Breast Cancer Related Lymphoedema

After treatment for breast cancer one in five women (20%) will go on to develop lymphoedema which is a side effect of some breast cancer treatments.  You may notice that your arm, breast, chest, hands, fingers, shoulder, or the area behind your armpit may start to swell.  In my case it was my boob, which became rock hard and was beetroot red.  My diagnosis was breast and posterior chest wall lymphoedema. Please understand that not everyone will experience the same symptoms therefore, it is essential you check yourself for any unusual swelling and report this to your breast care team.

Lymphoedema is caused by a build-up of fluid in the body’s tissues

 

Cancer related lymphoedema is known as secondary lymphoedema and is a failure of the lymphatic system that develops because of damage to a normally functioning system.  Surgery and Radiotherapy can cause damage to the lymphatic system, lymph nodes and the surrounding affected area, but any damage only affects the side that has been treated.

 

Lymphoedema is a lifelong condition and therefore our focus is on supported management and treatment through a lymphoedema practitioner. However, lymphoedema does require those of us who live with this condition to treat and selfcare for ourselves on a daily basis.  To manage your lymphoedema check out our Cancer Related Lymphoedema page more information.

 

For organisations, services and therapists check out our links page 

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Symptoms of lymphoedema

I cannot emphasise enough how important it is for you to contact your breast care team if you begin to develop any of the following symptoms.  The earlier you are diagnosed with lymphoedema the sooner treatment can begin.

  • Swelling

  • Arm stiffness

  • Discomfort maybe pins and needles, tingling

  • Skin Changes (peau d'orange or orange peel skin)

  • Dry skin, check for breaks in the skin

  • Hardness or firmness (which may be fibrosis)

  • Tightness

  • Less mobility in your arm

You will see in many articles that lymphoedema does not cause pain and that it only causes mild discomfort, however, many of our members will tell you it is painful and I think that many of our healthcare professionals are now beginning to accept this from their patients.  

We are all different, not all of us will experience the same symptoms. 

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Recognising changes and reducing risk

Recognising the different changes in swelling and reducing your risk of lymphoedema, or if you have been diagnosed with lymphoedema preventing your condition from progressing. Report any unusual swelling to your breast care team or lymphoedema specialist.  

Ask yourself the following questions:

  • Has my skin changed?

  • Has my bra become too tight? 

  • Are my rings or jewellery tighter than normal?

  • Is my swelling worse at the end of day?

  • Is it worse after strenuous activity or exercise?

  • Is it worse in the hot weather?

The clothes and jewellery you wear including your underwear should not leave indentations. 

 

Underwear that is normally well fitting might feel tighter in summer if your body swells from the heat.

Cording or Axillary Web Syndrome (AWS)

Unfortunately, some people experience cording after surgery for breast cancer, these cord like structures are under the skin of the inner arm and this happens when lymph nodes are removed from the area under the arm.  Find further information, reading and support here

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Movement

I know when you are first diagnosed that you may find it difficult to treat your arm as normal, you may feel overprotective of your arm, that is natural.  However, it is important after breast surgery and any subsequent treatments that you return to normal activities when you feel able.

Ask your cancer or lymphoedema practitioners for advice and report anything that you feel isn't normal.

Moving your arm regularly can help and wherever possible return to normal sporting activities.  

 

Start off slowly with you exercises, make sure you do warm-up exercises before your start.  Stop to take on fluids, keep hydrated, and remember to do cool-down exercises.

Only do as much as you feel able to do, better to build a routine slowly until you are comfortable with what you are doing.  For more ideas on arm and hand movements take a look here...

Until you build your strength back avoid carry heavy shopping, parcels and avoid moving heavy furniture.

For more ideas on how to improve your lymphatic health check out our #getmoving page

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Why is positioning important?

Whether you are sitting down or lying down you are looking to position yourself in way that helps the lymph fluid to drain.  Positioning often known as elevation will help to reduce your swelling.  With arm lymphoedema place your arm on a cushion or a pillow, be sure that you are comfortable and do not feel any strain. Your arm should not be above shoulder height.

Do not leave your arm in one position for too long, ideally you should shift your position every 30 minutes.

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Recognising Infection

For those of us that have lymphoedema we need to protect ourselves from inflammation and whilst this will seem like common sense to most of us, I have spoken to people who were never told about the risks of cellulitis. 

If you are diagnosed with cellulitis you need to seek help immediately.   You will require two weeks of antibiotics and in severe infections you may need intravenous antibiotics.  Speak to your GP if recurrent episodes of cellulitis (2 or more infections in one year) because you may need to keep emergency antibiotics at home.

The infection may enter via a break in the skin, such as a scratch or insect bite or through an existing wound or ulcer, or through an area of skin inflammation, e.g. athletes foot, eczema or dermatitis. However, it may not be possible to identify the cause and an attack may arise without warning.

 

These are the symptoms to look out for:

  • start to feel unwell. as if flu is starting

  • high temperature

  • fever

  • shivers

  • muscular aches and pains

  • headache, nausea

  • vomiting  

  • acute spreading inflammation of the skin

 

The swollen area usually develops a rash or becomes red, hot and tender to touch. Swelling may dramatically increase and pain may occur in the swollen area, of the arm pit, arm or hand. 

Please remember that not everyone who lives with lymphoedema will develop cellulitis and at this time, we do not know why.  On a poll that our support group did the split was 51% developed cellulitis and 49% did not.  I am one of the 49% who have not had cellulitis which is great considering I have lived with lymphoedema for 10 plus years.

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Reducing & treating infection

If you have had cellulitis, then it is highly likely that you will get it again.  Unfortunately, it is not always possible to prevent it from coming back.  Therefore, you need to take your own preventative measures.

  • wash hands regularly

  • keep you skin clean

  • keep nails short and filed (try not to scratch)

  • moisturize your skin daily to prevent skin drying/cracking 

  • ​prevent cuts and grazes by wearing gloves when doing DIY or gardening

  • keep arms and legs covered when doing DIY or gardening

  • protect your arms and legs from pets biting or scratching

  • ​cuts, bites, grazes keep clean, wash gently under running water, gently pat dry and cover with plaster or dressing

  • keep first aid kit where you can find it quickly

  • carry alcohol wipes in your bag or car for when you are not at home

​​Please remember athlete's foot, eczema and leg ulcers can increase your risk of cellulitis so if you have any of these conditions please talk to your GP.  Unfortunately, if you carry extra weight you can increase your risk of cellulitis so weight control is important..

 

​Speak to your GP if your cellulitis comes back or is not healing as your GP will have the option to refer you to a dermatologist, or skin infection consultant.  You can then discuss whether there is an option to take antibiotics on a long-term basis to protect from further infections.

You will find further information here

Wearing your compression may reduce the incidences of

infection

Selfcare

In an ideal world in the UK you would be supported by the NHS for all your lymphoedema needs including treatment, compression and if needed mental health support.  Sadly, not always the case therefore, learning to take care of yourself will be a become part of your lymphoedema management.  L-W-O Community is here for you, come and join our friendly support group and talk to people who understand what you are going through.  Or join the forum on this website.