Lymphedema results when lymph nodes and vessels are removed or scarred during breast cancer surgery. With fewer lymph nodes and vessels, it is more difficult for the upper body to drain lymph fluid. When excess lymph fluid builds up, pain and swelling occurs. Radiation for breast cancer also affects the flow of lymph fluid in the arm, chest, and breast area, and can cause lymphedema.
“Lymphedema is always a risk when a woman has had any lymph nodes removed or radiation for breast cancer,” says Monique Tiffany, R.N., nurse navigator at the Total Care Breast Center at Los Alamitos Medical Center. Tiffany advises women about lymphedema not only as a breast cancer care nurse, but also as a breast cancer survivor. She celebrated being cancer-free for 10 years this month.
Tiffany says she remains aware that lymphedema can still occur, even after a decade. “I still have to think about it if I’m going to get on a plane,” she says. Air travel can cause lymphedema to flare up.
Unfortunately, there is no way to prevent lymphedema prior to breast cancer surgery or radiation. Tiffany recommends that women get measured for a compression sleeve right after surgery, so the sleeve is available if needed. However, a woman newly diagnosed with breast cancer may find information about lymphedema overwhelming on top of everything else she is dealing with, so not all women will have the measurement done until lymphedema becomes an issue.
To manage the pain and swelling immediately after surgery, women are advised to raise the affected arm above heart level two to three times a day for 45 minutes, and to open and close their fist gently to help move lymph fluid out of the arm. Physical therapy and special exercises can help regain full range of motion in the weeks after surgery or radiation. A compression sleeve or special bandaging may be needed when pain and swelling persist.
Because cuts, burns, or bug bites on the affected arm make the body respond with extra lymph fluid, causing or worsening lymphedema, it’s important to avoid these injuries. Wearing gloves while cleaning or gardening, a mitt while handling hot foods, and a thimble while sewing can help prevent cuts and burns. Cuts and scratches on the affected arm need to be treated right away with antibiotic ointment.
Heat can make lymphedema worse, so hot tubs, saunas, or heating pads are on the list of things to avoid, along with harsh soaps, which can dry the skin and make it more prone to cracking.
Lymphedema can seem particularly onerous when it begins several years after breast surgery or radiation. Having to deal with compression sleeves and massaging and elevating the arm comes as a newly inconvenient and unwelcome after-effect of breast cancer treatment.
“Lymphedema can occur at any time,” notes Barbara Stone, physical therapist at MemorialCare Todd Cancer Institute at Long Beach Memorial Medical Center. Stone sees patients at the outpatient Lymphedema Program at Memorial, which is part of the MemorialCare Rehabilitation Institute. The Lymphedema Program is open to anyone in the community who needs treatment for lymphedema.
Stone recently encountered a patient who just developed lymphedema, although her mastectomy was 25 years ago. “She recently began using a walker, and the extra strain on that arm may have caused the excess fluid,” she explains. In another case, a breast cancer survivor developed lymphedema three years after her breast cancer surgery while caring for her ill husband. Helping him up and turning him in bed strained her affected arm, and she developed lymphedema. While lymphedema can’t be cured, it can be treated, even when it occurs long after breast cancer surgery or radiation.
The study indicated that there might be common and treatment-specific ways that cancer therapies negatively affect cancer survivors' mental abilities.
Previous research had suggested that chemotherapy could cause problems with memory and concentration in breast cancer survivors.
To compare the effects of different types of cancer treatment on such mental abilities, Paul Jacobsen, PhD, of the Moffitt Cancer Centre and Research Institute in Tampa, and his colleagues examined 62 breast cancer patients treated with chemotherapy plus radiation, 67 patients treated with radiation only, and 184 women with no history of cancer.
Study participants completed neuropsychological assessments six months after completing treatment and again 36 months later.
The study confirmed that chemotherapy could cause cognitive problems in breast cancer survivors that persist for three years after they finish treatment.
In addition, the investigators found that breast cancer survivors who had been treated with radiation (and not chemotherapy) often experienced problems similar to those in breast cancer survivors treated with both chemotherapy and radiation.
They did not find that hormonal therapy (such as tamoxifen) caused cognitive difficulties.
"These findings suggest that the problems some breast cancer survivors have with their mental abilities are not due just to the administration of chemotherapy," said Dr. Jacobsen.
"Our findings also provide a more complete picture of the impact of cancer treatment on mental abilities than studies that did not follow patients as long or look at mental abilities in breast cancer survivors who had not been treated with chemotherapy.
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