Ask The Helpline: Lymphoedema - the facts

BCNA’s Helpline includes experienced cancer nurses who provide support and information. Though the Helpline can’t provide personalised medical advice, the team can talk to you about concerns you may be experiencing and refer you to supports available to assist you. Here, the Helpline answers some common questions about breast cancer and its treatments.

  • Call our Helpline 1800 500 258 for free and confidential information, support and referral.
  • You can also contact our Helpline by emailing contact@nullbcna.org.au.
  • You can join our online network at bcna.org.au/onlinenetwork.

Lymphoedema

Lymphoedema is swelling that occurs when lymph fluid builds up in the tissue under the skin. In people treated for breast cancer swelling can occur in the hand, arm and chest of the affected side.

Why does lymphoedema occur?

Many people with breast cancer have lymph nodes removed as part of surgical treatment for breast cancer. The procedure removing at least one to three lymph nodes is called a sentinel node biopsy, and having many nodes removed is referred to as an axillary lymph node dissection. If cancer has spread, it is most likely to move into the lymph nodes in the armpit first, as they drain the lymph fluid from the breast. Some people can develop lymphoedema after surgery or radiotherapy to the lymph nodes under the arm and surrounding area. Surgery and radiation can interrupt or damage some of the nodes and vessels that lymph fluid moves through, resulting in a backup of fluid in the tissues. The risk of lymphoedema is low with sentinel node biopsy but increases with more treatment to the armpit, i.e. extensive axillary dissection and radiotherapy.

Early detection of lymphoedema is important to prevent the condition from worsening. It is also important to know that with good management of the condition, people can live normal lives.

Knowing your risk factors and being aware of early symptoms is critical, as lymphoedema is much more likely to be easily managed if identified early.

Symptoms of lymphoedema

  • swelling (oedema) in the hand/arm/chest of the affected side
  • tightness, feeling of heaviness or change in sensation (tingling, numbness)
  • a dull ache
  • arm stiffness, hardness or firmness
  • dry skin.

Reducing your risk

  • Knowing whether you are at high or low risk of developing lymphoedema is important. There are a number of things you can do to reduce your risk of lymphoedema, including:Maintaining a healthy weight by eating a healthy diet and engaging in regular activity such as swimming or resistance training. Starting slowly with exercise and building gradually is the key.
  • Ensuring you do your arm and shoulder exercises after surgery as directed by your physiotherapist.
  • Using your affected arm normally for daily activities.
  • Reducing your risk of infection (cellulitis) that can lead to lymphoedema. Contact your GP straight away if you notice any signs of infection such as heat, swelling, redness, pain or flu-like symptoms.
  • Taking good care of your skin, e.g. keeping it clean, dry and moisturised, protected with gloves if gardening or washing dishes, wearing protection when in the sun, treating any cuts to the skin with antiseptic, using an electric razor to shave your armpit, taking care when cutting nails and applying insect repellent to avoid bites/stings.
  • There is not strong evidence that having injections, taking blood or having your blood pressure taken on an at-risk arm will cause cause lymphoedema. However, you may prefer to use your other arm. It is important you speak to a health professional if you are concerned about any procedures on your affected arm.
  • There is not strong evidence that air travel or cabin pressure triggers lymphoedema. Doing gentle exercises such as clenching and un-clenching your fist or moving your arm during flights or long journeys can reduce the risk of swelling. If you are at high risk of lymphoedema or have lymphoedema already, it is important that you have a well-fitted sleeve prior to flying. This needs to be fitted by a specialist lymphoedema therapist, as an ill-fitting sleeve may also cause problems. Keeping well hydrated is also important. Speak to your lymphoedema therapist for advice before travelling.
  • Other precautions include wearing comfortable clothing and avoiding tight fitting jewellery so as not to impede lymph drainage. The important thing to remember is that early detection and early management can often prevent lymphoedema from developing or prevent it from getting worse.

Managing lymphoedema

To reduce the discomfort and swelling associated with lymphoedema it is important to be assessed and treated. Your GP may refer you to a specialist qualified lymphoedema therapist who will assess your symptoms and discuss the best ways to manage your lymphoedema. Complex lymphoedema therapy (CLT) may include for example, skin care, manual lymphatic drainage, compression bandages/sleeves and other techniques. Your specialist
lymphoedema therapist will discuss the best management plan for you.

Staying active and maintaining a healthy weight is also important. Being overweight can also affect how much your arm swells and the response to treatment. Physical activity is a key way of managing lymphoedema, as moving
muscles encourages lymph fluid to move away from the swollen area. Swimming, cycling, dragon boat racing, running, walking and yoga can all be helpful.

Your lymphoedema therapist may recommend you wear your compression garment during exercise or after you have cooled down.

  • BCNA also has two webcasts on lymphoedema. Click here to sign up and watch them.
  • To find a qualified therapist visit the Australasian Lymphology Association website. Also talk to your GP about accessing a specialist lymphoedema therapist through a chronic disease management plan that allows five Medicare-subsidised visits per year.
Issue 85
Spring 2019