Lymphoedema

Lymph is fluid that forms in the body and drains into the bloodstream through a network of lymphatic vessels and lymph nodes. The lymph nodes filter the fluid, trapping bacteria, cancer cells and other particles that could be harmful to the body. Lymph nodes are found in many places around the body, including the armpit (axilla), chest and neck. 

The lymph nodes in the armpit (axilla) are often the first place that breast cancer will spread outside the breast. Many people with breast cancer have at least two or three lymph nodes removed (sentinel node biopsy) and sometimes many nodes removed (axillary lymph node dissection) as part of the surgical treatment for breast cancer. 

When lymph nodes are removed during breast cancer surgery or treated with radiotherapy, the flow of fluid from your breast and arm can be restricted, causing fluid to build up in the tissues under the skin. This swelling is called lymphoedema. Lymphoedema can occur in the arm, hand or chest wall on the side of the body that was treated. 

Most people who have treatment for breast cancer do not develop lymphoedema, but it is important to be aware of your risk. People who have a sentinel node biopsy during surgery have a low risk of developing lymphoedema. The risk of lymphoedema is increased for people who have extensive axillary lymph node dissection or radiotherapy to the axilla. 

Reducing your risk 

If you need axillary (armpit) lymph nodes removed as part of your treatment for breast cancer, early intervention and surveillance are important in reducing your risk of developing lymphoedema. Ask your doctor or breast care nurse if baseline measurements of the lymph flow in your hand and arm can be taken before your surgery.

This is done using Bioimpedance Spectroscopy to give an L-Dex score. This is a quick and painless process. The measurement should be done at regular intervals following your surgery so that any changes to your lymph flow are detected even before visible changes are obvious. This means that management and care can be started early and help prevent any lymphoedema becoming a complex and chronic condition. 

You can do many things to help reduce your risk of developing lymphoedema following surgical removal of lymph nodes, including taking care of your skin and keeping active. 

Taking care of your skin: 

• Keep your skin moist using a moisturising cream such as Sorbolene. 
• Protect your skin from the sun with clothing and sunscreen. 
• If shaving your armpit, use an electric razor instead of a wet razor. 
• Use insect repellent and, if bitten, use a product to reduce the itchiness of the bite. 
• Protect your hands with gloves while washing dishes or gardening. 
• Treat any cuts or breaks to the skin with antiseptic. 
• If a cut, bite or break to the skin becomes red or inflamed, or if your arm swells quickly or becomes red and warm, see your doctor as soon as possible as you may have an infection that requires antibiotics. 

Keeping active: 

• Ensure that you do your arm and shoulder exercises after surgery, as directed by your physiotherapist. Regular exercise, including resistance training, causes muscle contraction which helps to push lymph fluid through the lymph channels, reducing the chance of swelling. Following surgery, gradually build up the amount of exercise you do. Check with a lymphoedema therapist if unsure. 
• Use your affected arm normally for daily activities. 
• Maintain a healthy weight and eat a well-balanced diet. 

Early intervention 

Be aware of the signs of lymphoedema (see below). It’s important to contact your doctor if you develop symptoms of lymphoedema for management. Early detection and early intervention can often prevent lymphoedema from developing or prevent it from getting worse. 

Here are some general tips that can help prevent and manage lymphoedema: 

• Apparel – avoid tight clothing such as bra straps or jewellery on your affected arm. 
• Travelling – there is no strong evidence that air travel or other long trips by car or train trigger lymphoedema. Doing gentle exercise such as clenching and unclenching your fist or moving your arm during long journeys can reduce the risk of swelling. For people who have a high risk of developing lymphoedema or have lymphoedema, wearing a well-fitted compression garment prior to travelling is important. Talk to your lymphoedema therapist about any travel plans you may have for advice. 
• Injections and blood pressure measurements – for people who have had lymph node surgery and have not developed lymphoedema, there is no strong evidence that you should avoid having injections or your blood pressure taken on the arm of your affected side. For those who have lymphoedema, an alternative site is recommended for these procedures but not always essential and should be discussed with your lymphoedema therapist for individual advice. 

Symptoms 

Although there is a lifelong risk, most people who are going to develop lymphoedema do so within the first two years following surgery.  

The early symptoms of lymphoedema include: 

• swelling of the arm, breast or hand of the affected side (i.e. (your rings, sleeves or wristbands may feel tight) 
• feelings of discomfort, heaviness or fullness in the arm or breast 
• aching, pain, tension in the arm, shoulder, hand, chest or breast area 
• transient swelling (comes and goes) 
• dry skin 
• infection in the arm on the affected side. 

If you have any of these symptoms, it is important that you see your doctor so that you can be referred to a lymphoedema therapist for assessment. 

Assessment 

If you are showing signs of lymphoedema or at risk of developing lymphoedema, it is important that you see a suitably qualified person, such as a physiotherapist or occupational therapist who has been trained in the management of lymphoedema, for an assessment of your individual situation.  

Early detection and early management are important to prevent the condition from worsening. Together with your practitioner, you will develop a tailored a plan to effectively manage your lymphoedema or your risk of developing lymphoedema.  

Visit the Australasian Lymphology Association (ALA) website to find an accredited lymphoedema practitioner in your area.  

Treatment

Although there is no cure for lymphoedema, good management generally enables people with lymphoedema to live normal lives.  

The aims of lymphoedema treatment are to: 

• reduce swelling  
• improve movement and function  
• prevent infection 
• enhance quality of life. 

Treatment for lymphoedema may involve: 

• education about skin care and ways to reduce your risk of infection 
• exercise 
• specialised massage called manual lymphatic drainage  
• compression therapy to reduce swelling and improve lymph flow – this may involve bandaging and/or wearing a compression sleeve or using a compression pump. 

Compression garments

Lymphoedema compression garments such as a sleeve or vest are an important part of lymphoedema treatment. The compression garments need to be properly fitted by a lymphoedema practitioner to ensure they are effective.

Each state and territory in Australia has subsidies available to help cover the cost of the garment. For more information about compression garment schemes in your state or territory, visit the Australasian Lymphoedema Association website.