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Understanding Lymphedema for People With Breast Cancer

Untreated lymphedema can have serious consequences, including severe infections, skin ulcers (open sores that don’t heal,) and extreme swelling and thickening of the skin (elephantiasis). Lymphangiosarcoma, a form of cancer, was historically of concern for people who had breast cancer surgery. However, with the development of more sophisticated mastectomy procedures, this is nearly unheard of today.

Diagnosis

Lymphedema is generally easy to diagnose. The swelling is usually evident, and a measurement of the affected and unaffected arms can be compared. Testing is typically not done to diagnose lymphedema, though it may be considered if there is a suspicion that another process is going on, or if the swelling is not responding to initial attempts to control it.

Imaging tests — such as computed tomography (CT), ultrasound or magnetic resonance imaging (MRI) scans — can resolve any lingering questions about the diagnosis. A test called lymphatic scintigraphy can provide additional information about the area of blockage. This test involves the injection of a radioactive dye and then recording images of the dye as it moves through the lymphatic system.

Treatment

Unfortunately, there’s no outright cure for lymphedema. Instead, the condition is managed in an effort to minimize its effects by seeking to decrease the swelling, control the discomfort or pain, and avoid complications.

Lymphedema treatments include:

  • Exercise: Special kinds of exercises that gently contract muscles can aid in pumping lymph fluid out of the swollen limb.
  • Massage: Specially trained physical or massage therapists can provide manual lymph drainage, a series of gentle massage maneuvers that encourage lymph flow out of the affected limb. However, people who have active cancer, infections, blood clots or congestive heart failure should not undergo this form of treatment.
  • Compression: Compression can also encourage the flow of lymph out of the affected arm. Compression can be provided in a number of ways, including elastic bandaging, a special compression sleeve or stocking, or the use of an air-driven (pneumatic) pump.

Prevention and Management

It’s important to avoid anything that might constrict or injure the affected arm because this can greatly increase the risk of infection. Try to do the following:

  • Achieve and maintain a normal weight, as recommended by your physician.
  • Continue to use your arm as normally as possible, as muscle contractions help pump fluid out of your arm.
  • Keep your arm and hand clean and well-moisturized, to avoid cracking from dryness.
  • While reading, watching TV or otherwise at rest, keep your arm elevated above the level of your heart.
  • Avoid exposure to heat (for example, don’t use hot tubs or saunas,)
  • Use sunscreen daily and consider wearing sun-protective clothing.
  • Wear gloves when you garden, clean house or do yard work.
  • Be very careful when using sharp instruments in the kitchen or while doing craft projects.
  • Avoid tight jewelry or clothing, other than prescribed compression garments.
  • Avoid blood draws, shots or intravenous (IV) placements in the affected arm.
  • Ask to have your blood pressure taken in your unaffected arm.
  • Carry your purse on your unaffected arm.
  • Avoid lifting heavy items, including children.
  • Wear long sleeves outside — and consider using bug spray — to avoid insect bites.
  • Even if your doctor hasn’t recommended that you wear a compression sleeve, ask whether you should do so when traveling by airplane. Cabin pressure changes can worsen lymphedema.

It’s important to see your doctor if you think that you are developing lymphedema. Your doctor may also refer you to a physical therapist who specializes in treating this condition.






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