4.1 Lymphedema

4.1.1 What is Lymphedema?

As mentioned in Chapter 2, lymphedema is swelling in your arms or chest that can occur after breast cancer surgery (Lymphedema Working Group, 2012). This chronic condition happens when your lymph nodes are not functioning properly, causing lymph fluid buildup.

4.1.2 Lymphedema vs. Post-Surgical Swelling

Post-surgical swelling is normal, but it can be hard to distinguish it from lymphedema swelling (Lymphedema Working Group, 2012). Both cause swelling in the arm on the side you had surgery on. The main difference is that lymphedema swelling does not decrease over time, and it causes changes in tissue texture.

If you are unsure whether you have lymphedema, talk to your healthcare provider so that they can assess you and start treatment if necessary.

4.1.3 Stages of Lymphedema

Like breast cancer, you can stage lymphedema (Lymphedema Working Group, 2012). The most common staging system is the following:

Stage 0

Swelling is not present even if your lymph channels have been affected (Lymphedema Working Group, 2012). You can be in this stage for months or years before you notice swelling.

Stage I

Fluid builds up in your tissue, but elevating your arm disperses it temporarily (Lymphedema Working Group, 2012). Pitting (indents left after pressing on the skin) may be present. Treatment for this stage will usually improve any lymphedema symptoms occurring.

Early Stage II

Elevating your arm does not reduce swelling from fluid buildup, and pitting occurs (Lymphedema Working Group, 2012). Treatment at this stage is more intense but can still improve symptoms.

Late Stage II

Pitting is less likely to occur as the affected arm’s tissue might be experiencing tissue fibrosis, also known as skin hardening (Lymphedema Working Group, 2012).

Stage III

Tissue fibrosis is present (Lymphedema Working Group, 2012). You will also notice other changes to your skin, such as colour changes, more skin folds, and texture changes.

See Image 20 for an example of how lymphedema progresses in an arm (DocHealer, 2017).

Image 20: Upper limb lymphedema

4.1.4 Prevention

You can help lower your risk of lymphedema in a few ways.

Do not raise your arm on the side you had surgery on higher than 90 degrees while your drain is still in (Lymphedema Working Group, 2012). Furthermore, avoid heavy lifting; nothing over 2.5 pounds for two weeks post-surgery and nothing over 10 pounds until six weeks post-surgery. At the same time, be sure that you are doing any exercises recommended to you by your healthcare team.

Other preventative measures you can do include:

• wearing a compression garment to help prevent swelling,
• avoiding exposure to extreme temperatures,
• keeping your skin healthy by moisturizing and wearing sunscreen,
• avoiding tight clothing or jewellery that restricts your affected arm,
• shaving your armpits carefully to avoid accidental cuts,
• and informing your healthcare team as soon as you notice any changes to your affected arm (Lymphedema Working Group, 2012).

4.1.5 Early Detection

As mentioned previously, catching lymphedema in the early stages is critical for effectively managing symptoms (Lymphedema Working Group, 2012). Here are some of the early-stage symptoms to watch out for in your affected arm:

• heaviness, increased pressures, or swelling,
• redness and heat,
• pitting,
• numbness or tingling,
• changes in skin colour or texture,
• changes in size (compared to the unaffected arm),
• sharp and achy pain,
• and trouble finding the veins (Lymphedema Working Group, 2012).

Additionally, you may have a fever or feel like you have the flu (Lymphedema Working Group, 2012).

4.1.6 Pre-Treatment Arm Measurements

As the name implies, pre-treatment arm measurements are measurements of your arm taken before treatment starts (Lymphedema Working Group, 2012). Your healthcare team takes them so that they have a baseline of what your arms look like normally.

After your treatment, your current arm measurements are checked against your pre-treatment arm measurements to see if swelling is present (Lymphedema Working Group, 2012). Changes in your arm might be as small as 2 cm, but this can still mean lymphedema is occurring.

Keeping track of your arm measurements is important for preventing and monitoring lymphedema should it occur (Lymphedema Working Group, 2012).

Chapter 4: Learning Activity