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Lymphedema of the Arm
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Lymphedema of the Arm

The standard treatment for breast cancer includes removing and/or radiating some or all of the axillary lymph nodes.  As a result, an average of approximately 30% of the patients develop secondary arm lymphedema and/or secondary chest edema.  The more lymph nodes are affected, the greater the risk of developing lymphedema, however, even with a sentinel lymph node biopsy, the risk is still present.  Breast cancer treatment is the number one cause of lymphedema in the United States.

Removal of the axillary lymph nodes disrupts the superficial and deeper lymphatic drainage pathways of the arm and chest on the affected side.  In many cases, the body is able to naturally find alternative drainage pathways, and there is no significant swelling, but when this doesn't happen, or if the burden becomes too great, lymphedema can result.  

If left untreated, lymphedema will become worse over time, and fibrosis or sclerosis can cause tissues to harden.  In addition to arm swelling and hardening, the risk of an infection called cellulitis or erysipelas becomes a concern.  If an arm with lymphedema goes untreated for a great length of time, there is a small chance the lymphedema can develop into a malignant tumor called lymphangiosarcoma or Stewart-Treves syndrome.

How is arm lymphedema recognized?

In early onset lymphedema, the patient notices a pulling on the inner side of the upper arm.  They may also notice a feeling of heaviness and other sensations in the arm, but not usually pain.  In secondary arm lymphedema, swelling will usually begin in the upper arm, but may not be noticed until it has progressed further down the arm towards the fingertips.  It is pretty common for the swelling to disappear overnight and come back during the day.  When swelling is noticed, it is often after some type of overexertion.  

Lymphedema is generally thought to be a permanent condition that can be treated and managed, but not cured.  Early intervention may possibly "reverse" lymphedema, or provide the best outcome, so it is important for a patient to contact their doctor immediately if they experience any signs or symptoms of lymphedema.

Therapy for lymphedema of the arm

Therapy for arm lymphedema may vary depending on how far it has progressed.  In the early stages, wearing a compression sleeve with a glove or gauntlet and maintenance with MLD (manual lymph drainage) may be adequate.  The gold standard for treating lymphedema is called "Complete Decongestive Therapy."  Complete Decongestive Therapy, sometimes called "Combined Decongestive Therapy," or "Complex Decongestive Therapy," includes a combination of MLD, bandaging, exercise and skin care.  For the most effective results, patients will usually see their lymphedema therapist on a daily basis, or at least a few times a week for Phase I of therapy, which may last anywhere from two weeks up to about six weeks.  Phase II, or the "maintenance phase," usually involves wearing a compression sleeve and glove during the day, sometimes a different type of compression at night, and MLD given by a therapist or self-MLD on a regular basis.  

Diet and exercise also play an important role in managing lymphedema.  It is recommended patients drink up to two liters of water per day, as adequate fluid intake is important for both hydration and filtration.  The best diet is a stable, well-balanced diet.  For someone who is overweight, a low-calorie, low-protein diet is recommended.  Salt restriction is important because salt causes water retention.  Exercise should be something the patient enjoys doing, which will not over-burden the body.  Swimming is usually an excellent option, as it offers good external compression, can keep the body from over-heating, and is low-risk for injury.  Since obesity contributes to lymphedema, maintaining or striving for an optimal body weight is important.