Lymphedema is swelling caused by a build-up of lymph fluid in the surface tissues of the body.
This may happen as a result of damage to the lymphatic system because of surgery or radiotherapy to the lymph nodes under the arm (axilla) and surrounding area.
Sometimes lymphedema can be caused by cancer cells blocking the lymph system.
Lymph is made up of water and protein and also contains white blood cells called lymphocytes, which help your body fight infection.
The lymph nodes help fight infection by filtering out waste products like bacteria. They can also filter out cancer cells that have spread from a breast cancer, destroying some of them in the process.
Swelling often happens in the arm or chest area immediately after breast surgery. This is part of the healing process and usually settles within a short time without any treatment, but it’s important this is checked by your specialist team.
Swelling in the hand, fingers, arm, breast or chest can occur on the side of the body you had your surgery or radiotherapy.
The arm or breast can feel tight when there is extra fluid in the tissues. Some people feel tightness in the arm without the arm appearing swollen. Gentle exercise can relieve this feeling.
- Dry skin
Where there is swelling the skin is stretched and can become dry, flaky, itchy and prone to infection. Try to keep the skin clean by washing gently and avoiding soaps that dry out the skin. Dry your arm and hand thoroughly after washing and use an unperfumed moisturizing cream to help keep the skin supple and moist. This will help protect the skin and ease these symptoms.
- Arm stiffness
If your arm is swollen, it may limit movement in the joints. It’s important to exercise your arm and shoulder regularly to reduce stiffness and encourage lymph fluid to drain. If you were given specific exercises after your surgery or radiotherapy, it is very important to continue doing them for as long as recommended.
Some people will experience discomfort with lymphedema. This may be a tight, heavy feeling in the arm or breast, and the discomfort tends to be dull and vague. Discomfort often occurs after strenuous activity.
To help relieve this, try doing some gentle exercise. When you’re sitting, rest your arm on a pillow or cushion (but not so that it’s above the height of your shoulder). If the discomfort continues or you feel pain, it’s important you contact your specialist team.
TREATMENTS FOR LYMPHEDEMA
The aim of treatment for lymphedema is to encourage lymph fluid to move away from the swollen area, to try and improve symptoms and stop them getting worse. The way this is done will depend on how severe your lymphedema is, but your treatment may include some, or all, of the following approaches at different times. You can do quite a lot of these yourself alongside any professional treatment you are having
Skincare is important because having excess lymph fluid in the arm or chest area, together with having fewer infection-fighting lymph nodes, increases the risk of infection. Small breaks in or damage to the skin, or some skin conditions which cause the skin to become red and sore, can become a site for infection. Dry, flaky or cracked skin can also lead to infection and make controlling any swelling more difficult. If an infection develops it can lead to further damage to the lymph system due to scarring, and may make the lymphedema worse.
Exercise will keep your joints supple and encourage muscle activity which is very important for lymph drainage. Although you may already use your arm actively in your everyday life or work and get plenty of exercise in this way, swelling can sometimes restrict movement of the arm and extra exercises may be helpful.
Sport and fitness Sports and activities that you did before you developed lymphedema and those you wish to take up now are still possible, as long as you return to/start them slowly and stop if you have any discomfort or you notice further swelling. If you want to increase your activity levels or take up a new sport, make sure you do it gradually. Research suggests that exercise is helpful when you have lymphedema and does not make the lymphedema worse.
General activities try not to use the affected arm for lengthy, strenuous activities such as lifting, carrying heavy objects or pushing heavy equipment like lawn mowers. If you need to do these activities, try to do other things in between to break up the length of time spent on them.
- Maintaining a healthy body weight
Being overweight can affect how you respond to treatment for lymphedema, so it’s important to try to keep your weight within normal limits. There’s no specific diet that will help but if you are overweight, try to follow a healthy, well-balanced eating plan and a regular exercise programme
- Compression garments
If the swelling is in your arm and/or hand you may be fitted with a compression garment in the form of a sleeve and/or glove to help control your lymphedema. If the swelling is in your breast or chest wall area, you may be fitted with a compression bra or vest. Your lymphedema specialist will assess which size and type of garment is best for you and this will usually be available on prescription.
Compression garments are designed to reduce existing swelling and prevent further swelling by encouraging lymph fluid to drain away from the affected arm. The garment provides a firm resistance against which the lymph vessels are squeezed by the muscles during activity. This allows the lymph fluid to move up the arm more effectively. Wearing the garment may feel quite strange at first but it should feel comfortable and supportive. You will normally be provided with two garments so that one can be washed while the other is being worn.
The average life span of a compression garment is about six months, after which it loses some of its elasticity and effectiveness. Therefore, make sure you contact your breast care nurse or lymphedema specialist to request new garments.
If you find the garment difficult to cope with, and your lymphedema specialist has checked that it fits correctly, try wearing it when you are most active and then take it off when you are least active. The compression garment is most useful when your muscles are working actively and least useful during rest. Evidence is limited to support the use of compression garments during air flight in people with lymphedema.