An Overview of Lymphedema in Breast Cancer

Why breast cancer can cause arm swelling

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A woman undergoes radiation therapy.
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Lymphedema is a type of swelling that is commonly associated with cancer. In breast cancer, it typically affects the arm on the same side as the cancer. The swelling is the result of an accumulation of lymph—fluid that contains immune cells and proteins that flows throughout your body—that occurs when lymph nodes or lymph vessels become damaged or blocked. This is a common complication of breast surgery and radiation, but can also be due to a tumor itself.

In addition to swelling, lymphedema often brings pain, impeded flexibility, and other uncomfortable symptoms.

It is estimated that between 30 percent and 70 percent of women who have breast cancer develop lymphedema at some point during the disease course.

Symptoms

Sometimes lymphedema is temporary, occurring just after surgery and then resolving. Often, however, it is a chronic condition that waxes and wanes over the course of one's life, even after breast cancer has completely been cured. And rarely, lymphedema may occur decades after breast cancer surgery.

The main signs and symptoms of lymphedema include:

  • Arm swelling
  • A feeling of heaviness or fullness in your affected arm
  • A sense that the skin of your arm feels tight
  • An indentation when your skin is pressed
  • A tight fit of your clothes or jewelry on one arm
  • Weakness and diminished flexibility of your arm
  • Aching, itching, or pain in your arm
  • Redness of the skin on your arm

Untreated lymphedema can have serious consequences, including infections, skin ulcers (open sores that don't heal), and extreme swelling and thickening of the skin (elephantiasis).

Causes

The lymphatic system, through which your immune system rapidly delivers protective immune materials throughout the body, also includes lymph nodes that filter lymphatic fluid. Lymphedema occurs when the flow of lymphatic fluid through those vessels or nodes becomes impaired. The fluid can back up and enter into the nearby soft tissue, causing the characteristic swelling of lymphedema.

If you have breast cancer, surgery or radiation therapy can cause lymphedema to develop. And while it is less common, the disease itself can lead to lymphedema.

Breast cancer can result in lymphedema when:

  • Breast cancer surgery damages or cuts lymph vessels or lymph nodes in the chest wall and armpit
  • Surgical scar tissue blocks the flow of lymph through lymph vessels
  • Radiation-induced scarring blocks or damages lymph nodes and vessels
  • Cancer cells migrate to lymph nodes, causing the nodes to enlarge or become blocked
  • A breast mass or tumor presses on lymph nodes or vessels, obstructing lymph flow

Because breast cancer can spread to nearby lymph nodes, it is not uncommon for a breast cancer evaluation to include a lymph node biopsy. Biopsy or removal of lymph nodes in the chest or armpit increases the chances of developing lymphedema.

Diagnosis

Lymphedema is diagnosed based on your physical examination and may involve some diagnostic testing as well. The arm swelling is usually evident, but it can be subtle. The diameter of the affected and unaffected arms can be compared with a tape measure, and these values may be recorded so your doctor can see if you have any changes (improvement or worsening) over time.

If you have breast cancer, your doctors might not do any additional testing to determine the cause of your lymphedema because breast cancer is often associated with this complication.

However, there are times when your medical team may be concerned that lymphedema is a sign of an infection or cancer extension. Congestive heart failure can also cause arm swelling, as can blood clots in the arm. Your medical team may need to rule out these health problems, and diagnostic tests can help clarify the cause of your arm swelling.

Imaging tests such as computed tomography (CT), ultrasound, or magnetic resonance imaging (MRI) scans can often identify masses or areas of infection.

Lymphatic scintigraphy involves the injection of a radioactive dye, followed by recorded images of the dye as it moves through the lymphatic system. This test can help identify areas of slow lymphatic flow or blockage.

Treatment

Symptoms of lymphedema, such as swelling and pain, can often be managed. The lymph nodes and lymphatic vessels cannot be repaired, but they may heal on their own.

Sometimes, physical pressure caused by a tumor can be relieved with surgery or radiation, but these treatments may worsen lymphedema and the main objective of these techniques is treating the tumor, not the lymphedema.

Lymphedema treatments include:

  • Exercise: Special kinds of exercises that gently contract muscles can aid in pumping lymph fluid out of the swollen limb.
  • Massage: Specially trained physical or massage therapists can provide manual lymph drainage with a series of gentle massage maneuvers that direct lymph flow out of the affected limb. However, these treatments are not safe for everyone, and you cannot undergo this type of massage if you have metastatic cancer, infections, blood clots, or congestive heart failure.
  • Compression: Compression can also direct the flow of lymph out of the affected arm. Compression can be provided in a number of ways, including elastic bandaging, use of a special compression sleeve or stocking, or the use of an air-driven (pneumatic) pump.

Coping

When you have lymphedema, it's important to avoid anything that might worsen your condition or cause complications. You will need to make a few adjustments to your daily life to avoid exacerbating your lymphedema.

Tips for coping include:

  • Continue to use your arm as normally as possible, as muscle contractions help pump fluid out of your arm.
  • Keep your arm and hand clean and well-moisturized to avoid cracking from dryness, which increases the risk of infection.
  • While reading, watching TV, or otherwise at rest, keep your arm elevated above the level of your heart, which helps decrease the swelling.
  • Avoid exposure to heat (for example, don't use hot tubs or saunas).
  • Wear gloves when you garden, clean your house, or do yard work to avoid cuts and resulting infections.
  • Be very careful when using sharp instruments in the kitchen or while doing craft projects to avoid an injury.
  • Avoid tight jewelry or clothing, other than prescribed compression garments.
  • Avoid blood draws, shots, or intravenous (IV) placements in the affected arm.
  • Ask to have your blood pressure taken in your unaffected arm.
  • Carry your purse on your unaffected arm.
  • Avoid lifting heavy things, including children.
  • Wear long sleeves outside and consider using bug spray to avoid insect bites.

Air Travel

Even if your doctor hasn't recommended that you wear a compression sleeve, ask whether you should do so when traveling by airplane. Cabin pressure changes can worsen lymphedema.

Airplane travel can also increase the risk of blood clots, and this risk is higher if you have or have had cancer. Lymphedema may also increase the risk of blood clots, so be sure to ask your doctor if you should take any special precautions.

A Word From Verywell

Lymphedema itself is not necessarily dangerous, but it can be uncomfortable, and there are a few complications associated with the condition. In some instances, lymphedema is the first sign that cancer is spreading, so it is important to let your doctor know if you develop arm swelling for the first time or if your lymphedema worsens.

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