February 5, 2009

Preventing Lymphedema, Maintaining Quality of Life

Lymphedema (poor lymph flow) is the buildup of lymph fluid in the tissues just under the skin. As the blood travels into smaller and smaller vessels, excess fluid, protein and other substances are pushed out into the surrounding tissue. The combination of these substances is called lymph fluid. Under normal circumstances, lymph fluid is removed from the tissues by the lymph system, which is a series of vessels and organs that move the fluid back toward the heart and filter it through lymph nodes. Lymph nodes are specialized structures that are composed of white blood cells and serve to “clean” the lymph fluid of bacteria or other contaminants. If there is damage to or blockage in the lymph system, the lymph fluid cannot be removed and builds up in the tissues.

Lymphedema is caused by blockage or damage to the lymph system. It may be caused by cancer treatment or the cancer itself. The primary cause of lymphedema is damage to the lymph system by surgery or radiation, particularly when these treatments are applied to the underarm, groin, pelvic, or neck regions. Lymphedema commonly occurs in patients with breast cancer who had lymph nodes removed in the underarm and/or received radiation to that area. Swelling may occur immediately after treatment, or it may arise weeks, months or even years later.

Lymphedema that is caused by the cancer itself is usually related to:

  • Spread (metastasis) to the lymph nodes in the neck, chest, underarm, pelvis or abdomen
  • Growth of cancer in the pelvis or abdomen that block lymph drainage by invading or putting pressure on the lymphatic vessels and/or the large lymphatic duct in the chest

Preventing Lymphedema Can Start with Selecting Cancer TreatmentLymphedema occurs less frequently now than in the past because of improved surgical techniques. Historically, when breast cancer was thought to spread to the lymph nodes, the surgeon would remove as many lymph nodes as possible. This approach would sometimes cause severe lymphedema. Recently, a technique has been developed that makes it possible to remove only one lymph node, called the sentinel node. The sentinel node is the first node that drains a particular area, such as the breast. In a sentinel node biopsy, the surgeon injects a dye into the affected area to identify which node is the first to be marked by the dye. If the sentinel lymph node is free of cancer, then it is unlikely any of the other lymph nodes located “downstream” have cancer and they are not removed.

Research now indicates that sentinel node biopsy appears to be just as effective in determining cancer spread to axillary lymph nodes as an axillary lymph node dissection, and results in fewer side effects in patients with early stage breast cancer. 1

Effective Management of Lymphedema Starts with Being Aware of SymptomsUnderstanding and recognizing symptoms of lymphedema at their first onset is important for successful management of this condition. Even a slight increase in swelling in the extremities should not be ignored. Patients should notify their healthcare provider immediately upon noticing any of the following:

  • Feelings of tightness in the arm or leg
  • Decreased flexibility in a hand, elbow, wrist, fingers or leg
  • Difficulty fitting into clothing
  • Ring, wristwatch, bracelet, shoe that fits tighter than usual
  • Pain, aching, heaviness, or weakness in the arm or leg
  • Redness, swelling, or signs of infection
  • Skin that feels stiff or taut
  • Pitting (small indentations left on the skin after pressing on the swollen area)

Staying Vigilant: Lifestyle Choices Can Help Prevent LymphedemaWhile newer treatment techniques reduce the number of lymph nodes removed, some patients still develop symptoms. A few lifestyle changes can also help prevent lymphedema. The basic principles for preventing lymphedema are to minimize any increases in lymph production and minimize and impediments to lymph flow.

Circumstances that tend to increase lymph flow and should be avoided include:

  • Extreme heat from saunas, hot tubs or heating pads
  • Strenuous, fatiguing exercises
  • Airplane travel and high altitudes (increased pressure)
  • Excessive sun exposure

Avoiding the following can help minimize any impediments to lymph flow:

  • Blood pressure monitoring on affected arm
  • Restrictive clothing or jewelry
  • Extreme cold (like an ice pack)
  • Carrying a handbag or luggage with affected arm

Furthermore, attention to health and hygiene improves overall health and can also help prevent lymphedema:

Hygeine: Clean the skin of the arm or leg daily, but avoid rigorous scrubbing. Keeping the affected arm clean can reduce the risk of infection, which is higher among patients experiencing lymphedema because of the decreased capacity of their lymphatic system to carry bacteria away from the tissues. There is also a higher presence of protein and oxygen in the spaces between the cells, providing an environment where bacteria can flourish.

Exercise: The muscle contraction of moderate exercise promotes lymph flow and an increased absorption of protein. However, fatiguing exercise can actually increase the production of additional fluid. Therefore patients should consult with a doctor to determine the most beneficial type of exercise and do the prescribed exercises regularly.

Diet: Maintaining an ideal weight and following a healthy, low-fat, low-sodium diet is associated with improved overall health that may hinder the development of lymphedema.

References1)Veronesi U, Paganelli G, Viale G, et al. A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer. The New England Journal of Medicine. 2003;349:546-553.

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Tags: Breast Cancer, Uncategorized