After breast cancer treatment, many women face unexpected challenges, and one of the most common is lymphoedema. It is a condition marked by swelling in the arm that can develop after surgery or radiation. Though often overlooked, Lymphoedema can cause discomfort, pain, and even long-term complications if not managed properly. Understanding why it happens and how to manage it is crucial for those on the path to recovery. We spoke to our expert Dr Mathangi J, HOD and Senior Consultant Radiation Oncologist, Gleneagles BGS Hospital. Kengeri Bengaluru, who shed light on this hidden side effect and offer practical tips for managing it.
According to the World Journal of Clinical Oncology, women treated for breast cancer face a lifelong risk of developing lymphedema, a chronic condition affecting up to 40% of survivors, significantly impacting their quality of life.
Lymphatic System and Its Role in Breast Cancer Treatment
To fully grasp the intricacies of lymphoedema, it's essential to understand how the lymphatic system works and how it plays a role in breast cancer treatment.
Lymph
"It is the extravascular fluid in the third compartment between the arteries and venous flow. They have their own drainage pathway that follows along the major arteries. Apart from carrying the proteins and minerals it also carries the antigens and the cancer cells within them. They have filters at specific points called nodal regions," said Dr Mathangi.
Lymph nodes
Whenever there is an infection or cancer of the draining regions the antigens or the cancer cells get filtered in these nodes resulting in their enlargement which is felt as a firm or hard swelling. The lymph nodes that drain the breast are situated in the axilla (armpit) lower neck and internal mammary regions.
Also Read: Breast Cancer Awareness Month: Expert Explains The Role Of Gut Health In Breast Cancer Prevention
Pattern of the Spread of Breast Cancer
The majority of the lymph from the breast drains to the axillary lymph nodes. Hence, the breast cancer cells spread first to this region. The draining lymph nodes from the axilla are removed together with the entire axillary pad of fat when the malignant mass in the breast is removed.
Lymphoedema
It is the collection of lymphatic fluid in a given region causing the swelling of the involved part. In breast cancer patients, the lymph nodes removed from the armpit region also drain the same side of the arms. "Therefore, after the surgery, the pathway for drainage is disrupted and hence slowly starts accumulating over the years. This swelling is called lymphoedema, swelling of the same side of the arm after breast cancer," added Dr Mathangi.
Factors Worsening Lymphoedema Symptoms
- Extensive disease spread to the axilla
- Extensive removal of lymph nodes from the axilla
- Less movement of the arms and shoulder after surgery
- Lack of exercise after surgery
- Pooling of lymph because of gravity with arms always left down
- Recurrence of the nodes in the axilla blocking the drainage
- Radiotherapy to the axilla after axillary surgery
- Infusions in the affected side arms should be avoided
Complications of Lymphoedema
- Swelling of the involved side arms
- Tightening of the skin
- Pain due to stretching of the skin
- Cosmetically disfiguring
- Delayed healing of the wounds in the skin
- Dryness of the skin, itching, or scratching
- Lymphangiosarcoma, cancer of the soft tissue due to long-standing lymphoedema
How to Prevent Lymphoedema After Breast Cancer?
Here are some preventive measures listed by the expert:
1. Early Detection
When breast cancer is detected early by regular monthly self-breast examination and yearly mammography, if the nodes are not clinically enlarged during examination, then sentinel lymph node biopsy can be done instead of removing all the lymph nodes.
- Sentinel lymph node biopsy: When the nodes in the axilla are not clinically enlarged before surgery, then a dye is injected in and around the tumour in the breast and we try to look for the draining nodes which take up this dye in the axillary region. Only these few nodes are removed to check for involvement with cancerous cells. "If these nodes are not involved, then a nodal dissection can be avoided. This prevents lymphoedema from happening since other nodes are available for lymphatic drainage of the arms. Tracking the lymph nodes can be done with a dye or a radioactive substance," explained Dr Mathangi.
- Lower axillary dissection: In this procedure, only level I and II axillae are cleared when the rest of the nodes are taken care of by postoperative radiotherapy.
2. Postoperative early shoulder mobilisation
The patients are started on shoulder mobilisation physiotherapy as early as the first postoperative day. This helps in maintaining the full range of shoulder movements, prevents frozen shoulders, and decreases gravitational pooling of fluid in the arms. The later and less the patients move their arms, the more the fluid accumulates slowly and steadily over the years and becomes irreversible.
3. Arm Exercises
The specific against gravity arm exercises are taught to improve the lymph fluid movements across the axilla. Also, these exercises are effective in decreasing swelling by encouraging fluid drainage from the affected limb and maintaining better limb mobility.
4. Arm Sleeves
These compression stockings are designed for the arms, extending from just below the shoulders to below the wrist region. They should be worn as soon as the wounds are healed and healthy. "They should be worn throughout the day for the first two years. The compression sleeves serve two purposes: first, preventing fluid from collecting, and second, helping new channels to develop by bypassing the original axillary drainage from the arms," said Dr Mathangi.
5. Arm Massages
The daily massage of the arms helps again in three ways. Drain the existing fluid if any; prevent fluid from collecting; and of course, pressure forces the body to create alternate pathways of drainage. These massages clearly should be directed towards the heart – from the fingers upwards towards the shoulders.
Bottomline
Dr Mathangi concluded, “Prevention is better than cure. Still, arm sleeves, arm massages, and lymphoedema massage machines are available with guarded results. Some surgical diversion procedures are also available with variable results.”
[Disclaimer: This article contains information provided by an expert and is for informational purposes only. Hence, we advise you to consult your own professional if you are dealing with any health issues to avoid complications.]