How to Manage Lymphedema After Breast Cancer Treatment
Lymphedema is a common side effect of breast cancer surgery that physical therapy can effectively treat and manage. Lymphedema is a build-up of fluid under the skin due to inadequate drainage of the lymphatic system and leads to swelling in the affected area. A certified lymphedema therapist uses complete decongestive therapy to decrease swelling, drain built-up fluid, and improve quality of life for patients with lymphedema.
The lymphatic system is a network of small vessels and small, bean-shaped organs called lymph nodes that carry lymph (a colorless fluid) throughout the body. The lymphatic system is part of the immune system and helps protect and maintain the balance of fluid in the body by filtering and draining lymph and waste products away from each region of the body.
What is Breast Cancer-Related Lymphedema?
Nearly 33% of breast cancer survivors can develop lymphedema within the first six to eighteen months after treatment; however, breast cancer-related lymphedema can also develop years after treatment. Breast cancer treatment can damage or remove lymph nodes, whether through surgical removal of the lymph nodes of the underarm (axillary lymph nodes) or due to radiation therapy that damages and scars the lymph nodes.
The axillary lymph nodes drain lymphatic vessels from the arms, breast, chest, neck, and underarm area. Breast cancer-related lymphedema commonly manifests in swelling of the arm from which the lymph nodes were removed, although it can occur in the breast, trunk, or back.
Symptoms of lymphedema include:
swelling
feeling of aching, tingling, heaviness, or pressure in the affected area
feeling of tightness in the skin of affected area
pitting (indentation) in tissues of the limb
repeated infections in the limb
difficulty bending or moving a joint (wrist, elbow, or shoulder)
How does physical therapy treat lymphedema?
Working with a certified lymphedema physical therapist is critical before and after breast cancer surgery. Prior to surgery, the physical therapist can provide education about lymphedema, proper diet and skincare instruction, a preventative compression garment, and a post-surgical home exercise program to help achieve full shoulder range of motion.
If lymphedema does develop following surgery, the physical therapist can help breast cancer survivors manage and treat lymphedema with a customized treatment plan. Treatment for breast cancer-related lymphedema involves complete decongestive therapy (CDT) to drain lymph fluid and protect the limb.
Complete Decongestive Therapy for Lymphedema includes:
Manual lymphatic drainage to help improve the flow of lymph from the affected area
Compression bandaging to reduce swelling
Skincare
Therapeutic exercise that involves aerobic, weight-training, and stretching exercises to improve range of motion, overall physical fitness, and increased drainage of the affected area
A trial measuring the incidence of lymphedema in women at risk of breast cancer-related lymphedema (after removal of 5 lymph nodes) showed that only 7% of those who engaged in a supervised progressive weight training program had lymphedema versus 22% of the women at risk who did not exercise. In breast cancer survivors with stable lymphedema, those who did weight training were not at any higher risk of developing arm swelling and had a lower incidence of lymphedema flare ups (14% in the exercise group versus 39% in the no exercise group).
A physical therapist can help breast cancer survivors maximize their physical function, prevent and/or address lymphedema early on, and safely support physical recovery from cancer. Our certified lymphedema specialist, Sue, is qualified to work with breast cancer survivors to prevent lymphedema and/or help manage the condition to improve function and overall quality of life.
