Lymphoedema

What is lymphoedema?
Lymphoedema is a swelling that occurs when lymph collects in a limb or other part of the body.

What is lymph?
Lymph is a clear, colourless fluid that accumulates in the spaces between body cells, and is collected by the vessels of the lymphatic system. It flows through the lymphatic vessels to the lymph nodes and is eventually absorbed into the bloodstream. The lymphatic system plays an important role in the immune system by filtering excess fluid, bacteria and byproducts of infections in the lymph nodes.

What causes lymphoedema?
Normal lymph drainage is sometimes interrupted or hampered as a result of damage to the lymphatic vessels and lymph nodes. This causes lymph to accumulate in the affected limb or part of the body.

How does this affect breast cancer patients?
Damage to the lymphatic vessels and lymph nodes can be caused by the tumour or by infection, but in most cases it is caused by the treatment. Lymph nodes can be damaged or removed during breast surgery, and radiotherapy in the armpit area may cause lesions.

Can the risk of lymphoedema be reduced?
Many surgeons help to reduce the risk of lymphoedema by avoiding the routine removal of lymph nodes during surgery and rather opting for sentinel node biopsy.

How long after treatment can lymphoedema occur?
It can occur weeks, months or years after surgery.

Are there different types of lymphoedema?
Acute, moderate lymphoedema may occur immediately after surgery and is usually temporary. Acute and painful lymphoedema can present 4 to 6 weeks after surgery. The most common type of lymphoedema starts gradually and is relatively painless. It usually occurs 18 to 24 months after surgery or radiotherapy.

How is lymphoedema diagnosed?
There are no specific diagnostic tests for lymphoedema. The doctor will make a diagnosis based on your medical history and by examining you.

What are the consequences of lymphoedema?
Circulation in the lymphatic system is hampered – as a result infection is not combated effectively. That is why it is very important to promote circulation as much as possible and to prevent possible infection.

What causes the onset of lymphoedema?
The onset of lymphoedema is usually caused by a specific trigger, such as an injury to the arm or hand nearest the damaged lymph node, for example a bruise, cut or pressure (by a blood pressure cuff, bracelet or elastic cuff). After surgery to an area where lymph nodes may have been damaged, such as the breast or armpit area, it is of the utmost importance to avoid these triggers and to do post-surgery exercises to promote drainage.

What are the symptoms and signs of lymphoedema?
Check any swelling, a feeling of heaviness or tightness or a constant pain or discomfort in or against the arm on the operated side. Your hand may swell – take note if your rings become too tight. The affected arm may also feel weak. You must inform your doctor of even the smallest sign of swelling.

How is lymphoedema treated ?
Your doctor will assess the condition by comparing the swelling with the other arm and determining whether any tightness or heaviness is present. Any other possible causes, such as infection, a tumour or thrombosis will be ruled out. Treatment for lymphoedema usually includes wearing a compression bandage. Lymphatic manual draining (a medical massage technique) may also be prescribed. Exercise and certain preventative measures are also recommended.

What is a compression bandage?
It is an elastic bandage in the shape of a garment, such as a sleeve that fits tightly around the arm. A compression sleeve may cover the whole arm, as well as the wrist and shoulder. It is made by qualified staff according to the doctor's prescription and must be replaced every 4 to 6 months to ensure a tight fit. The compression bandage exerts pressure on the swollen arm and prevents lymph from accumulating in one area. It is worn according to the doctor's instructions, sometimes only during the day, sometimes 24 hours per day. By wearing the compression bandage regularly lymphoedema can be improved considerably.

How can exercise help?
Exercise improves the flexibility of your arm and promotes the drainage of lymph. Your doctor or physiotherapist can prescribe appropriate exercises. The Reach for Recovery exercise pamphlet is specially compiled to improve lymphoedema.

How can massage help?
Lymph drainage by means of gentle manual massage is a medical massage technique which can reduce swelling and pressure. It is particularly effective if lymphoedema is diagnosed early.

Which preventative measures should I take?
It is very important to take precautions against lymphoedema to prevent the risks of swelling and infection.

• Avoid exposure to extreme temperatures:
• Avoid a long, hot bath or sauna
• Avoid sunburn and burns on the affected arm

Avoid infections caused by:

• insect bites grazes, cuts and scratches to the skin, for instance caused by gardening, pets, a razor, a kitchen knife, manicure, innoculations, acupuncture, injection

Protect the hand or arm on the affected side as follows:

• Avoid carrying heavy objects (shopping bags, shoulder bags, hand bags, cardboard boxes)
• Elevate the arm as much as possible – by keeping it elevated, drainage is promoted.
• Offer the other arm for measuring blood pressure, taking blood samples, giving injections or applying a drip.
• Avoid tightly fitting clothes (such as bra straps and sleeves with elasticated cuffs), rings, bracelets and wrist watches.
• Use a special compression bandage when you travel by air.
• Use an electric razor for the armpit to prevent cuts.
• Use a thimble for sewing to prevent pricking your finger.
• Wear plastic or gardening gloves when gardening or working with household chemicals.
• Care for your skin by keeping it clean and dry and regularly using a moisturising body lotion – apply the lotion with upward strokes away from the hand.
• Good nail care is important to keep nails in a good condition. Avoid pulling or cutting the cuticles.
• Treat cuts and sores by washing them with soap and water and applying an anti-bacterial cream and bandage.

Follow general guidelines for good health:

• Follow a balanced, vitamin rich, low salt diet.
• Avoid overweight.
• Avoiod alcohol and nicotine.
• Exercise moderately.

Consult a medical doctor or clinic immediately if you have any of the following symptoms in the affected arm:

• any swelling, even the slightest
• a feeling of heaviness
• constant pain or discomfort

Reach for Recovery would like to thank Gretha Aalbers for compiling this pamphlet, and The Ralph Nussbaum Foundation for sponsoring the printing.