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by
powersteph65
What lymphoedema is
Lymphoedema is pronounced
lim-fo-dee-ma. It is chronic swelling, usually
of an arm or leg. It happens because cancer, or
the effects of treatment, block the normal fluid
drainage channels of the lymphatic system. Fluid
called lymph begins to collect in an area and
does not drain in the normal way. So the area
swells.
The information on this page is mainly
for people who have lymphoedema following
treatment for breast cancer.
About 1 in 5 people (20%) will
have lymphoedema of the arm after breast cancer
treatment that includes surgery to remove lymph
nodes or radiotherapy to the lymph nodes in the
armpit. If lymphoedema is not treated, it will
get worse. It can be painful and make it
difficult to move your arm.
Lymphoedema is becoming less
common because many specialists now use a
procedure called sentinel lymph node biopsy so
that they can just remove a few lymph nodes and
avoid damaging lymph channels. They also try to
avoid giving women both surgery and radiotherapy
to the armpit as this combination greatly
increases the risk of causing lymphoedema.
Preventing lymphoedema
After treatment, some things can
increase fluid collection in your arm and
increase your risk of lymphoedema.
These include
- Infection in a cut or graze
- Insect bites
- Severe sunburn
- Putting too much strain on your
arm too early
- So you can help to prevent
lymphoedema by
- not using your arm for anything
heavy until you are told you can
- Not letting anyone take blood,
give injections or take your blood pressure from
the treated arm, unless it is an emergency and
there is no other option
- Wearing gloves when gardening or
doing housework
- Taking care when playing with
pets
- Using insect repellent and high
factor sunscreen
- Using nail clippers rather than
scissors and not pushing your cuticles back
- Using an electric razor rather
than a manual one if you shave under your arms
- Avoiding anything that will
increase the temperature of your skin, like very
hot baths or showers, sitting too close to a
heater, saunas, steam rooms and sunbeds
- Using a non scented moisturiser
or oil on your skin each day to help it stay
moist and supple
- Using a thimble when sewing
- Continuing to do the arm and
shoulder exercises you were taught after your
surgery
- If you get a cut or scratch on
your arm, however small, wash it well and cover
it until healed. If you see any redness or
swelling around the cut, see your GP straight
away. You may need antibiotics.
Remember – lymphoedema can start
at any time after you have been treated for
breast cancer.
It is important to take these
precautions for the rest of your life.
Treating lymphoedema
If you get lymphoedema because
of your cancer or its treatment, it cannot be
completely cured. But symptoms such as swelling
and pain can be treated. Treatment for
lymphoedema aims to reduce swelling and prevent
the fluid building up again. The treatment takes
a while to show results. You should notice the
swelling going down within a few weeks. But it
can come back, so you will always need to be
careful and get some help if you have problems.
At the first signs of swelling
in your arm or leg you should see a doctor or
nurse. For example, you may notice that your
watchstrap, rings or clothes are getting
tighter.
Treatment for your lymphoedema
aims to push excess fluid back out of your arm.
There are different ways of doing this. You may
have
- An elastic sleeve to wear, from
the wrist to the top of your arm
Your arm bandaged up with a
particular type of stretchy bandage that your
lymphoedema specialist puts on
- A special type of massage called
manual lymphatic drainage (MLD)
- Exercises that help the fluid to
drain from your arm
All these are very specialist
treatments. Ask your breast care nurse, surgeon
or GP to refer you to a lymphoedema specialist.
You need to have your arm or leg measured and
properly assessed. Wearing a badly fitting
elastic sleeve or stocking can make the swelling
worse. The British Lymphology Society have a
register of lymphoedema practitioners.
Your nurse or lymphoedema
specialist will also teach you how to do gentle
exercises at home to help prevent or decrease
swelling in your limbs. You will get the most
benefit from the exercises by wearing your
stocking or sleeve when you are doing the
exercises. Heavy lifting or too much repetitive
exercise could make lymphoedema worse. So be
sure to stop exercising if your skin is starting
to become red, hot and sweaty. But a US trial in
2009 tried a programme of progressive weight
lifting for arm lymphoedema. In progressive
weight lifting, the weight and number of
exercises is increased very slowly. The
researchers found that this type of carefully
supervised exercise can help to stop lymphoedema
getting worse and can help to reduce symptoms
such as discomfort or pain in the affected arm
in some women.
Doctors have been looking at a
new way of treating lymphoedema after
radiotherapy. This is called hyperbaric oxygen
therapy (HBO). They think that high pressure
oxygen treatment can help improve the flow of
lymph and so reduce swelling. The patients in
the trial have hyperbaric oxygen treatment in a
special chamber that contains compressed air. A
qualified attendant sits in the chamber, along
with up to 6 other patients. While in the
chamber they breathe in 100% oxygen through a
special hood. An early trial of HBO has taken
place in the UK. This trial is now closed and we
are waiting for the results.
Other ways of helping to control
the symptoms of lymphoedema include
Eating a healthy diet and
staying at a healthy weight
If you are overweight it is much
more difficult to control limb swelling. If you
begin to put on a bit of weight, you will notice
that your treatment sleeves will not fit as well
as they used to, and will be less effective. You
will either need to be fitted for new ones, or
to lose weight. If you would like some help with
healthy eating tips or losing weight, ask your
doctor to refer you to your hospital dietician.
There is information about the right weight for
you in CancerHelp UK.
Some people have said that spicy
foods and alcohol increase the swelling in their
affected limb. Some people find that travelling
by plane seems to increase the swelling but
there is no research evidence to prove this.
Positioning your affected limb
You can help to prevent further
swelling of your affected arm by positioning it
carefully. When you are sitting down, rest your
arm on a table, cushions or pillows rather than
hanging it down by your side. Other tips are
- Don’t carry heavy shopping or
other things with your affected arm – ask for
help even if it makes you feel uncomfortable
- Don’t repeatedly stretch your
arm – for example, by hanging out washing on a
clothes line
- Wear your watch or any other
jewellery on the arm that is not affected
- Don’t cross your legs when you
are sitting down
- Don’t have blood taken from the
affected arm
- Your feelings and getting
support
You may feel very angry, upset
and embarrassed by the swelling in your arm.
After going through a diagnosis of cancer, then
tough treatment, it may feel too much to have to
cope with lymphoedema. It is not easy.
Many people find it very hard,
so do give yourself time to adjust to what has
happened. If your arm is very swollen, it can
change your whole image of yourself and may
affect your self esteem. You may feel less
attractive or find it more difficult to go out
and socialise. With time things get easier but
it does not always help to hear this at first.
Some people find that it helps
to talk to someone else who has been through
similar experiences. Not everyone wants to do
this or feels they need to. But if you want to
talk to someone else, there are lots of
organisations offering help and support to
people with lymphoedema. The organisations can
put you in touch with someone else who has
lymphoedema. It also helps to talk to your
friends and family. If you are feeling very down
about what has happened, then do let someone
know. You might find it helpful to read the
section in CancerHelp UK on low mood, anxiety
and depression. This includes information on how
to help yourself cope when you feel low. |
