What is lymphedema?
During surgery for breast cancer, the doctor might remove one or more lymph (limf) nodes from the underarm area to see if the cancer has spread. When lymph nodes are removed, lymph vessels that carry fluid from the arm to the rest of the body are also removed because they route through and are wrapped around the nodes.
Removing lymph nodes and vessels changes the flow of lymph fluid in that side of the upper body. This makes it harder for fluid in the chest, breast, and arm to flow out of these areas. If the remaining lymph vessels cannot drain enough fluid from these areas, the excess fluid builds up and causes swelling, or lymphedema (limf-uh-dee-muh). Radiation treatment to the lymph nodes in the underarm can affect lymph fluid flow in the arm, chest, and breast area by causing scarring and damage, further increasing the risk of lymphedema.
Lymphedema is a build-up of lymph fluid in the fatty tissues just under your skin. It usually develops slowly over time. The swelling can range from mild to severe. It can start soon after surgery or radiation treatment. But it can also begin months or even many years later. Women who have many lymph nodes removed and women who have had radiation therapy for breast cancer have a higher risk of getting lymphedema.
Doctors still do not fully understand why some patients are more likely to have problems with fluid build-up than others. It’s expected that in the future fewer women will develop lymphedema because:
- Breast surgery and treatment keep getting more conservative (that is, more women are treated with breast-conserving surgery, which removes the cancer and a small amount of healthy tissue around it, rather than mastectomy, which removes the entire breast and more lymph nodes).
- Research advances have led to methods like the sentinel lymph node biopsy (a procedure that allows the surgeon to remove fewer lymph nodes).
- Newer studies are looking at finding which lymph nodes drain the arm before surgery so they can be saved when possible. This procedure is called axillary reverse mapping.
One type of lymphedema that does not seem to be decreasing, and may even be on the rise, is breast edema. It’s possible that this is because more women are being treated with breast-conserving surgery and chest wall radiation than in the past.
There’s still a lot to be learned about lymphedema, but there are ways that you can care for your arm and breast area to reduce your chances of having future problems. Once lymphedema has started, it cannot be cured. But early and careful management can reduce symptoms and help keep it from getting worse. In fact, some women manage their lymphedema so well they become convinced they no longer have it. All women who have had episodes of lymphedema should follow these guidelines and their doctor’s instructions to avoid the return or worsening of lymphedema swelling.
Women who have had many lymph nodes removed and women who have had radiation therapy have a higher risk of developing lymphedema.
What is the lymph system?
Our bodies have a network of lymph nodes and lymph vessels that collect and carry watery, clear lymph fluid, much like veins collect blood from distant parts of the body (like the hands and arms) and carry it back to the heart. Lymph fluid has proteins, salts, and water, as well as white blood cells, which help fight infections. In the lymph vessels, one-way valves work with body muscles to help move the fluid through the body. Lymph nodes are small collections of tissue that work as filters for harmful substances and help us fight infection.
The lymph system in the upper body
Why do I need to know about lymphedema?
Some women who have been treated for breast cancer develop swelling or lymphedema of the arm, breast, and chest. Most women who have had breast cancer will not develop this side effect. The risk of lymphedema is higher for women whose breast cancer was treated with both surgery and radiation therapy. We also know that the risk of lymphedema goes up with the number of lymph nodes removed and is higher in women who are obese. Still, there’s no way to predict who will develop this condition.
Here is what we know about lymphedema, the signs you can look for, steps you can take to lower your risk of getting it, and things you can do to try to keep it from getting worse. Talk to someone on your health care team about your lymphedema risk and what you can do to lower it. There are things you can do to try to prevent lymphedema. And recognizing it early and starting treatment right away can help manage it.
Last Medical Review: 07/03/2013
Last Revised: 07/03/2013