If part of your breast cancer treatment included the removal of lymph nodes under the arm (a procedure known medically as axillary node dissection), you are at risk of developing lymphedema, which can result in swelling of the arm. The risk increases if treatment includes radiation and chemotherapy.

Lymphedema is swelling due to impaired circulation of the lymph fluid. Our bodies have a lymph system which clears out waste from the cells into the blood stream for removal. The lymph fluid also contains white blood cells that fight off infections. If this system is compromised by scar tissue, loss of lymph nodes, cancer, or surgery, then the fluid can’t flow properly and backs up, causing the arm to swell.

Lymphedema usually comes on slowly and has symptoms such as:

  • swelling of the arm
  • tightness or a feeling of heaviness in the affected arm or leg
  • snugness of clothing and jewellery feel
  • difficulty moving a joint
  • aching or burning feeling in the limb
  • warm feeling in the skin of the arm and leg
  • shiny skin
  • thickening of the skin
  • small blisters that leak fluid
  • itchy toes or legs

Preventing lymphedema

The following are some general tips to help you avoid lymphedema:

  • Keep the arm or leg raised above the level of the heart when possible.
  • Clean the skin of the arm or leg daily and moisten with lotion.
  • Use an electric razor for shaving.
  • Wear gardening gloves and oven mitts.
  • Use thimbles for sewing.
  • Take care of your fingernails; do not cut cuticles, and cut nails straight across.
  • Clean cuts with soap and water, then use antibacterial ointment.
  • Avoid getting injections or having blood taken in the at-risk arm.
  • Avoid extreme hot or cold such as ice packs or heating pads, saunas, or hot showers.
  • Wear loose jewellery, and wear clothes without tight bands.
  • Wear sunscreens and avoid burns
  • Avoid pet scratches and insect bites.
  • Use compression garments while travelling by air.
  • Stay physically active and maintain a healthy weight.
  • Carry a handbag on the unaffected arm.
  • Do not use blood pressure cuffs on the affected arm.
  • Watch for signs of infection, such as redness, pain, heat, swelling, and fever. Call the doctor immediately if any of these signs appear.

Treating lymphedema

Lymphedema is treated using physical methods and, sometimes, with medication. Treatment methods include:

  • supporting the arm in a raised position above the heart
  • mild exercise such as swimming and arm stretches
  • manual lymphatic drainage (a specialized form of very light massage that helps to move fluid from the end of the limb toward the trunk of the body)
  • wearing custom-fitted clothes (sleeves) that apply controlled pressure around the affected limb
  • cleaning the skin carefully to prevent infection
  • taking diuretic medications (“water pills”)

Other treatments include laser therapy, surgery, and pneumatic pumps.

Interestingly, in the past, breast cancer patients at risk for lymphedema were cautioned not to exercise their at-risk arm. Studies are now revealing that this may not affect the risk of developing lymphedema, but more studies are needed for a stronger conclusion.

Ruth Ackerman