Breast Cancer Basics: Lymphedema

Up to 5 million Americans suffer from lymphedema, mostly as a result of cancer treatment. This is a chronic condition that can develop as a consequence of surgery and/or radiation therapy to the lymph nodes in the neck, armpit, pelvis and groin areas, leading to impaired flow of lymph fluid through the draining lymphatic vessels and lymph nodes. This can cause lymph fluid to accumulate in the dependent tissues. Without intervention, lymphedema can lead to progressive swelling, fibrosis of the soft tissues, neurologic changes (i.e, pain and/or paresthesias), and infection. Early identification of the signs and symptoms of lymphedema is essential to the management of all patients who have received surgery and/or radiation to lymph draining regions. When treated in the earliest stages, complications of this condition may be minimized.

Dr. Lawenda’s Comprehensive Article on Cancer-Related Lymphedema

Several Factors Influence Your Risk of Developing Lymphedema:

For instance, the extent of treatment to the lymph node region (if you undergo both surgery and radiation therapy, your risk is significantly higher than if you just had either of these two treatments alone), obesity, and surgical infections in the draining lymph node regions

Lymphedema Typically Progresses in Stages and Severity:

  • The earliest stage (“stage 0”) starts with a feeling of heaviness or tightness, aching or discomfort of the affected limb. Stage 1 is characterized by soft, pitting edema with no noticeable fibrosis (skin thickening). Prolonged elevation of the limb above the level of the heart leads to complete resolution of the swelling.
  • Stage 2 presents with mild skin fibrosis, decreased skin suppleness and pitting edema. Skin infections are more common in this stage, due to decreased flow of immune cells into the affected tissues.
  • Stage 3 involves severe skin fibrosis, increase in tissue volume and the development of papillomas, cysts, fistulas and hyperkeratosis. Skin folds on the wrists and ankles deepen , and the risk of recurrent bacterial or fungal skin infections increases significantly. (REF)

Reducing Your Risk:

Early detection and treatment of lymphedema is of the utmost importance, as the sooner lymphedema is diagnosed, the greater your chances are of being able to more effectively treat it.  Once lymphedema has progressed to more advanced stages, it becomes increasingly difficult to return the affected tissues to their pre-treatment state.  Nevertheless, all stages of lymphedema can and should be treated to prevent worsening symptoms and complications.

To reduce the risk of developing lymphedema, it’s best to discuss with your surgeon or radiation oncologist if the treatments you will be receiving could place you at a higher risk. If so, ask for a referral to a certified lymphedema therapist (CLT). CLT’s have received specialized training and certification in the diagnosis and management of lymphedema. At your CLT consultation, they take baseline measurements of your limbs and will educate you about arm or leg care during and after treatment. Any risk factors that may put you at an increased risk for the development of lymphedema will be noted. Find a qualified CLT here:

Diagnosing Lymphedema:

There are several, non-invasive ways to assess whether you have lymphedema:

  • Tape measurement diameter comparisons of opposing limbs
  • Volume measurement comparisons of opposing limbs using water displacement techniques
  • Infrared optoelectronic volumetry employs a computerized analysis of limb volume
  • Bioimpedence measurements of interstitial fluid using bioimpedance spectroscopy devices (i.e. SOZO device)

Treating Lymphedema:

Once lymphedema is diagnosed, treatment should begin quickly. While there are no curative treatments, the sooner treatment is started the better the outcomes of reversing the overt clinical symptoms. The goals of treatment are to decrease the excess volume as much as possible and maintain the limb or other affected tissues (i.e. breasts, neck, abdomen, back) at its smallest size.

The most common treatment is called complete decongestive therapy (CDT), which involves a treatment and a maintenance phase. The treatment phase, lasts 2 to 4 weeks in duration. During this time, the patient receives treatment on a daily basis, 5 days per week. The span of the treatment phase is dependent on the patient’s response to therapy. Once the patient’s tissue measurements have plateaued and maximal benefit is achieved, the patient begins the maintenance phase, which consists of life‐long self‐care to maintain the size of the limb.

The treatment phase of CDT consists of 4 components: skin and nail care, manual lymphatic drainage (MLD), compression bandaging, and therapeutic exercise:

  1. The first step of CDT is MLD, a manual technique that is performed to stimulate the flow of lymph fluid in superficial lymphatic vessels. MLD is a massage‐like technique that is performed for 30 to 60 minutes not only on the affected tissues but also other areas of the body to improve lymphatic flow.
  2. The skin and nail care component consists of inspecting the affected tissue to confirm that they are free of any cuts, scratches, areas of irritation, or signs of infection. A pH‐balanced moisturizer is applied to tissues before compression bandaging.
  3. The next step of CDT, after MLD, is the application of compression bandaging to the affected tissues. This is worn 24 hours per day during the treatment phase. It consists of padding materials and short‐stretch bandages, which apply pressure during movement to stimulate the flow of lymph fluid in the superficial lymphatic vessels.
  4. The final step of CDT is therapeutic exercise. Exercises are performed with the compression bandages in place to increase lymph fluid flow during limb movement through a comfortable range of motion.

Once the patient reaches a plateau in volume reduction for the affected tissues, the patient begins the maintenance phase. The maintenance phase is a life‐long, self‐care program. During this phase, the patient continues with a daily home maintenance program that includes:

  • Self‐MLD
  • Skin and nail care
  • Compression garments worn during waking hours and compression bandaging at night, if necessary
  • A home exercise program that includes both aerobic and low‐load resistance exercises

Dr. Lawenda Talks About Breast Cancer-Related Lymphedema (2012)

Dr. Lawenda’s Lymphedema Patient Information Page