Recognizing and Treating Lymphedema After Breast Cancer

By Nikki Couloumbis, MSOTR/L,CKTP,CLT

Lymphedema is a chronic and sometimes disfiguring condition in which lymphatic fluid no longer circulates normally, resulting in swelling and pain, most often in a limb. Other parts of the body can also be affected, such as the head and neck, or chest and back. Lymphedema can develop in people with congenital impairment of the lymphatic system, or in survivors of cancer, after surgery with lymph node removal and/or radiation treatments to areas containing lymph nodes.

Every cancer survivor treated with surgery or radiation needs to be vigilant about recognizing the signs of lymphedema. Studies reflect that about 15-20% of breast cancer survivors who have lymph nodes removed during surgery will go on to develop the condition. Radiation treatment, whether primary or adjunctive, can also injure lymph nodes and therefore increase the risk of lymphedema development.

Generally, the more one’s lymphatic system is compromised by surgery and other treatments, the more closely one should monitor for signs of a problem. Early symptoms of lymphedema in an affected arm or leg are usually mild, and they tend to show up in the hand or foot first: a slightly perceptible difference in size between affected and unaffected sides; puffiness that obscures tendons, veins, or knuckles; jewelry that feels too tight; a heavy and tired sensation. At this early stage, swelling may resolve with elevation and rest, leading patients to dismiss symptoms or to think that they will get better without intervention.

However, treatment is required to help re-establish lymphatic flow and prevent the fluid from causing irreversible tissue damage!

As the condition progresses, a size difference between affected and unaffected sides is easy to see, the skin becomes unnaturally hard, indentations occur with pressure, and the limb begins to lose its shape. Unfortunately, lack of knowledge about lymphedema often means people do not seek diagnosis and treatment until this stage, when risk of infection, disfigurement, and loss of function is greater.

In 2009 the Medical College of Wisconsin’s Center for Patient Care and Outcomes Research published findings from a study examining lymphedema development after breast cancer surgery. Among 1338 women aged 65 and older, approximately 14% selfreported having lymphedema 4 years after their surgery. After controlling for age, tumor size, surgery type, and the use of other therapies, two risk factors were found to most accurately predict the later development of lymphedema: the removal of more than 5 lymph nodes and the presence of cancer in the biopsied lymph nodes.

In 2009 the Journal of Clinical Oncology published results of a 5-year study of 631 women, showing that the cumulative incidence of lymphedema development was 42%, with 80% of cases diagnosed the first two years after initial cancer diagnosis. The study authors observed that lymphedema is a “common” side effect of treatment, noting that the majority of cases were clinically classified as “mild.” However, they found that women with “mild” and untreated lymphedema were 3 times more likely than women with no lymphedema symptoms to rapidly progress to “moderate/severe” lymphedema. The researchers also found that the most common early signs of lymphedema reported by the women (a subtle difference in the size of one hand, and their rings being too tight) were often overlooked or dismissed by patients and their physicians.

Treatment

The most effective treatment for lymphedema is complex decongestive therapy (CDT). CDT includes a specialized type of massage called manual lymphatic drainage, the application of multilayered compression bandages, fitting of gradient compression garments, meticulous skin hygiene to prevent infection, and specific therapeutic exercises. CDT has been used in Europe for decades safely and effectively, and in the past 20 years has become a recognized treatment protocol in the U.S.

If you suspect you may have lymphedema, don’t wait! Control of lymphedema requires lifelong adherence to self-management strategies, and catching the disorder early makes it easiest to produce improvement. Working with a therapist trained in CDT can help you regain your sense of physical well being and begin the path to recovery.

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About Nikki Couloumbis, MSOTR/L,CKTP,CLT

Nikki completed her master’s degree in occupational therapy at Columbia University’s College of Physicians and Surgeons in 1994. The owner of On-Site Wellness, LLC, she is a Certified Lymphedema Therapist, Certified Kinesiotaping Practitioner, and Certified Strength Training Specialist. She has focused on the prevention and treatment of upper limb disorders and injuries of all kinds, and has extensive experience treating lymphedema. Nikki’s lymphedema services include complex decongestive therapy (CDT), garment fitting, lymphatic kinesiotaping, periodic “maintenance” sessions, and specialized fitness training for cancer survivors. For appointments call 240-285-6514

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