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 lymphatic ducts.
Lymphedema can be a hereditary condition (primary)(rarely), or caused by injury to the lymph nodes or ducts (secondary)(commonly).
Most commonly, lymphedema in an arm, occurs after the treatment of breast cancer. Breast cancer treatment often requires surgery, axillary lymph node dissection, or radiation therapy, and any of these can cause lymph-edema.
However, a 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, fatigue, and fluid accumulation in other areas of the body.
Breast cancer staging using sentinel lymph node dissection is much less likely to bring about lymphedema
When breast cancer is being diagnosed and staged, it is quite common to take a sentinel lymph node biopsy to check for lymph node metastasis. If the results are positive or suspicious for metastatic breast cancer, an axillary lymph node dissection may then be performed. Women in which only a sentinel node dissection was performed have a significantly lower rate of lymphedema 5 years later.
Lymphedema is quite common following breast cancer treatment
Statistics show that breast cancer related lymphedema occurs in about 13% of breast cancer surgeries, with an average time of about 8 to 9 months before it occurs.
There is some evidence to suggest that obesity may cause a women to be slightly more likely to develop lymphedema following breast or axillary surgery. The deeper the fat layer, the harder the surgeon finds it to identify landmarks in the axilla while dissecting, and lymphatic ducts are injured more commonly.
Risk of secondary lymphedema may increase with air travel and use of tamoxifen
There is some evidence to suggest that secondary 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. Blood clots in 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
Lymphedema is usually treated wither by complete decongestive therapy or by sequential gradient pump therapy. Antibiotics may be also be used if there is infection or threat of infection. New statistical evidence is now suggesting that women with metastatic breast cancer but 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, feeling of heaviness or tightness, restricted range of motion, aching or discomfort, recurring infections, and hardening/thickening of the skin (fibrosis).
- How is lymphedema caused? 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 your 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. These causes include surgery, radiation treatment, cancer, and infection.
- What are the causes of primary lymphedema? Primary lymphedema is a rare, inherited condition caused by problems with the development of lymph vessels. These causes include Milroy’s disease (congenital lymphedema), Meige’s disease (lymphedema praecox), and late-onset lymphedema (lymphedema tarda).
- What are the known risk factors of lymphedema? Older age, excess weight or obesity, and rheumatoid or psoriatic arthritis.
- 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, and/or 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 exercises, wrapping the lymphedema area, massage, pneumatic compression, compression garments, and 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.