Arm Lymphedema following Breast Cancer Surgery
Lymphedema is a word referring to the problem of having fluid building up and causing swelling in a limb, usually due to a blockage of thelymphatic ducts.
Lymphedema can be a hereditary condition, although this is very rare. More commonly, an injury to the lymph nodesor ducts is the cause of lymphedema.
Most commonly, arm lymphedema occurs after the treatment of breast cancer. Breast cancer treatment often requires surgery, axillary lymph node dissection or radiation therapy. Unfortunately, any of these procedures can cause lymphedema.
However, arm lymphedema will not necessarily happen right away, but may develop months or even years after the initial therapy.
In terms of symptoms, lymphedema associated with breast cancer surgical treatments can often cause:-
- a heavy and swollen limb
- skin discoloration
- fluid accumulation in other areas of the body
Sentinel lymph node Biopsy is much less likely to cause Arm Lymphedema
When doctors diagnose and stage breast cancer, it is quite common now to take a sentinel lymph node biopsy to check for lymph node metastasis.
If the results are positive or suspicious for metastatic breast cancer, surgeons may then perform an axillary lymph node dissection. For women who undergo only a sentinel node biopsy there is a significantly lower rate of arm lymphedema 5 years later.
Arm Lymphedema is quite common following breast cancer treatment
Statistics show that arm lymphedema occurs in around 13% of breast cancer surgeries. Furthermore, the average time span that arm lymphedema develops after surgery is about 8 to 9 months.
There is some evidence to suggest that obesity may cause a woman to be slightly more likely to develop arm lymphedema following breast or axillary surgery. The deeper the fat layer, the harder the surgeon finds it to identify landmarks in the axilla whilst dissecting. Thus the lymphatic ducts are injured more commonly.
Risk of secondary arm lymphedema may increase with air travel and use of Tamoxifen
There is some evidence to suggest that secondary arm lymphedema development in post-surgery breast cancer patients may be associated with air travel.
Lymphedema in the legs has also been attributed to the use of tamoxifen (breast cancer hormone therapy) which may contribute to the development of deep vein thrombosis and blood clotting. However, blood clots in the legs, is a completely different issue.
IV and needle pokes on the affected side of body
There’s an old wives tale, told by generations of surgeons and oncology nurses, telling women who had breast cancer surgery, to avoid having needle pokes and IVs into the arm that is on the same side as her breast cancer surgery. There is NO EVIDENCE published on this, and I can only give anecdotal counter-evidence saying that throughout my career, I have told every breast cancer patient I met, that it was bogus.
I’ve performed thousands of PICC lines, 99% in the left arm, and 50% of breast cancer patients had left-side surgery, and none of them developed lymphedema from it. Simply, the plumbing of lymphatic ducts that converges from the arm in the level 3 axilla region, is VERY FAR AWAY from the arm veins used for blood-drawing for blood tests, or for IVs or PICC lines. So far distance, there is no causal relationship.
Treatment by either mechanical means or by medication
New statistical evidence is now suggesting that women with metastatic breast cancer who never develop lymphedema tend to live about 1 to 2 years longer than women who do develop lymphedema. The reasons for this discrepancy remain unclear.
Below are a few common Q&A about this topic:
What can cure lymphedema?
There is no cure for lymphedema, but it can be managed with early diagnosis and diligent care of your affected limb.
What are the lymphedema symptoms?
Some signs and symptoms include:-
- swelling of the limb or limbs
- feeling of heaviness or tightness
- restricted range of motion
- aching or discomfort
- recurring infection
- hardening/thickening of the skin (fibrosis)
What Causes Arm Lymphedema?
It is most commonly caused by the removal of, or damage to, your lymph nodes as a part of cancer treatment. It results from a blockage in your lymphatic system, which is part of the immune system. The blockage prevents lymph fluid from draining well, and the fluid buildup leads to swelling.
What causes secondary lymphedema?
Any condition or procedure that damages your lymph nodes or lymph vessels can cause lymphedema. The causes include:-
- radiation treatment
What are the causes of primary lymphedema?
Primary lymphedema is a rare, inherited condition caused by problems with the development of lymph vessels. These conditions include:-
- Milroy’s disease (congenital lymphedema)
- Meige’s disease (lymphedema praecox)
- late-onset lymphedema (lymphedema tarda)
What are the known risk factors of lymphedema?
How is lymphedema diagnosed? What are some tests?
If you’ve recently had cancer surgery involving your lymph nodes, your doctor may diagnose lymphedema based on your signs and symptoms.
If the cause of your lymphedema isn’t as obvious, your doctor may order imaging tests to get a look at your lymph system. Tests may include:-
- MRI scans
- CT scans
- Doppler ultrasound
- radionuclide imaging of your lymphatic system (lymphoscintigraphy)
What is the treatment of lymphedema?
Already mentioned, there is no cure for lymphedema. Treatment focuses on reducing the swelling and controlling the pain. Treatments include:-
- wrapping the lymphedema area
- pneumatic compression
- compression garments
- complete decongestive therapy
- Cheifet, O. Management of secondary lymphedema related to breast cancer.z Canadian Family Physician published online (January 2011)
- Kwan, ML, Darbinian, J., Schmitz, KH., Citron, R., Partee, P., Kutner, SE., Kushi, SH. Risk Factors for Lymphedema in a Prospective Breast Cancer Survivorship Study. Arch Surg.(2010);145(11):1055-1063.
- Goldberg JI, Wiechmann LI, Riedel ER, Morrow M, Van Zee KJ. Morbidity of sentinel node biopsy in breast cancer: the relationship between the number of excised lymph nodes and lymphedema. Ann Surg Oncol 2010;17:3278-86.
- Norman SA, Localio AR, Potashnik SL, Simoes Torpey HA, Kallan MJ, Weber AL, et al. Lymphedema in breast cancer survivors: incidence, degree, time course, treatment, and symptoms. J Clin Oncol 2009;27:390-7.
- Lee TS, Kilbreath SL, Sullivan G, Refshauge KM, Beith JM. The development of an arm activity survey for breast cancer survivors using the Protection Motivation Theory. BMC Cancer 2007;7:75.
- Hayes, SC., DiSipio, T., Rye, S., Battistutta, D., Newman, B., Prognostic significance of secondary lymphedema following breast cancer. 2010 Breast Cancer Symposium.
- McLaughlin SA, Wright MJ, Morris KT, Giron GL, Sampson MR, Brockway JP, Hurley KE, Riedel ER, Van Zee KJ. Prevalence of lymphedema in women with breast cancer 5 years after sentinel lymph node biopsy or axillary dissection: objective measurements. J Clin Oncol. (Nov. 2008) 10;26(32):5213-9.