Lymphoedema Westmead Breast Cancer Institute
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
Lymphoedema Westmead Breast Cancer Institute
What is lymphoedema? What is the lymphatic What are the
system? symptoms of
Lymphoedema is swelling that develops when lymph fluid
builds up in the body’s soft tissues and does not go away. The lymphatic system is a network of tiny lymphoedema?
channels called lymph vessels. These
It may develop in the arm or breast/chest region after treatment People with lymphoedema usually have
vessels carry fluid around the body, like
for breast cancer when the lymph nodes (lymph ‘glands’) in the blood vessels carry blood around the body. one or more of the following symptoms:
armpit are removed with surgery or treated with radiotherapy. > Swelling of all or part of the arm.
The lymph vessels carry fluid to groups of
Treatment to these lymph nodes can interfere with the way > Swelling of the hand and fingers.
lymph nodes in the armpit, groin, neck and
fluid moves through the lymphatic system, and can cause a several other areas in the body. Lymph fluid > Swelling of the breast/chest or armpit
build-up of fluid in the arm and chest. This build-up of fluid is is moved through these channels when region.
called lymphoedema. muscles are moved when you are active.
> Feelings of heaviness, pain, aching,
Lymphoedema is most common in the
first twelve months after treatment but
What is the risk There are particular pathways that fluid
normally travels along to reach the lymph
tightness or ‘bursting’ in the arm or
hand.
may develop any time, including years later. of developing nodes. If one set of lymph nodes has been
> Skin changes such as the skin feeling
Lymphoedema usually develops gradually. removed, the fluid is usually simply re-
If you develop lymphoedema this does not lymphoedema? routed along different channels to another
different or the skin being drier and
more sensitive to irritation.
mean that your breast cancer is coming Anyone who has treatment to the lymph group of lymph nodes, because the system
back. nodes as part of breast cancer treatment is able to adapt to change. However, > Difficulty putting on clothing, with the
may develop lymphoedema. sometimes fluid build up occurs, resulting sleeves feeling tight.
Most people who have treatment to
the lymph nodes, however, will never The risk is highest for people who have in lymphoedema. The early symptoms of lymphoedema
develop lymphoedema. It is our goal to most of the lymph nodes removed from The lymphatic system acts to fight infection, may come and go, depending on things
prevent lymphoedema occurring or at the axilla which is known as an axillary control the immune system and help get like how active you are and how hot it is.
least detect it early to avoid long term lymph node dissection (ALND) (up to 20%) rid of some of the body’s waste products.
problems. Prevention and early detection and for those who have both ALND and Antibodies to fight infection are made
are the keys to success and there are radiotherapy to the lymph nodes in the by the lymphatic system and some
things that can be done to help reduce axilla (up to 30%). waste products are broken down in
the risk! A newer surgical technique known as the lymph nodes.
This brochure explains what lymphoedema sentinel node biopsy (SNB) has a lower
is and gives you some simple guidelines to risk of developing lymphoedema ( Yellow pages – general information about that fluid from the breast ‘drains’ to first.
(near collarbone)
lymphoedema. It is thought that if cancer cells were to
move from the breast they would spread Axillary (armpit) lymph nodes
> Green pages – guidelines for reducing the Internal mammary lymph nodes
to these ‘sentinel nodes’ first. SNB is a
risk of lymphoedema and its impact on (between the ribs or under
technique that aims to identify and remove the breast bone)
your everyday life.
just the sentinel node/s and no others.
> Blue pages – information about treatment Removing only the sentinel nodes can
for lymphoedema. lessen the likelihood of complications Thoracic duct
(Lymphatic trunk)
including lymphoedema.
Fig 1. Lymphatic channels drain fluid from the body and carry it to the lymph nodes. The breast
lymphatics drain fluid (and sometimes cancer cells) from the breast to the lymph nodes in the axilla
(armpit), internal mammary chain, supraclavicular and infraclavicular areas. The sentinel lymph nodes
Inguinal (groin) lymph nodes
(first lymph nodes draining a breast cancer) are found in these areas.
2 3
Caring for your arm important, however, for you to be aware
of your body’s signs and symptoms.
and skin Work towards doing your normal activities:
This section gives you information on how > Start slowly, gradually building up your
to look after your arm and skin. Caring for level of activity, rather than trying to do
your arm and skin during and after breast your previous best immediately.
cancer treatment may help to lessen the > Take notice of your symptoms; your body
risk of lymphoedema. Being aware of the will tell you how much you can do.
things that put an added strain on the > You can do any exercises or activities
lymphatic system and avoiding them is an including resistive training exercises such
important part of managing lymphoedema. as going to a gym and doing weights
Some simple guidelines on how to look training, walking, cycling, aerobics and
after your arm are explained below. aqua aerobics.
These guidelines are also useful for
Fig 2. A lymphoedema therapist can measure your arm to see if you have lymphoedema. women who are living with lymphoedema. 2. Keep the skin of your arm and
All women who have treatment for hand healthy and unbroken
When is swelling not Early detection helps breast cancer that includes surgery or The skin is an important barrier against
lymphoedema? Early education and ongoing monitoring
radiotherapy to the lymph nodes should
follow these guidelines.
infection. If the skin is broken, bacteria can
of any arm symptoms may reduce the enter the body and cause infection.
Swelling in the first few months after onset of any long term problems of To help prevent and manage An infection or repetitive infections in the
surgery for breast cancer is not lymphoedema. lymphoedema it is recommended that arm at risk of lymphoedema (your ‘at-risk’
lymphoedema. Swelling in this early you:
Bioimpedance Spectroscopy is a technique arm or chest region) may cause or worsen
stage is part of the normal process of 1. Use the arm as normally as possible.
that measures fluid in the arm. By taking lymphoedema in that arm. To keep your skin
recovering from surgery and is known
measurements before surgery and at regular 2. Keep the skin of your arm and hand healthy and prevent infections, follow these
as post-surgical swelling.
intervals after surgery, lymphoedema can be healthy and unbroken. simple instructions:
Any type of swelling that does not go detected in its early stages and treatment 3. Avoid using the arm in a way that puts Keep your skin well moisturised
away should be discussed with your can be commenced even before any visible
doctor. You may need to be referred to an extra load on your lymphatic system. > Use a moisturiser every day.
swelling is present. The L-Dex reading
a lymphoedema therapist. A qualified All of these suggestions apply only > When you put moisturiser on, always
should be between -10 and +10 to be in
lymphoedema therapist can be found to your arm at risk of or affected by stroke your arm upwards as this
the normal healthy range.
on the National Lymphoedema lymphoedema. The lymphatic system in encourages fluid to move up your arm
Practitioners Register at www.nlpr.asn.au. You can contact a lymphoedema therapist the other arm and in the rest of your body and away from your hand.
to have your fluid levels measured. should be working normally and need no
Fig 4. Using your arm as normally as possible
Fig 3. Bioimpedance Spectroscopy is a simple and accurate measurement of fluid in the arm. special treatment. is important.
It can detect lymphoedema at an early stage.
1. Use your arm as normally
as possible
Using your arm normally helps to keep the
lymph fluid moving and achieve your full
range of movement quickly.
Many women who have had treatment for
breast cancer are worried that using their
arm will increase their risk of developing
lymphoedema. You should be able to do
all of the things you were doing before
4 you had breast cancer treatment. It is 5
Things you can do to avoid getting too hot:
> When you exercise, do so in the early
morning or in the evening as these are
the coolest times of the day.
> Make use of air conditioning when possible
during the hot summer months.
> Pace yourself when you are doing
something active. If you start to get hot,
have a short break and cool down before
you continue.
> Avoid putting your hand directly into hot
Fig 5. Using your arm as normally as possible Fig 6. Apply moisturiser by stroking upwards. water (greater than 34°C). This may mean Fig 7. Learning to look after your arm is important
is important. wearing rubber gloves to do the washing when you have been treated for breast cancer.
up, using a dishwasher, or using cooler
> Choose a simple moisturiser that does > Think about different ways you can do things water to wash the dishes. to fly, speak to your lymphoedema therapist
not contain perfume, as perfume can to avoid injuries / infections to your skin. > Avoid getting sunburnt. Wear SPF-rated about things you can do to help your arm while
irritate the skin. Sorbolene and vitamin E If the skin of your at-risk arm gets broken, clothing and use sunscreen. Even minor flying. This can include wearing a compression
cream are good choices. treat it quickly burns lead to an increase in the amount sleeve and completing regular exercises.
> Massage around the scar using Bio-oil of lymphatic fluid that the system has to Avoid activities and clothes that make
> Gently wash the area with clean water.
or a similar product twice daily for the deal with. your arm feel tight
> Use an antiseptic product to clean the wound.
duration of treatment and then daily Try not to repeat the same movements Anything that is tight around your arm may
thereafter for two years. > Cover the wound with a non-stick dressing. especially if they are strenuous and block the flow of lymph fluid. This may cause
> Spend some extra time caring for the skin > Avoid sticky dressings that can damage the cause symptoms swelling, even if the pressure is only there for
around your nails, as this is a place where area further when they are removed. Some women find that if they do something a short period of time.
bacteria can enter and cause infection. > Check the wound regularly over the next with their arm over and over again (such as To avoid making your arm feel tight:
> Avoid using soap on your at-risk arm few days. kneading dough, or vacuuming) their arm
> When you have your blood pressure taken,
as soap can dry out the skin; non-soap > See your doctor if the wound does not heal aches or starts to swell.
ask the doctor or nurse to use your other arm.
cleansers are better alternatives. as quickly as another part of your body would, To avoid repetitive or strenuous movements
> Avoid wearing clothing or jewellery that feels
Avoid damage to the skin of your arm or if it looks red or infected. You may need pace yourself, doing intense activities in short
tight and cuts into your arm.
and hand dressings or antibiotics. bursts and resting, or alternating intense work
with less strenuous activities. This is often > Wear a properly fitted bra that does not leave
> Even minor injuries to the skin such as marks in your skin.
scratches, insect bites, cuts and places 3. Avoid using your arm in a more effective than trying to finish an intense
where you have had injections can be way that puts an extra load on activity in one go.
enough to cause infection in your at-risk your lymphatic system Avoid long periods of not moving Diet and body weight
arm. If there is extra strain on your lymphatic system If you don’t move your arm muscles for a long
> Consider ways that you can protect your for a long time, you may increase the risk of time, lymph fluid can build up in your arm. There is no special diet that you should follow
skin. For example, wear gloves and a long- developing lymphoedema. There are several To avoid long periods of not moving: to reduce your risk of developing lymphoedema
sleeved top while gardening, use an insect things you can do to reduce the strain on your or the amount of swelling in your arm. However,
> Take regular breaks to stretch and move eating a healthy balanced diet is advisable to
repellent, and ask health professionals lymphatic system. around when you travel a long distance,
to take blood pressure readings and give maintain a healthy body weight.
Avoid letting your body become too hot (for example by bus or car).
injections in your other arm. Being overweight may increase the risk of
When the body gets hot, blood vessels open > Use your arm as normally as possible, lymphoedema after your breast cancer
> As a last resort, your treated arm can up in the skin to cool the body. This leads to an within the limits explained above.
be used for injections as long as special treatment. It is thought that additional fat in the
increase in the amount of fluid flowing through > If you travel by plane, your lymphatic system arm reduces the efficiency of the lymphatic
precautions are taken by the doctor or the skin into the lymphatic system, which
nurse to avoid infection. is affected by both the inactivity and the system and muscles in draining fluid.
may cause the arm to swell more. change in cabin pressure. If you are planning
6 7
What if I have a qualified lymphoedema therapist. A
lymphoedema therapist is an occupational
If your lymphoedema is severe, you
may need to have manual lymph drainage
that the pressure is firmest at the wrist,
gradually becoming less firm as it goes
lymphoedema? therapist, physiotherapist or nurse who is performed by a therapist as part of an up the arm. This helps move the fluid out
specially trained to treat lymphoedema. intensive treatment program. If the of the arm. A glove or mitten is often also
This section explains the treatments They can be found at www.nlpr.asn.au. lymphoedema is less severe, you may used to avoid the fluid moving down to the
available for lymphoedema. Following the The therapist will discuss your symptoms be able to perform this massage yourself. hand and fingers instead.
guidelines in the previous (green) pages with you and examine and measure your If there is another person who can help, Over time, both bandages and
is also an important part of lymphoedema arm and breast/chest to find out how the massage can also move lymph fluid compression garments lose their stretch.
management. severe your lymphoedema is. A treatment across your back where there is usually no It is recommended that garments be
plan can be designed for your individual scarring from the surgery. A lymphoedema replaced after about six months of wearing
Can lymphoedema situation.
Complex Lymphatic Therapy (CLT) is
therapist can teach your partner, or a friend
to perform this special massage.
them constantly. Private health funds may
provide assistance to pay for garments.
be cured? the usual technique used for treating
lymphoedema. The aim of this treatment 2. Applying pressure 3. Exercise
Early detection is the key to success! is to reduce the swelling and other (compression)
If you are aware of the symptoms of The lymphatic system of the arm relies
symptoms associated with lymphoedema, on arm movements. Fluid is moved along
lymphoedema and seek advice early, the Compression has two purposes:
and so reduce the impact of lymphoedema the vessels as muscles are tightened and
impact of lymphoedema on your life may on your life. > It stops your arm and hand from swelling
be reduced. Moderate lymphoedema any further by providing relaxed. Using your arm as normally as
This therapy program comprises: possible is an important way to try to keep
cannot be cured but the swelling and a barrier to the swelling; and
symptoms can be reduced and managed > Draining the lymph fluid by massage the lymph fluid moving. A balance needs
> It helps to move the lymph fluid to be found however, because doing too
well by following a few simple guidelines. (manual lymphatic drainage)
out of your arm and hand by helping your much (or over-exercising) can make your
> Applying pressure (compression) muscles tighten and relax. symptoms worse.
How is lymphoedema > Exercise
> Skin and arm care
Compression for lymphoedema can
be provided by special bandages or by
There are exercise programs that help
move extra fluid out of the affected arm.
treated? > Psychological support specially manufactured compression The exercises encourage fluid to clear
garments for your arm and hand. first from the trunk and abdomen. Then
If you think you may have lymphoedema, > Low Level Laser Therapy may also
be included. The compression provided by garments and they target the shoulder, arm and hand,
speak to your doctor for a referral to
by bandages varies in strength. This means to encourage the fluid to move out of
Fig 8. Massage techniques may help move 1. Manual lymphatic drainage
fluid out of the arm. Fig 9. Compression garments can reduce swelling caused by lymphoedema.
This is a special form of massage that helps
drain the lymph fluid, and may also help
develop new pathways for lymph fluid to
move around the areas that are blocked.
Manual lymph drainage uses long, slow,
gentle strokes starting on the chest and
stomach area, and then moving to the
arm and hand. The aim is to first make a
‘space’ ready to take the extra fluid from
the arm, then to move this extra fluid out
of the arm.
The fluid is always moved towards the
lymph nodes that are working properly;
these are usually the lymph nodes in the
opposite armpit and in the groin.
8 9
Things to remember Contacts
about lymphoedema Westmead Breast Cancer Institute
Westmead Hospital
> Most people who have treatment to (02) 8890 8888
their lymph nodes for breast cancer do
not get lymphoedema. Lymphoedema Clinic
Westmead Hospital
> The lymphatic system adapts very well, (02) 8890 6500
and after treatment for breast cancer, other
lymph nodes are usually able to take over Lymphoedema Support Group NSW
the work that was done by the lymph nodes http://www.lymphoedemasupport.com/
in the armpit.
> Use your arm as normally as possible.
Be aware of possible symptoms, and adjust
what you do accordingly.
> Do not do things that consistently cause
your symptoms to appear. If doing a certain Choose a qualified Lymphoedema Therapist
thing seems to cause symptoms such as with confidence.
arm swelling, you should rest, and elevate
Fig 10. Bandaging the arm from the hand upwards has a similar effect to a compression garment. National Lymphoedema Practitioners
your arm. Swelling that lasts for only a short
time and settles with simple measures such Register
the arm, and into the cleared trunk area.
The exercises are gentle, and they are
Diet and body weight as raising your arm up may mean that your
lymphatic system is under strain.
www.lymphoedema.org.au
A service of the Australasian Lymphology
done each day. A lymphoedema therapist Maintaining your weight within your ideal > If you are able to do an activity without
Association
can teach you these exercises. body weight is recommended in the noticing any symptoms, it is safe to continue A public register of lymphoedema practitioners
Resistive training exercises have also management of lymphoedema. Research doing this activity without concern. in Australia and New Zealand. These
been shown to assist lymph drainage studies also show that even small practitioners fulfil the accreditation and
> If you develop symptoms that do not go registration requirements of the Australasian
and should be encouraged. amounts of weight loss may be helpful in away or you are worried about developing Lymphology Association
reducing arm swelling. lymphoedema, talk to your doctor who may Dietitians Association of Australia (DAA)
4. Skin and arm care If you have lympoedema, it is important refer you to a lymphoedema clinic to be www.daa.asn.au
to ensure you eat adequate protein each assessed by a lymphoedema therapist.
You should look after your arm and Accredited Practising Dietitians are registered
day as this helps to prevent your body’s > Remember that early detection is important
skin in the same way when you have nutrition professionals who are able to offer
muscle being broken down which may and early symptoms of lymphoedema can
lymphoedema as you would when trying personalised advice about maintaining a healthy
make fluid build-up worse. be managed well. Discuss your symptoms diet and achieving a healthy weight.
to reduce your risk of developing
lymphoedema. There is not a lot of research conducted with your doctor, or lymphoedema therapist
regarding whether a high salt diet worsens
You should try to keep the skin healthy,
lymphoedema. However, limiting salt
prevent infection, and avoid doing things
that put extra strain on your lymphatic
intake may be helpful for some women Useful contacts/websites
and is a general part of a healthy diet.
system. See the green section ‘How
to look after your arm and skin’ in this It is also important to ensure you drink Cancer Australia canceraustralia.gov.au
brochure. adequate fluid each day. Reducing Cancer Council cancer.org.au
your fluid intake will not help reduce
lymphoedema and may actually worsen Cancer Council Helpline 13 11 20
it. Try to drink eight glasses of fluid each Breast Cancer Network 1800 500 258
day to meet your requirements. Australia (BCNA) bcna.org.au
10 11
Supporting People with Breast Cancer Today and Every Day Providing screening, diagnosis, treatment and care by expert teams With world-class research, education and innovation Engaging the help of our community and supporters To shine a Ray of Hope PO Box 143 Westmead NSW 2145 T +61 2 8890 6728 F +61 2 8890 7246 www.bci.org.au The Westmead Breast Cancer Institute (BCI), NSW Australia, is supported by NSW Health & the generosity of the community. Prepared by the Westmead Breast Cancer Institute and reviewed by consumers, and scientific and plain-English editors. Version 4 WSP 115 June 2014 © Westmead Breast Cancer Institute 2012 IMPORTANT At all times you should rely on the expert judgement of your medical advisor(s). This information guide is not a substitute for medical advice. It is designed to help you understand and discuss your treatment. Images 1-10 Westmead BCI
You can also read
