Lymphedema And Breast Cancer In Women

During surgery for breast cancer, the doctor removes at least one lymph node from the underarm area to see if the cancer has spread. Sometimes doctors remove more than one. When lymph nodes are removed, the lymph vessels that carry fluid from the arm to the rest of the body are also removed because they are wrapped around the nodes.

Removing lymph nodes and vessels changes the way the lymph fluid flows in that side of the upper body. This makes it harder for fluid in the chest, breast, and arm to flow out of this area. If the remaining lymph vessels cannot drain enough of the fluid from these areas, the excess fluid builds up and causes swelling, or lymphedema. Radiation treatment to the lymph nodes in the underarm can affect the flow of lymph fluid in the arm and breast area in the same way, further increasing the risk of lymphedema.

Lymphedema is a build-up of lymph fluid in the fatty tissues just under your skin. It usually develops slowly over time. The swelling can range from mild to severe. It can start soon after surgery or radiation treatment. But it can also begin months or even many years later. Women who have many lymph nodes removed and women who have had radiation therapy to the breast and/or underarm area may have a higher risk of getting lymphedema.

Doctors still do not fully understand why some patients are more likely to have problems with fluid build-up than others. They expect that in the future fewer women will develop lymphedema because

• breast surgery and treatment keep getting more conservative (that is, more women are treated with lumpectomy);

• research advances have led to methods like the sentinel lymph node biopsy (a newer procedure which allows the surgeon to remove only 1 or 2 lymph nodes); and

• newer studies are looking at finding which lymph nodes drain the arm before surgery so they can be preserved when possible. This procedure is called axillary reverse mapping.

There is still much to be learned about lymphedema, but there are ways that you can care for your arm and breast area to reduce your chances of having future problems. Once lymphedema has started, it cannot be cured. But early and careful management can reduce symptoms and help keep it from getting worse.

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