Lymphoedema is an abnormal swelling found, most commonly, in the arms and/or legs, but can be seen elsewhere in the body such as the breast, rib area or around shoulder blades.
A variety of conditions can cause lymphoedema including infection, trauma (such as the removal of lymph nodes), or chronic venous insufficiencies.
Lymph is a thick watery fluid that circulates throughout the body. It is rich in proteins and contains fat cells, acids, waste products (from cell metabolism), viruses and bacteria. Lymph fluid, like blood, is carried in vessels that circulate the fluid throughout the body. Where it differs from blood is that this fluid is moved along by the activity of the vessels, aided by muscle contraction and the mechanism of breathing.
Lymph vessels form very thick networks that reach out to all parts of the body. The lymph originates under the skin and in the abdomen, and is formed by fluid that leaks out of blood capillaries into surrounding tissue spaces. 90% of this fluid is re-absorbed into the capillaries but the remaining 10% is absorbed by the lymph vessels, and forms lymph fluid.
At various points on the lymphatic system there are small, bean-shaped structures called lymph nodes. These act as filters – removing bacteria, viruses and cancer cells. The lymph nodes are garbage collectors and act as an alarm system for the immune system. Clusters of lymph nodes are found in certain areas of the body such as the armpits, groin, neck, chest and abdomen. When the body has an infection (e.g. tonsillitis) these nodes become swollen and activate the immune system. When cancer spreads, some cancer cells remain in the nodes. These lymph nodes can be removed and investigated to see how far the cancer has spread.
Lymphoedema is a progressive condition that occurs when the lymphatic system is damaged or absent, and cannot drain the lymph fluid that has leaked from the blood system in an area of the body.
We normally have between 15-25 nodes in one armpit. According to the World Health Organisation the risk of developing lymphoedema after the removal of lymph nodes in the axilla (armpit area) is 50-56% depending on how many nodes are removed. The risk of developing lymphoedema increases with radiation therapy by 7-47% and increases with each year that goes by after your surgery and radiation therapy.
When lymphoedema develops immediately after breast surgery it is usually mild and eases within a couple of weeks. If lymphoedema develops later on (approximately 6 – 8 weeks after surgery or radiation therapy) it can be treated and improved.
The Sooner the Better
The most common form of lymphoedema develops gradually and you may only become aware of it months, or even years, after your breast cancer therapy. The sooner you begin treatment the better. If lymphoedema is not treated, you may experience repeated infections of the skin or lymph vessels. You may also experience changes to the skin, such as skin thickening, hyperkeratosis (scaly warty growths), deepened skin creases and/or a deterioration in your quality of life and activities of daily living because the limb becomes heavy, stiff and painful.
Unfortunately there is no cure for lymphoedema, but it can be easily managed and need not worsen if precautions are taken.
Factors that can aggravate lymphoedema are:
• Heat – hot baths, showers or cooking
• Minor injury
• Blood samples, injections or drips on the affected limb
• Constrictions (tight clothes, bras, jewellery or blood pressure cuffs)
• Infections in the operated area and the affected limb
• Travel – more than four hours by car or air
• A poor diet – high in salt and fat content.
Remember to drink at least 6-8 glasses of water a day, exercise, walk with your hands held at waist level, take deep breaths into your tummy and enjoy a low salt and fat diet.
Written by Sue Serebro