keep it from building up again.”
“In the first, more intense phase of treatment we use specialized bandaging techniques and compression garments to help move the fluid. Compression garments and sleeves are made of different types of flexible fabric and are designed to put a controlled amount of pressure where it’s needed to keep the accumulated fluid moving in the right direction. It’s very important to get a correct fit with compression garments and the amount of time you need to wear them depends on the severity of the lymphedema.”
“Once the tissue swelling has been improved, the next phase of treatment focuses on maintaining the results through regular check-ups and a range of self-care steps. During both the more intense and the maintenance phases of treatment, the lymphedema therapist or other health professional provides the education and training needed to help assure the best possible outcome.”
The Value of a Personalized Lymphedema Plan
“Every case of lymphedema is different. Some people experience mild symptoms that flare up from time to time and other people have more severe and persistent symptoms that require more active treatment. And in each individual, the condition can change over time. That’s why it’s important to work with a health professional and get the support needed to help understand how your body responds to treatment, to change your management plan as needed and to determine what makes the most sense for your individual situation. Proactive treatment, getting the information and support you need and paying close attention to your body are the best resources we have for managing lymphedema and maintaining an optimal quality of life.”