When a woman is diagnosed with breast cancer, she focuses on 2 things--saving her life and, once it's confirmed that she'll live, then saving her breast. The threat of getting a disorder called lymphedema after she's through with treatment never enters her mind.
Lymphedema is one of the most annoying and debilitating complications of breast-cancer surgery. It can strike patients who have had a portion of their lymph nodes removed from under the arm or who have had radiation aimed at their armpit. Some survivors swear that this complication, which can haunt them for years, is far worse than the diagnosis of breast cancer.
Though the incidence of lymphedema is markedly less today than it was, say, 10 years ago (due to improvements in surgery that allow far fewer nodes to be removed), the risk of developing this chronic condition can last a lifetime.
What causes lymphedema?
A common procedure during breast cancer surgery--specifically, the removal of one or more lymph nodes from under the arm--can potentially lead to lymphedema.
Lymphedema is the development of an uncomfortable, though not painful, swelling of the arm on the affected side where lymph nodes have been removed. This disorder is caused by an abnormal buildup of lymph fluid, which ordinarily would be drained away naturally. This buildup can happen either when an axillary (armpit) node is removed or when radiation has been beamed into the armpit as part of breast cancer treatment. Either of these treatments can disrupt the flow of lymph fluid.
Over time, the accumulating fluid starts making the arm swell up until it can't be moved or flexed without difficulty and discomfort. Some believe that the more lymph nodes removed, the greater the risk for lymphedema; however, actual studies have not been done to validate this. Someone who had 7 nodes removed might develop lymphedema and someone who had 17 nodes removed may never have a problem.
A threat that lingers
A breast cancer patient can often recover from her surgery and radiation therapy in a matter of weeks or months, but she can remain susceptible to lymphedema for months or years. That is, there's no magic time limit after which a woman can assume she's escaped the danger: She must continue taking precautions against it indefinitely. And if lymphedema does develop, it can become chronically disabling, affecting a woman's mobility, strength, and quality of life. This is why it's so important to treat lymphedema early!
Early detection is crucial
A new study conducted by the National Institutes of Health and the National Naval Medical Center, shows that if lymphedema is detected early, it can be treated effectively by the prompt use of compression garments.
Traditionally, whenever lymphedema has been a possibility, doctors have put off treating the condition until unmistakable signs of real trouble become apparent--either measurements reveal that a limb has increased in size or the patient herself reports symptoms. Today, however, new technology has made it much easier to determine if someone is at risk, even in the very early stages--even, in fact, before the patient herself has noticed any symptoms.
How is lymphedema detected?
Two new pieces of equipment can spot the beginnings of lymphedema as much as 10 months before a limb becomes swollen enough for a patient to notice. One (typically used in hospitals) is the perometer, an infrared laser measuring device. The other is a tool that calculates fluid retention in a limb by sending low-frequency electric current through the patient's arm(s). Since an electric current travels faster through fluid than through muscle, fat, or bone, even a slight increase in fluid in the arm will give an abnormal lymphedema score.
So, if you or someone you know has had or will be having either an axillary-node dissection or radiation to her axilla as part of her cancer treatment, be aware of the possibility of lymphedema.
Know, too, that the sentinel-node biopsy was expressly developed to avoid the need for a full axillary-node dissection: If you have a negative sentinel node for breast cancer, then removing any more nodes is unnecessary and will only expose you to the risk of developing this chronic condition that requires daily care.
Research is of course ongoing in this controversial field. There are even some newer studies encouraging women to exercise as a way to reduce lymphedema risk. So debate continues on the subject of lymphedema. Stay posted.
