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Care of the Breast Cancer Patient


Lymphedema is an accumulation of lymphatic fluid that causes swelling in the arms and legs. This condition occurs when the lymphatic vessels are impaired and the lymph fluid collects in the tissues of the extremities. Lymphatic vessels are similar to veins, but rather than circulating blood, they carry lymph fluid through the body. Lymph fluid contains oxygen, protein, glucose and white blood cells that help fight infection. If left untreated, lymphedema can interfere with wound healing, promote infection, and lead to a chronic inflammatory condition resulting in fibrosis, or hardening of the tissues.

Lymphedema is described as being primary or secondary. Primary lymphedema results from developmental abnormalities in the lymphatic system, usually present at birth. Secondary lymphedema can result when the normal functions of the lymphatic system have been disturbed by surgery, trauma, radiation, cancer, or other similar conditions. Anyone who has had breast surgery in combination with lymph node removal, biopsy or radiation therapy is at risk of developing lymphedema. This risk varies individually based upon the number of lymph nodes removed, the amount of radiation received, and how the remaining lymphatic system functions to compensate for the disturbance.

Some swelling in the breast and arm area is normal during the first few weeks following breast surgery. Chronic swelling, or lymphedema of the arm can occur as soon as immediately after surgery, or as late as many years after cancer therapy has concluded. It is important to know the signs of lymphedema. They include:

feeling of tightness in the arm
pain, aching or heaviness in the arm
swelling and redness of the arm
jewelry or clothing do not fit
reduced ability to move the arm, hand, wrist, or fingers

Seek medical care immediately upon noticing any of the above signs. Early recognition of lymphedema and the beginning of physical therapy can relieve the swelling and prevent progressive disease. In addition, contact your physician immediately if you notice: a rash, blistering, redness or warmth in the arm; any swelling that lasts one to two weeks; or a temperature of 100.5 or above without any cold or flu symptoms. If lymphedema is diagnosed and treated early, the chances for improving the condition are much greater than if the swelling goes untreated.

The American Cancer Society (www.cancer.org) and the National Cancer Institute (www.nci.nih.gov) both have very thorough guidelines available that can help breast cancer patients reduce their risk of developing lymphedema. The following are recommendations to follow soon after breast cancer surgery:

Use the arm in normal activities soon after surgery to facilitate full range of motion.
Following surgery, raise the arm above the level of the heart for 45 minutes, two to three times a day while lying down. Use a pillow to rest your arm so that the hand is higher than the wrist, and the elbow is slightly higher than the shoulder.
Keep the arm clean. Use lotion such as Nivea or Eucerin.
Having injections, blood tests, or blood pressure testing in the affected arm should be discussed with your physician.
Avoid tight jewelry, clothing or elastic bandages on the affected arm or fingers.
Avoid any injuries to the affected arm such as cuts, sunburn, insect bites, or scratches. Wear gloves while doing housework, gardening or other work that could result in minor injury. Wear protective sun block and covering.
Do not use any chemical underarm hair removers. An electric razor is recommended.
When manicuring nails, avoid cutting cuticles. Please inform your manicurist.
Avoid extreme temperature changes when bathing or washing dishes. Do not use hot tubs or saunas.
Avoid heavy lifting with the affected arm. Avoid heavy handbags or bags with over-the-shoulder straps.
Avoid vigorous, repetitive movements against resistance with the affected arm.
Exercise regularly. Rest the affected arm if it becomes sore or tired.
Maintain a balanced diet and an ideal weight. Obesity increases the risk of developing lymphedema.

A careful examination to determine the cause of this condition is very important in determining the appropriate treatment. If the lymphedema is caused by an infection, antibiotics will be used to fight the infection. If not caused by infection, the treatment may include massage therapy, physical therapy, compression therapy, patient education and emotional support. The use of these various therapies is called Complex Decongestive Therapy or CDT. CDT includes a specialized massage therapy called Manual Lymph Drainage, MLD, which stimulates the movement of lymph to healthy lymph vessels. Therapists certified in MLD focus on gently massaging the connective tissue rather than the more standard muscle tissue massages. Compression bandages and sleeves help to increase drainage and prevent fluid from refilling in the arm.

Lymphedema, as with many chronic conditions can be difficult emotionally. Coping with a chronic condition can be stressful. Support groups, therapy and education can all help make living with lymphedema easier.

If you have additional questions or concerns, please call us at 847-797-9000

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