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Advances in medical, radiation, and surgical treatments are extending the lives of many women with breast cancer. But as survival rates increase and more and more women live longer, they also face the possibility of experiencing delayed side effects from their cancer treatments. Among these potential side effects is lymphedema, the abnormal swelling of one or more limbs caused by the accumulation of lymph fluid under the skin.
Usually, lymphedema occurs gradually over time, and it may take months or years after cancer treatment for it to develop. Although experts cannot predict with certainty which women treated for breast cancer will develop lymphedema, research suggests that certain factors, such as being overweight or obese, may increase the likelihood of this complication.
A recent study led by Mei R. Fu, PhD, RN, and an associate professor of chronic disease management at the New York University College of Nursing, reinforces the link between carrying excess weight and lymphedema.
“Obesity is an established risk factor not only for breast-cancer-related lymphedema, but also for breast cancer occurrence, recurrence, and fatality,” Dr. Fu said in a university news release. “Accordingly, we believe obesity is a significant, but modifiable, risk factor for lymphedema.”
So, if you undergo surgery or radiation for breast cancer, it’s vital to understand what lymphedema is, recognize the warning signs, and work with your cancer-care team to minimize your risk.
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Cancer that originates in the breast, skin, or other areas of the body may progress to nearby lymph nodes and spread throughout the body via the lymphatic system. In many cases, surgery for breast cancer and other forms of cancer requires the removal of one or more lymph nodes and lymph vessels to check for any cancer spread. Radiation also may be recommended after surgery for patients with cancer found in the lymph nodes.
Removing the lymph nodes and vessels from under the arm during breast cancer surgery or damaging them with radiation therapy can make it more difficult for lymph fluid to flow out of the breast, arm, and chest, raising the potential for fluid accumulation and the characteristic swelling of lymphedema.
Keep a watchful eye out for the signs of lymphedema:
- Swelling in the arm, hand, shoulder, breast or chest. For some women, lymphedema may manifest only as mild swelling that’s barely noticeable, but for others it can be significant enough to affect arm movement or flexibility.
- A feeling of heaviness or fullness in the affected area.
- Changes in your skin’s texture (such as tightness, hardness or redness).
- Aching, discomfort or tingling sensations in the affected area.
- Difficulty fitting into your bra, jacket, or shirt sleeves.
- Tighter fitting rings, bracelets, or watches.
After breast cancer surgery or radiation, periodically check your upper body in the mirror and look for any swelling or changes in your skin, so you can identify any potential trouble spots and seek treatment as soon as possible.
Reduce Your Risk
The more lymph nodes removed during breast cancer surgery, the higher the risk of lymphedema, according to the American Cancer Society (ACS). Women treated with radiation therapy also face a greater risk.
While you may not be able to change these risk factors, you do have control over another one: your weight. In Dr. Fu’s study, 136 women, average age 52, who underwent breast cancer surgery were followed for a year; more than 60 percent of the participants were obese or overweight. At the one-year mark, nearly three-quarters of the study participants had maintained their pre-surgery weight, 15.4 percent had lost more than 5 percent of their body weight, and 12.5 percent had experienced weight gains greater than 5 percent. Lymphedema occurred more commonly in the participants with a body mass index greater than 30 (signifying obesity) throughout the study period, the researchers reported.
“General instructions on having nutrition-balanced and portion-appropriate diet and physical activities daily or weekly can be effective to maintain pre-surgery weight,” Dr. Fu said in a statement. “Such general instructions may create less burden and stress to women when facing the diagnosis and treatment of breast cancer.”
In addition to maintaining a healthy weight via a healthy diet and exercise, experts recommend these tips to help reduce your risk of lymphedema after breast cancer treatment:
- Use your affected arm to perform normal activities of daily living, like brushing your hair. Doing these gentle activities can help you heal, rebuild your strength, and help drain lymph fluid from your arms. However, talk to your doctor and/or a physical therapist certified in lymphedema management about much you should use your affected arm, how soon after treatment you can resume exercise and other strenuous activities, and which exercises are appropriate for you.
- Keep your arms clean, and take precautions against cuts, scrapes or burns, which can lead to infection. In response to infection, your body sends additional lymph fluid carrying infection-fighting white blood cells, and this extra fluid can cause or exacerbate lymphedema.
- Elevate your arm above the level of your heart, to promote fluid drainage.
- Wear loose-fitting clothing, bras, and jewelry, avoiding anything that fits tightly around your arm or chest. Have your blood pressure measured on your unaffected arm.
Lymphedema is not curable, but several treatments can help ease swelling and keep it from worsening. Your doctor or a certified lymphedema therapist may guide you on gentle exercises that encourage fluid drainage in your arm.
These specialists also may perform a massage therapy known as manual lymph drainage and instruct you on the use of special bandages or compression garments on your arm, all of which can help improve the flow of fluid from your arm back to your trunk. Be sure to review any compression garments or bandaging techniques with your healthcare specialist, as using them incorrectly may actually increase your risk of, or worsen, lymphedema.
Originally posted in June 2016 and updated.