After breast cancer: Preventing lymphedema

By Elsa Mitchell, DPT, CLT, physical therapist and certified lymphedema therapist, Providence Clackamas Rehab

Lymphedema affects as many as 56 percent of women after breast cancer treatment. This abnormal accumulation of fluid, or “edema,” is caused by a blockage of the lymphatic system. Often first noticed as a swelling, heaviness or tightness in the arm, hand, wrist, fingers, breast or torso on the same side as the affected breast, it can happen right after surgery or radiation, or years later. Since a healthy lymphatic system is a crucial part of the immune and circulatory system, every woman who has been treated for breast cancer should learn about the signs, symptoms and management of lymphedema.

Think of the lymphatic system as a system of rivers that carries proteins and white blood cells – the key immune system defenders – throughout the body, fighting infections and keeping everything clean. When the flow becomes blocked by damage from surgery, radiation or infection, the lymphatic fluid builds up like a river behind a dam. The results are swelling from the fluid buildup, impaired drainage, reduced ability to remove contaminants, and increased risk of infection.

Although there is no cure for lymphedema, it can be controlled and prevented with diligent skin care and proper exercise.

Prevent infections with good skin care

Any damage to the skin sends the lymphatic system to the rescue. However, if your lymphatic flow is compromised or blocked, it has a harder time getting in to do its job, and then getting out when it’s done. The slow-moving fluid that accumulates in the lymph system increases, rather than decreases, the risk of infection.

The more you can do to reduce injury, infection or constriction to the affected arm, hand and fingers, the lower your chances of developing lymphedema. Following these guidelines from the American Cancer Society and the National Lymphedema Network will help:

Avoid blood pressure checks and injections in the at-risk arm – whenever possible, use the opposite arm.

Keep the arm clean and dry – wash daily, and again if you get dirty or perspire. Avoid vigorous scrubbing, and dry your arm thoroughly.

Apply moisturizer daily to prevent the skin from chapping, chafing or cracking.

Be careful with nail care – do not cut your cuticles or pick at hangnails.

Take care with razors – avoid nicks and skin irritation.

Wear loose-fitting clothing – avoid anything that constricts your hand or arm in one spot, such as tight sleeves and watchbands.

Avoid repetitive lifting and heavy carrying – don’t carry heavy handbags or bags with over-the-shoulder straps that pull on the affected arm.

Wear gloves in the garden and kitchen to protect your hands and prevent injury or infection.

Protect exposed skin with sunscreen and insect repellent.

Do your best to avoid cuts, scratches, insect bites, burns and strong detergents. Wash cuts and scrapes immediately with soap and water; apply antibiotics and observe for signs of infection.

Watch for signs of infection: If you develop a rash, itching, redness, swelling, tightness, pain, hot skin, fever or flu-like symptoms, contact your physician immediately.

Keep the river flowing with appropriate exercise

Following breast cancer treatment, your physician or surgeon may advise you to limit the use of the arm on your affected side while your tissues are healing. Once they have healed, though, it is important to start regaining your strength and range of motion through gentle stretching, progressive resistance exercises, and aerobic conditioning. Since the lymphatic system does not have a heart to pump its fluid, it requires muscle contractions and deep breathing during exercise to act as its pump and increase lymphatic flow.

Current research has shown that exercising and maintaining your ideal body weight not only may reduce your risk of developing lymphedema – it also can reduce your risk of cancer recurrence.

Exercise helps keep your lymphatic rivers flowing freely, but like anything, it can be overdone, so be sure to keep the lines of communication flowing with your health care team regarding the types of exercise that are appropriate. Here are some guidelines for starting safely:

  • First, get clearance from your medical team.
  • Stay well hydrated.
  • Do not fatigue the affected arm.
  • Build up the time and difficulty of any activity or exercise very gradually. This includes gardening, cleaning or any other daily activities that increase your heart rate.
  • Pace yourself and take frequent breaks during activity to allow your arm to recover.
  • Monitor the arm, wrist and fingers during and after activity for any change in size, shape, texture, soreness, heaviness or firmness compared to the opposite arm.
  • Ask your doctor for a referral to a certified lymphedema therapist to assess whether or not you need a compression garment, and to fit you properly. These garments prevent fluid accumulation during activities that increase lymphatic flow. If recommended, wear it during exercise, cleaning, heavy lifting and air travel.

If you do notice signs of lymphedema, contact your physician. You may be referred to a physical therapist with special training in the management and treatment of this condition. A certified lymphedema therapist can provide education on proper skin-care techniques, manual lymphatic drainage (a massage technique that works to reroute the fluid through your remaining healthy lymphatic vessels), compression bandaging or fitting for appropriate compression garments, and instruction in safe and appropriate exercise progression.

Through education, diligent skin care and proper exercise, most women can reduce their risk of lymphedema and keep their lymphatic system flowing.

For more information, see these resources: