Breast Cancer: Side Effects of Treatment: Lymphedema

The buildup of lymph, a fluid your body makes, happens when lymph vessels or nodes that the fluid travels through are missing, damaged, or removed.

There are two types of lymphedema: primary and secondary.

Primary is rare. It happens when certain lymph vessels are missing or faulty at birth.

Secondary lymphedema happens when a blockage or another problem changes the flow of lymph fluid through your body's network of lymph vessels and nodes. It can develop not only after breast cancer surgery, but can also come from an infection, scar tissue formation, trauma, deep vein thrombosis (a blood clot in a vein), radiation, or other cancer treatments.

People who've had any of these procedures may be at risk:

• Simple mastectomy in combination with axillary (arm pit) lymph node removal
• Lumpectomy in combination with axillary lymph node removal
• Modified radical mastectomy in combination with axillary lymph node removal
• Combined cancer surgery and radiation therapy to a lymph node region (such as the neck, armpit, groin, pelvis, or abdomen)
• Radiation therapy to a lymph node region

You can get lymphedema within a few days of surgery, but it can also happen months or years afterward. If untreated, it can become worse.

A small amount of swelling, even in your arm, is normal for the first 4 to 6 weeks after breast cancer surgery. Some women may also have redness or pain in the arm, which may be a symptom of inflammation or an infection.

But if you think you have any of the symptoms below, call your doctor right away. Prompt treatment can help get lymphedema under control.

• Swelling in the arms, hands, fingers, shoulders, chest, or legs
• A "full" or heavy sensation in the arms or legs
• Skin tightness
• Less flexibility in your hand, wrist, or ankle
• Trouble fitting into clothing in one specific area
• A tight-fitting bracelet, watch, or ring that wasn't tight before

Your doctor will look into your medical history (including past surgeries and treatments) and your current medications and symptoms. They'll also give you a complete physical exam. They might ask you to take other tests, too, like an MRI, CT scan, or ultrasound to check for fluid build-up.

Treatment will depend on how bad the swelling is and its cause. If you notice symptoms of lymphedema, contact your doctor. Other causes of limb swelling, such as deep vein thrombosis or cancer recurrence, need to be excluded before lymphedema therapy can begin.

If an infection is to blame, for example, your doctor may prescribe antibiotics.

Other treatments can include bandaging, proper skin care and diet, compression garments, exercises, and manual lymphatic drainage, a gentle form of skin stretching and massage.

Get treated ASAP to nip potential problems in the bud. If you don't get medical care for lymphedema, it can lead to more swelling and a hardening of the tissue -- and that can impact how well your affected limb moves and works. It can also lead to infections and other illnesses.

Take good care of yourself to lower your odds of getting the condition.

Get Good Nutrition

• Cut back on foods high in salt and fat.
• Have at least two to four servings of fruits and three to five servings of vegetables each day.
• Eat a variety of foods to get all the nutrients you need.
• Use the package label information to make healthy choices.
• Get fiber from whole-grain versions of breads, cereals, pasta, and rice. Fruit and veggies are good sources too.
• Drink plenty of water.
• Stay at your ideal body weight. A registered dietitian or your doctor can calculate it.
• Limit alcoholic drinks.

Exercise Regularly

First, check with your doctor before you start a new exercise program.

Depending on what they give you the OK to do, you could take walks, swim, or do low-impact aerobics like biking -- all of which are aerobic workouts that get your heart pumping. Your care team might also give you specially prescribed exercises. Whatever you do, aim to get 30 minutes of exercise a day at least 5 days a week.

Include a 5-minute warm-up before any aerobic activity, and take 5-10 minutes to cool down after your workout.

If your normal exercise routine includes upper-body weight lifting, check with your doctor about the best time to get back to it as well as any weight restrictions.

Stop doing any exercise that gives you pain. And if your arm on the side where you had surgery becomes tired during exercise, cool down, then rest and elevate it.

Avoid Infections

• Wear gloves while doing housework or gardening.
• Avoid cutting your cuticles when manicuring your nails. Use care when cutting your toenails.
• Wash your hands with soap and warm water often, especially before you prepare food, after you use the bathroom, or after you touch soiled linens or clothes.
• Protect your skin from scratches, sores, burns, and other irritations that might lead to an infection. Use electric razors to remove hair, and replace the razor head frequently.
• Use insect repellents to prevent bug bites.

If you think you have an infection, tell your doctor right away.

Stay alert for these warning signs of infection:

• Fever over 100.4 degrees F
• Sweats or chills
• Skin rash
• Pain, tenderness, redness, or swelling
• A wound or cut that won't heal
• Red, warm, or draining sore
• Sore throat, scratchy throat, or pain when swallowing
• Sinus drainage, nasal congestion, headaches, or tenderness along upper cheekbones
• Persistent dry or moist cough that lasts more than 2 days
• White patches in your mouth or on your tongue
• Nausea, vomiting, or diarrhea
• Flu-like symptoms (chills, aches, headache, or fatigue) or generally feeling "lousy"
• Trouble peeing: pain or burning, constant urge, or needing to go often
• Bloody, cloudy, or foul-smelling urine

Don’t wear tight clothing, shoes, or jewelry.

You should wear well-fitted bras. The straps shouldn’t be too tight. Avoid underwires, and wear pads under the bra straps if necessary. Wear comfortable, closed-toe shoes and avoid tight hosiery. Wear watches or jewelry loosely, if at all, on the affected arm.

Talk with your doctor about heavy lifting with the affected arm.

Slowly increasing the amount of weight you lift with your affected arm may increase strength and help lymphedema symptoms.

Newer studies show that some controlled heavy lifting in a gym may be OK.

Keep your skin clean.

Dry your skin thoroughly (including creases and between fingers and toes) and apply lotion.

Take precautions during visits to the doctor.

Ask to have your blood pressure checked on the unaffected arm. Get shots or blood drawn from that arm, if possible.

Tell your doctor about any symptoms.

Let them know if you have redness, swelling, a skin rash, or blistering on the side of your body where you had surgery, or if you have a temperature greater than 100.4 degrees F. These warning signs of infection could be an early sign of lymphedema and should be treated immediately.

Follow all of the recommendations for preventing lymphedema. That helps you lower the risk for more swelling.

It's a good idea to follow these tips, too:

• Avoid extreme temperature changes.
• Do not use hot tubs, whirlpools, saunas, or steam baths.
• Use warm, rather than hot, water when bathing or washing dishes.
• Always wear sun protection (at least SPF 30) when going outdoors.
• Talk to your doctor before traveling.
• When traveling by air, ask your doctor if you should wear a compression sleeve on your affected arm or a stocking on your affected leg. For long flights, additional bandages may be needed.
• When sitting or sleeping, elevate your affected arm or leg on pillows.
• Don’t spend a lot of time lying on your affected side.

Your doctor may refer you to an occupational therapist (OT) who specializes in managing lymphedema. Your OT may have you do specific exercises, limit certain activities, and possibly recommend a compression sleeve or other devices.

See your doctor as recommended.

With proper care and treatment, your affected limb can be restored to a normal size and shape. The condition can usually be controlled so that it doesn’t get worse.

But remember, it's important to get your symptoms treated as soon as possible.

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