Breast Cancer related lymphedema, symptoms and conservative treatment

Lymphedema is a problem that may occur after cancer surgery when lymph nodes are removed. Lymphedema can occur months or years after treatment. It’s a chronic (ongoing) condition that has no cure. But steps can be taken to help keep it from starting, and to reduce or relieve symptoms. If left untreated, lymphedema can get worse. Getting treatment right away can lower your risk of infections and complications.

What is the lymphatic system?

The lymphatic system is a network of tiny vessels and small, bean-shaped organs called lymph nodes that carry lymph throughout the body. Lymph is a clear, color less fluid that contains a few blood cells. It starts in many organs and tissues. The lymphatic system is part of your immune system. It helps protect and maintain the fluid balance of your body by filtering and draining lymph and waste products away from each body region. The lymphatic system also helps the body fight infection.

How Lymphedema Happens

During surgery for cancer, nearby lymph nodes are often removed. This disrupts the flow of lymph, which can lead to swelling. This is lymphedema. Lymphedema can affect one or both arm, the head and neck, the belly, the genitals, or the legs. Swelling can worsen and become severe. Skin sores or other problems can develop. Affected areas are also more likely to become infected.

Often during breast cancer treatment, some or all of the lymph nodes under the arm are treated with radiation. The lymph nodes under the arm are also called the axillary lymph nodes. They drain the lymphatic vessels from the upper arms, from most of the breast, and from the chest, neck, and underarm area.

When many lymph nodes under the arm have been removed, a woman is at higher risk of lymphedema for the rest of her life. Radiation treatments to the under arm lymph nodes can cause scarring and blockages that further increase the risk of lymphedema. Lymphedema may occur right after surgery or radiation, or months or even years later.

Symptoms of Lymphedema

The main symptom of lymphedema after breast cancer treatment is swelling of the arm on the side where lymph nodes have been removed. The amount of swelling may vary. Some people may have severe swelling (edema) with the affected arm being several inches larger than the other arm. Others will have a milder form of edema with the affected arm being slightly larger than the other arm.

Other symptoms of lymphedema may include:

Feeling of fullness, heaviness, or tightness in the arm, chest, or armpit area

Bra, clothing, or jewelry don't fit as normal

Aching or new pain in the arm

Trouble bending or moving a joint, such as the fingers, wrist, elbow, or shoulder

Swelling in the hand

Thickening of or changes in the skin

Weakness in the arm

If you notice any of these symptoms, see your healthcare provider right away. Treatment needs to be started right away to keep lymphedema from getting worse.

Stages of BCRL:

What are the stages of lymphedema?

Based on your symptoms, your doctor will help assess which stage you’re in and tailor medical or surgical options to your needs.

Stage 1:

You have no signs or symptoms.

Abnormal flow in the lymphatic system.

Stage 2:

Accumulation of fluid and swelling.

Swelling goes away when you elevate the affected limb or body area.

Pressing on the area may leave a dent.

Stage 3:

Permanent swelling that does not go away when you elevate the affected area.

Pressing on the area no longer leaves a dent.

Scarring and thickening of the skin can be seen.

Stage 4:

Elephantiasis (large deformed limb) is evident.

Skin thickens

Wart-like growths and extensive scarring on your skin.

Prevention of BCRL:

People who have had surgery to remove lymph nodes in the armpit should be aware of those activities that put too much pressure on the affected arm. Protective measures to avoid injury and infection include:

Maintaining Proper Hygiene

Clean the skin of the affected arm daily and apply lotion. When drying the arm, be gentle but thorough.

Take proper care of the fingernails and avoid cutting cuticles.

Clean all cuts with soap and water, and then apply antibacterial ointment and a sterile dressing.

Staying Fit

Do exercises regularly to improve drainage, but first consult with your doctor or physical therapist.

Eat a well-balanced, low-sodium diet.

Keep the arm elevated when possible.

Taking Precaution with Everyday Activities

Protect your fingers from needle pricks and sharp objects. Use a thimble when sewing.

Avoid vigorous, repetitive movements against resistance, such as scrubbing, pulling or pushing, with the affected arm.

Avoid sunburns and other burns to the affected arm.

Use an electric shaver when shaving underarms.

Wearing the Right Attire

Wear gloves when gardening and when using strong household detergents.

Do not wear nightgowns or clothing with elastic cuffs.

Carry your handbag or heavy packages in the unaffected arm.

Conservative treatment of BCRL:

Decongestive Therapy for Lymphedema

Treatment for lymphedema depends on the severity and extent of the condition. Prevention and controlling lymphedema play an important role with this condition since there is no cure.

Decongestive treatment is commonly recommended for the first two stages of lymphedema. Treatment options may include:

Exercise. 

Exercise helps to restore flexibility and strength, and it improves drainage. Specific exercises will be recommended by your doctor and/or physical therapist.

Bandage. 

Wearing a customized compression sleeve or elastic bandage may help to prevent an accumulation of fluid.

Arm pump. 

Applying an arm pump often helps to increase the fluid flow in the lymphatic vessels and keeps fluid from collecting in the arm.

Diet. 

Eating a well-balanced diet and controlling body weight is an important part of treatment.

Keep the arm raised. 

Keeping the arm raised above the level of the heart, whenever possible, allows gravity to help drain the accumulated fluid.

Infection Prevention.

 It is important to follow preventive measures, such as good skin care, to protect the affected arm from infection and skin breakdown.

Surgical procedure for BCRL:

If your lymphedema progresses despite using conservative treatments, you may be a candidate for surgery. There are several options that your doctor will discuss with you:

Liposuction: 

Once lymphatic fluid spills into your surrounding tissues, it can cause inflammation and stimulate fat stem cells to grow. Your surgeon removes this extra fat caused by lymphedema. Liposuction for lymphedema is typically an outpatient procedure with a very short recovery time.

Lymphaticovenous anastomosis (also referred to as lymphovenous bypass): 

Your surgeon uses microsurgical techniques and equipment to reroute your lymphatic system, bypassing damaged nodes and connecting lymphatic channels directly into your veins. The lymphovenous bypass is an outpatient surgery. You can return to regular activity within a few days.

Vascularized lymph node transfer surgery (lymphovenous transplant): 

Your surgeon transplants a group of lymph nodes from a healthy part of your body to the affected area, effectively rewiring the lymphatic system. This is an inpatient procedure with a recovery time of a few days before you can resume regular activity.

Charles procedure (skin grafts): 

Affected tissue is removed and your surgeon uses part of it as skin grafts to repair the area. Skin grafts require more extensive care of the surgical site after your procedure, and it can take up to one month to return to normal activity.

While there is no full recovery for lymphedema, these treatment options significantly lower swelling and discomfort. Talk to your doctor about the best treatment options for you

Conclusion:

Breast Cancer related lymphedema is a condition that can be prevented. Once it develops there are options to manage it, be it conservative or surgical treatment. But prevention is better than cure.