What Is Lymphedema?
Some women who have been treated for breast cancer are at risk for lymphedema, or arm swelling. Our bodies have a network of lymph nodes and lymph vessels that carry lymph fluid to all parts of the body, similar to the way blood vessels circulate blood. The lymph fluid contains white blood cells, which help us fight infections.
During surgery for breast cancer, it is customary to remove at least one of the lymph nodes from the underarm area to see if the cancer has spread. Some lymph vessels that carry fluid from the arm to the rest of the body will also be removed because they are intertwined with the nodes. Removing lymph nodes and vessels from the underarm changes the way the lymph fluid flows within that side of the upper body. At times, this may make it more difficult for fluid in the arm to circulate to other parts of the body. If the remaining lymph vessels cannot remove enough of the fluid in the breast and underarm area, the excess fluid builds up in the arm and causes swelling, or lymphedema. Radiation treatment to the lymph nodes in the underarm can also affect the flow of lymph fluid in the arm and breast area in the same way, increasing the risk for lymphedema.
Lymphedema usually develops slowly over time. The swelling can range from mild to severe, and it may develop at any time following surgery or radiation therapy. The risk of developing lymphedema increases depending on the number of lymph nodes removed, but it may occur with the removal of only one lymph node. The risk of lymphedema developing is approximately 5-8% after a sentinel node biopsy, and can be as high as 20-25% after full axillary node dissection. We do not fully understand why some women develop lymphedema while others do not, although obesity, extent of breast cancer surgery, injury, and other factors may play a role.
Early Detection and Prevention
Up until recently, we have only been able to detect the development of lymphedema through physical signs, such as tightening of the skin of the hand and forearm, difficulty putting on or taking off rings and watches, and changes in arm measurements. Unfortunately by the time swelling becomes obvious, it is more difficult to treat.
We currently have a way to assess patients for lymphedema before swelling and discomfort occur. By using a simple, non-invasive assessment called bioimpedence spectroscopy, we can more precisely evaluate you for early evidence of lymphedema, before tightness and swelling develops. The good news is that with early detection and intervention, studies have shown that we can potentially halt and even reverse the progression of lymphedema. The test is non-invasive, painless, and takes approximately 5 minutes to complete - it is similar to having an EKG reading performed.
Usually the test will be performed prior to surgery to obtain a baseline reading, and then at various intervals after surgery. Periodic testing after treatment will help us determine if fluid is building up in one of your arms even before the obvious physical signs of lymphedema have developed. If we note that the fluid content is increasing, early referral to physical therapy will result in more effective treatment. Bioimpedence spectroscopy is the only FDA-cleared device specifically for the detection of lymphedema, and I am excited to be one of the few facilities in the area to offer the this for my patients. In addition, all patients who are being evaluated for breast cancer surgery or radiation are referred to the lymphedema specialist at the Disney Family Cancer Center for preoperative assessment, as well as postoperative care if needed.
For more information on lymphedema, please review the information from the National Cancer Institute and the National Lymphedema Network.