Lymphedema is probably the most common side effect post-breast cancer treatment. It is often ignored, misdiagnosed and continues to be an unwelcome complication for many patients. There are two types of lymphedema, primary and secondary. Primary lymphedema (LE is the "shorthand" for lymphedema) is caused by a genetic defect, major trauma or can occur at the onset of the teen years. Secondary LE is caused by radiation, surgery, trauma or infection. Breast cancer patients are candidates for secondary lymphedema. The removal of lymph nodes during axillary dissection, or even sentinel node biopsy, as well as the trauma of surgery to the breast tissue puts you at risk for lymphedema. Radiation can further damage the lymph nodes. The risk of infection during post-surgery treatments is another possible cause of LE. Lymphedema is not easily recognized, either by the patient or the medical profession in general. Many women complain of a "fullness" or "tightness" in the affected arm or side of surgery/radiation, with no noticable swelling. Surprise! LE does not occur only in the arm - it can occur in the underarm area, the upper back, the chestwall and/or the neck. Although it is normal to experience some swelling at the surgical site, this should not last. Any lasting edema, or swelling, or sensation of tightness/fullness should be reported to your doctor. Don't be afraid to mention that you think you might have lymphedema. Lymphedema is a chronic condition which is fortunately not life-threatening, but is a royal pain. The "gold standard" for lymphedema treatment today is Complete Decongestive Therapy (CDT). This consists of manual lymphatic drainage (MLD), exercise, skin care, compression bandaging and patient education. There are specially trained therapists who are skilled in CDT - they are generally physical, occupational or massage therapists or nurses who have undergone an intensive course of over 100+ hours of training in this technique. MLD is a gentle, light touch massage which helps to open the clogged lymph pathways and redirect the flow of lymph to open lymphatic vessels. Lymph is a collection of waste fluids and proteins. The lymph nodes collect this waste and send it out of the body via the lymph vessels. When some of the vessels are lost, due to surgery, or comprised, due to radiation, this protein-rich fluid can build up, causing an uncomfortable sensation and/or swelling.
We will go into a bit more detail about lymphedema, staging and types, and the prevention/risks in the next installment.
The copyright of the article Lymphedema in Breast Cancer Research is owned by Linda Bily. Permission to republish Lymphedema in print or online must be granted by the author in writing.
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