What every woman should know about breast cancer related lymphedema Francis Bevern, (name changed to protect patient identity) had to stop wearing her wedding ring. Even though her husband had died a few years back, she wanted to keep wearing the ring as a reminder of their relationship. But taking off the band was a necessary step because it didn’t fit her swelling finger. She had trouble fitting into her jacket and blouse sleeves and she experienced an odd and restrictive feeling in her arm and shoulder. Stepping on her scale revealed she hadn’t gained any weight and she started to question the reasons for her newfound swelling. At that time she didn’t know that her recent breast cancer surgery had put her at risk for developing infections and fluid build-up in her arm due to breast cancer related lymphedema (BCRL). The highest incidence of lymphedema, a common and serious condition affecting at least three million Americans, is observed following breast cancer surgery, particularly among those patients who undergo radiation therapy following the removal of axillary lymph nodes. Many of these individuals will develop (BCRL). BCRL is one of the most concerning and prevalent secondary complications of breast cancer treatments. “Research indicates that approximately 25 percent of patients develop lymphedema after breast cancer surgery. But for those who also undergo radiation therapy, the development of lymphedema increases to 38 percent,” according to the American Physical Therapy Association’s - “Physical Therapy Journal.” Lymphedema is a condition characterized by swelling in one or more extremities that result from impaired flow of the lymphatic system. It’s a complex matrix of specialized glands and vessels that spans throughout our bodies. A very simplistic example of this system can be likened to water going through a heavy duty nylon stocking. If the hosiery gets kinked, fluid would seep out above the kink. And fluid will descend with time and gravity.
Our complex network of specialized vessels also has fluid being efficiently transported. If our system gets “kinked,” the excess fluid will be blocked and result in localized swelling. There are many reasons for the blockages. Lymph node dissection disrupts lymphatic flow and results in a build-up of pressure in the vessel walls, causing them to distend and can lead to a backflow of fluid and blockage. This blockage obstructs the main lymphatic route and fluid can’t exit into their appropriate site. Not having enough lymph glands or too many damaged lymph glands can impair our system. Radiation treatment can scar and harden tissue and the surrounding specialized lymph vessels to the point of excess fluid accumulating in the upper extremity and chest. Lymph nodes are exquisitely susceptible to radiation treatments. If lymph nodes become impaired, they can’t filter the fluid and waste. And the stagnation of fluid provides a breeding ground for bacteria. That’s why lymphedema makes people more susceptible to infection. Any opening in the skin, (an insect bite, dry-cracked skin, or a knick while shaving the underarms) should be closely monitored and discussed with a doctor for signs of infection. Understanding the importance of lymphedema and the lymphatic system is paramount to Stanley Rockson, MD, director for Stanford University’s department of Lymphatics and Venous Disorders. “I think the easiest way to think of the lymphatic system is to imagine if you would build a house with bricks you would need mortar and although the mortar is not what the focus is on, it is really what holds the building together,” states Dr. Rockson during an online video representation at the Lymphatic Research Foundation. According to the American Cancer Society, “Recent studies are trying to find lymphedema early and treat it right away to help better control it. If you notice tingling or strange sensations in your arm after surgery, talk with your doctor, even if you haven’t noticed swelling. If you feel uncomfortable, ask your doctor to refer you to a specialist who’s an expert in managing lymphedema.” “If possible, ask to be referred to complete decongestive therapy (CDT). The therapists that have CDT among their title shows additional certification given to state licensed physical and occupational therapists that have undergone specialized training consisting of manual lymph drainage and compression wrappings,” states Mindy McCleery, director of rehabilitation for a facility that specializes in comprehensive outpatient therapy as well as lymphedema therapy. “Those who are experts in this condition can make lymphedema better,” she says. “It’s also important to know the best exercises to mitigate the effects of this condition. And there are so many ways to avoid infection and episodic flare-ups.” McCleery says that
overuse can result in injury and has also been linked to the start of lymphedema in some women. “If you’ve had surgery or radiation treatment, ask your doctor or therapist when you can initiate exercise. Then start working with a well-trained health professional to design a therapeutic regimen. With the proper education and treatment, you should notice improved function and quality of life,” she says.
Published in Our Colorado Health Magazine – September 2013