When to see a lymphoedema therapist

Gabriella Kourie advises on the tell-tale signs of when to see a lymphoedema therapist.

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In the world of oncology, patients are faced with multiple side effects that can trigger from the various treatments they receive. One of the more common secondary side effects associated with cancer-removal surgeries, and in particular breast cancer, is the onset of lymphoedema.

Like any disease, the sooner you detect it and get treatment, the less intense and the better the treatment outcomes are. Lymphoedema is not different. The factors that are important in treating and controlling lymphoedema are: 

1. What is lymphoedema and how is it caused? 
2. Are you an at-risk patient for developing lymphoedema?
3. What do the developing and/or early stages look like?

And ultimately, using the above information to determine:

4. When do you need to see a therapist?

What is lymphoedema? 

The official definition of lymphoedema is: the build-up of excess fluid in soft tissue that is caused by a blockage or gap in the lymphatic system. The main function of the lymphatic system is to help fight infection and other diseases by carrying lymph throughout the body. 

Our lymph travels throughout the body via a network of thin tubes called lymph vessels. In the case of cancer, it develops due to:

Surgery during which lymph nodes may be removed, causing a gap in the lymphatic system.

Radiation therapy with the main effect being inflammation which places tension on the lymphatic system.

Blockage of the lymph nodes and/or lymph vessels due to the spreading of the cancer.

Who is at risk?

Patients that have had any of the mentioned procedures are at risk of developing lymphoedema. The chances of the risk being high or low depend heavily on external factors such as: weight, smoking status, level of exercise, and existing comorbidities. 

Another big risk factor is the amount of lymph nodes removed during surgery. 

On a global scale, if you had five or less lymph nodes removed, many practitioners believe that you’re considered no risk at all for developing lymphoedema. However, there have been cases of patients with three nodes removed that have other external risk factors and have developed lymphoedema. 

Regardless, every breast cancer patient should have access to knowledge on what lymphoedema is and how to prevent and/or treat it early.

Warning signs

The main warning signs or indications that lymphoedema is developing are: 

• There may be some initial skin changes, such as hardening or thickening of the skin.
• The limb (on the side where the nodes have been removed) or trunk and genitalia may start to feel heavy and tight, and range of motion in the arm or leg may reduce.
• There may be a reoccurring tissue infection called cellulitis.
• Fluctuating swelling in the arm, leg or trunk (depending on the cancer and location of where lymph nodes have been removed or areas where the cancer has metastasised).

When to see a therapist

In most cases, patients seek guidance and advice from their oncology specialists and/or GPs. Though, the sad reality is that there are doctors that have poor insight into the treatment of lymphoedema and will often tell patients that nothing can be done. This could not be further from the truth. 

Although the intensity and success of treatment depends heavily on the stage of the disease and the prognosis of the patient, there is a form of intervention for lymphoedema at any stage.

I urge all patients that have had any cancer surgeries with lymph node removal to seek out guidance and intervention from a certified lymphoedema therapist. Prevention is better than cure and if caught early enough, the progression of lymphoedema can be fully controlled. 

The last and most important point is to make sure you are seeking guidance from the correct healthcare professional. All certified lymphoedema therapists in the country can be found on the Lymphoedema Association of South Africa (LAOSA) website (laosa.co.za) under the Find a Therapist tab.