Lymphoedema

Lymphoedema is characterised by swelling of a limb and/or parts of the body caused when the lymphatic system does not function properly.

The swelling occurs as a result of impairment in the normal process of lymph drainage in the affected part of the body. The lymphatic system plays an important role in the body’s defence against infection by filtering and removing bacteria.

Lymphoedema can be recognised by an unexplained swelling. Early signs and symptoms include a dull heaviness, aching or a feeling of fullness in the arm, and rings/jewellery or clothing may feel tight. Over time this swelling increases and can lead to a feeling of heaviness and discomfort in the area. If left untreated, lymphoedema can lead to loss of mobility and the skin becomes prone to infection.

Individuals who have undergone surgery and radiation therapy for the treatment of breast cancer are particularly susceptible to lymphoedema. We encourage you to speak with your surgeon, oncologist, breast care nurse or lymphoedema therapist about your specific risk factors for lymphoedema.

Lymphoedema can develop in around 1 in 5 people with breast cancer. The risk is highest in the first one to three years following breast cancer treatment, so this is a common time that you should be on alert for potential signs and symptoms. Regular lymphoedema screening is a good idea particularly if you are considered to be at higher risk.

Unfortunately, your risk never totally goes away, and some people can develop lymphoedema even many years after breast cancer treatment.

Lymphoedema is unfortunately one of the possible side effects of certain treatments for breast cancer.

We know that breast cancer treatment which involves removal of lymph nodes, radiation therapy and some chemotherapy drugs can cause lymphoedema. However, even after having treatments for breast cancer, there are some things that you can do to reduce your risk of lymphoedema such as:

• Maintaining a healthy weight
• Exercising and keeping active as much as possible
• Practicing good skin care to help prevent infection
• Moisturising the skin regularly in an upwards direction towards your armpit
• Avoiding having injections into the at-risk arm
• Having regular lymphoedema screening and monitoring

Early detection and management of lymphoedema helps to promote better outcomes. There are effective treatment programs that can reduce your symptoms, decrease your swelling and teach you how to self-manage your lymphoedema at home.

There are two types of lymphoedema: primary and secondary lymphoedema.

• Primary lymphoedema is the result of a congenital abnormality of the lymphatic system or part of it
• Secondary lymphoedema can result from damage to the lymphatic vessels and/or lymph nodes. This may be from surgery, the lymph nodes being removed, and/or radiation therapy. Other causes include trauma, infection, obesity and immobility.

Screening and monitoring can help detect lymphoedema in the early stages.  There are a number of different methods of lymphoedema screening such as:

1. Body measurements – using a tape measure to measure whether there is a difference in circumference between the affected and non-affected arm.
2. Pitting test – the thumb is pressed down onto the skin on the arm for 60 seconds and released. If there is a visible indentation that is not present on the unaffected arm, this can indicate a fluid buildup in the area.
3. Perimetry measurement – to test for changes in the circumference and volume of the limb.

These screening methods test whether there is any measurable difference in size between your affected and normal arm or limb at the earliest possible clinical stage.

Bioimpedance spectroscopy using a SOZO device is the newest form of technology for lymphoedema screening that detects the earliest signs of subclinical lymphoedema. During this subclinical stage, there is a small amount of water build-up in the tissue but no noticeable visible signs or symptoms or swelling. If lymphoedema is detected, it can be managed before it progresses to a clinical stage.

It is recommended that prior to your lymphoedema screening appointment you:

• avoid caffeine for two hours prior
• avoid exercise for two hours prior
• avoid alcohol for 12 hours prior

1. Australian Lymphoedema Association Position Statement – Early detection of breast cancer-related lymphoedema