Q&A: Upper Extremity Lymphedema and Cancer
CancerWise - October 2008
According to the American Cancer Society, as many as 20% of people who have been treated for breast cancer develop upper extremity lymphedema (ULE), which causes swelling, pain and infection.
Answering questions about lymphedema brought on by breast cancer treatment is Mattie McDowell, a research nurse in M. D. Anderson’s Department of Breast Medical Oncology. McDowell dedicated herself to the study, prevention and management of ULE after a patient died from complications of advanced ULE.
She recently presented a literature review on ULE at the Oncology Nursing Society 33rd Annual Congress. It examined 20 years of information and brought together a comprehensive list of strategies to treat lymphedema.
What is upper extremity lymphedema (ULE)?
ULE involves swelling, pain and infection in the arms, hands, fingers, shoulders or chest brought on by damage to, or removal of, lymph nodes in the upper part of the body.
ULE often can make everyday tasks, such as getting dressed or exercising, painful and diminishes a patient’s quality of life.
The immune system includes a network of lymph nodes, olive-sized organs that filter a colorless fluid called lymph or lymphatic fluid. Lymph nodes remove materials that might be harmful, such as bacteria, before the lymphatic fluid enters the bloodstream.
Normally, the amount of fluid flowing into an extremity is the same as the amount coming out, but in lymphedema this system gets backed up.
When the lymph nodes are damaged or removed, lymphatic fluid may build up, causing swelling and other problems. Lymphatic fluid contains a high level of protein, which helps infections grow.
What causes ULE?
ULE can be caused by breast cancer treatment including surgery, chemotherapy, radiation and other therapies.
More specific therapeutic causes of ULE may include:
- Surgical removal of the breast and lymph nodes
- Surgical removal of the tumor and lymph nodes
- Surgery and radiation to the area with lymph nodes
- Radiation to the area with lymph nodes
Any of these procedures change the lymphatic system pathway, which may cause fluids to build up.
Factors that cause or aggravate ULE include:
- Long airplane flights
- Weight gain after breast surgery
- Infection or injury of the lymph nodes
- Summer heat
When does ULE appear?
Most women have some swelling after breast cancer surgery. This is normal and goes away in a month or two.
Lymphedema symptoms may appear days or weeks after surgery, although they may not occur until many months or even years later.
What are the symptoms of ULE?
Women who have had breast surgery, chemotherapy or radiation should be on the lookout for symptoms. Treatment is usually easier and more effective if ULE is diagnosed in its early stages.
- Swelling in the:
- Swelling after a long airplane trip or injury
- Tight skin in the swollen area
- A heavy, full feeling in the swollen area
- Less flexibility in the arm, wrist or shoulder
Sometimes women first notice symptoms when a piece of clothing or jewelry, such as a ring or bracelet, becomes too tight.
How is ULE diagnosed?
Health care providers can conduct a complete physical examination and complete medical history, take arm measurements and review medications. Sometimes other tests, including blood tests, may be used to help diagnose lymphedema.
What is the treatment for ULE?
ULE treatment depends on the cause.
Care of the skin: Keep the skin clean and moisturized. Avoid injury and infection.
Massage: Manual lymph drainage massage and myofascial release (also known as soft-tissue mobilization) can help drain fluids and increase comfort. These techniques are performed by specially trained therapists.
Exercise: Special stretching exercises can help move lymphatic fluid.
Bandaging: A method of bandaging that may be taught to the patient to help apply pressure and drain fluid.
Compression clothing: Gloves and/or sleeves, much like support stockings, move the fluid and prevent further buildup.
Medications: If ULE is caused by infection, antibiotics may be prescribed. Other medications may be given, too.
What have you learned in your research?
As breast cancer treatments improve, women are living longer. This means many may face side effects for longer periods of time.
Early intervention is the key ingredient, along with ongoing physician and nursing assessments during each visit.
In addition to this, it’s imperative that we increase education and research. Nurses are on the frontline of patient care, and they may help prevent lymphedema by educating patients about triggers and symptoms, providing regular assessments and pursuing research.
M. D. Anderson resources:
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