Lymphoedema after breast cancer treatment
Breast cancer treatment can cause a build up of lymph fluid. This is called lymphoedema and is pronounced lim-fo-dee-ma. Find out how you can lower your risk of getting it and how to manage it.
The lymphatic system carries clear watery fluid called lymph, which drains out from the small blood vessels (capillaries) into the body tissues.
Here is a short video to show you how the lymphatic system works:
The lymphatic system helps our bodies get rid of toxins, waste and other unwanted materials including infections and cancer cells.
It is a system of thin tubes called lymph vessels and lymph nodes or glands. These run throughout the body.
The spleen, thymus, tonsils and adenoids are also part of the lymphatic system.
Along the lymph vessels are small, bean-shaped lymph glands.
You might be able to feel these in your neck, under your arm and in your groin. But they are also throughout the body including the chest, abdomen and pelvis.
The lymphatic system carries a colourless liquid called lymph.
As the blood circulates around the body, fluid passes from the blood into the body tissues, carrying food to the cells.
This fluid bathes the tissues, to form tissue fluid, which collects waste products, bacteria, damaged cells and cancer cells if there are any.
The fluid then drains back into the lymph vessels where it is transported towards the lymph glands. The glands then filter the lymph, taking out any harmful products. The lymph also contains lots of white blood cells, called lymphocytes, which help us fight infections.
The lymph eventfully reaches a large vessel at the base of the neck, called the thoracic duct which passes the filtered lymph back into the blood circulation.
If the lymph vessels or nodes are blocked, removed or damaged, it can cause a build up of fluid. This can cause swelling, known as lymphoedema.
For more information about lymphoedema and cancers of the lymphatic system go to Cancer Research UK.org slash lymphoedema.
Cancer or cancer treatment can affect the fluid drainage channels of the lymphatic system. Fluid then doesn't drain in the normal way, so the area swells.
About 1 in 5 people (20%) will have lymphoedema of the arm after breast cancer treatment that includes:
- surgery to remove lymph nodes
- radiotherapy to the lymph nodes
If lymphoedema is not treated, it may get worse. It can be painful and make it difficult to move your arm.
Lowering your risk of lymphoedema
Sentinel lymph node biopsy
Your surgeon might use a procedure called a sentinel lymph node biopsy (SLNB). This is when the surgeon removes the first lymph node (or first few lymph nodes). Removing the sentinel lymph nodes can cause damage to the lymph channels, so this can still cause lymphoedema. But the risk is much lower compared to removing most of the lymph nodes in the area.
Infection
Infection in a cut or graze can increase fluid collection in your arm and increase your risk of lymphoedema. There are things you can do to help protect your skin including:
- wearing gloves when gardening or doing housework
- using nail clippers rather than scissors
- using an electric razor if you shave under your arms
- take care when playing with pets
- using insect repellent and mosquito nets to prevent bites
If you get a cut or graze, wash it well and cover it up with a plaster or dressing until it's healed.
Go to your GP straight away if it looks red or swollen. You might need antibiotics.
Heat and sunburn
Severe heat and sunburn can increase your risk of lymphoedema. You can reduce your risk of sunburn or severe heat by:
- wearing a sunscreen with at least SPF 15 and at least 4 stars
- wearing suitable clothing to protect your skin from the sun such as long sleeved tops, trousers, long skirts and wide brimmed hats
- staying in the shade during the hottest part of the day between 11am and 3pm in the UK
- avoiding very hot baths and showers, including saunas
Take care of your skin by using a non scented moisturiser every day to keep your skin moist.
Looking after your arm
You'll get instructions on what exercises to do straight after surgery from your physiotherapist or specialist nurse. They’ll tell you what you can and can’t do after your type of surgery. You’ll have a programme that will gradually build up your arm movement and strength.
Putting too much strain on your arm after surgery can increase your risk of lymphoedema. Don't use your arm for anything heavy until your team say you can. Let your team know straight away if you develop any swelling.
Treating lymphoedema
You should see your doctor or breast care nurse as soon as you can if you notice any swelling in your arm. Early signs and symptoms you might notice include your watch strap, rings or clothes feeling tighter. Your arm, hand or shoulder may ache or feel heavy, stiff, tight or have a feeling of fullness.
Treatment aims to reduce swelling and stop the fluid from building up again. The treatment can take a little while to show results.
You might have:
- an elastic sleeve to wear to reduce arm swelling
- an elasticated vest (to reduce breast swelling)
- your arm bandaged up with a particular type of short-stretch bandage that your lymphoedema specialist puts on
- exercises that help the fluid to drain from your arm
- a specialised massage called manual lymphatic drainage (MLD)
You might see a lymphoedema nurse specialist for these treatments. They will measure your arm and talk to you about your symptoms.
Your nurse, physiotherapist or lymphoedema specialist can teach you how to do gentle exercises at home to help prevent or decrease swelling in your arm. You'll get the most benefit from the exercises by wearing your sleeve when you are doing the exercises.
Heavy lifting or too much repetitive exercise could make lymphoedema worse. So be sure to stop exercising if your skin is starting to become red, hot and sweaty.
It can be more difficult to control the swelling if you're overweight. Talk to the dietitian at the hospital or your GP if you would like some help with healthy eating tips or losing weight.
Positioning your arm
When you’re sitting down, it helps to position yourself in a way that helps the lymph to drain.
You can help stop further swelling in your arm by positioning it carefully. Raise your arm to a comfortable level by putting it on a cushion or a pillow, but not above the height of your shoulder.
Exercises for arm lymphoedema
Your lymphoedema specialist will show you arm exercises you can do to help your lymphoedema. They can also be useful if you are at risk of developing it.
The videos below show you how to do some exercises. Speak to your doctor or lymphoedema specialist if you are unsure about doing any of them and you should do them pain free. These videos were made with the lymphoedema team at University College Hospital London.
The first video shows deep breathing exercises. It is 1 minute long.
Hi I’m Carla, I’m going to show you some arm exercises.
Remember to repeat each exercise 5 to 10 times, to do your deep abdominal breathing before and after and its very important to be pain free.
Neck exercises
We’ll start with the head and the neck. And I want you to turn your head to the side, back to the middle and to the other side, as much as possible. Back to the middle.
Now ear to the shoulder, keep your shoulders relaxed and your body straight and to the other side. It is normal that you might feel a bit of stretching on this exercise on the side of the neck.
Shoulder exercises
Next one will be shoulders. Up, relax and down. And next one for the shoulders we’ll rotate them as much as possible, up, back and down. Backwards and then forward.
Arm
Now we’ll be doing combined movements. We’ll start on the knee, then touching the shoulder and up, going back to the shoulder and to the knee. If you have difficulties getting the arm as high as this, we’ll do it a bit lower. Then back to the shoulder and to the knee.
Another combination of movement will be pretend swimming. We’ll start with breast stroke and if this is painful on the shoulder, you’ll do it a bit lower.
Next one backstroke and if again you have problems with the shoulder you’ll do it a bit lower as well.
And the last one will be grabbing something that you can squeeze like a stress ball or a cushion and you’ll be pressing the hands together slowly. And this exercise is very good if you have any swelling of the breast area.
Wrist exercises
Next exercises will be the wrist. You can lean your forearm on an armchair or a table and what you’ll do is going up as much as possible and down as much as possible. Next one will be circles so one side first and going for the full movement and then the other side.
Hand exercises
Next ones will be the hand and we will do opening as wide as possible your fingers, bending the fingers only by the knuckles, and then touching with your thumb each finger and try to do it as quick as possible. And the last one will be with the ball. So, you’ll be squeezing the ball five to ten times and you can do that as well opening your hand as wide as possible and doing a fist
Remember to do all the exercises once a day minimum without pain and if you’re concerned, see your doctor or speak to your lymphoedema specialist. Remember that you can find more information about lymphoedema on the Cancer Research UK website.
The next video is about arm exercises and is just over 4 minutes long.
Hi I’m Carla, I’m going to show you some arm exercises.
Remember to repeat each exercise 5 to 10 times, to do your deep abdominal breathing before and after and its very important to be pain free.
Neck exercises
We’ll start with the head and the neck. And I want you to turn your head to the side, back to the middle and to the other side, as much as possible. Back to the middle.
Now ear to the shoulder, keep your shoulders relaxed and your body straight and to the other side. It is normal that you might feel a bit of stretching on this exercise on the side of the neck.
Shoulder exercises
Next one will be shoulders. Up, relax and down. And next one for the shoulders we’ll rotate them as much as possible, up, back and down. Backwards and then forward.
Arm
Now we’ll be doing combined movements. We’ll start on the knee, then touching the shoulder and up, going back to the shoulder and to the knee. If you have difficulties getting the arm as high as this, we’ll do it a bit lower. Then back to the shoulder and to the knee.
Another combination of movement will be pretend swimming. We’ll start with breast stroke and if this is painful on the shoulder, you’ll do it a bit lower.
Next one backstroke and if again you have problems with the shoulder you’ll do it a bit lower as well.
And the last one will be grabbing something that you can squeeze like a stress ball or a cushion and you’ll be pressing the hands together slowly. And this exercise is very good if you have any swelling of the breast area.
Wrist exercises
Next exercises will be the wrist. You can lean your forearm on an armchair or a table and what you’ll do is going up as much as possible and down as much as possible. Next one will be circles so one side first and going for the full movement and then the other side.
Hand exercises
Next ones will be the hand and we will do opening as wide as possible your fingers, bending the fingers only by the knuckles, and then touching with your thumb each finger and try to do it as quick as possible. And the last one will be with the ball. So, you’ll be squeezing the ball five to ten times and you can do that as well opening your hand as wide as possible and doing a fist
Remember to do all the exercises once a day minimum without pain and if you’re concerned, see your doctor or speak to your lymphoedema specialist. Remember that you can find more information about lymphoedema on eth Cancer Research UK website.
Your feelings
You may feel very angry, upset and embarrassed by the swelling in your arm. After going through treatment for breast cancer, it may feel too much to cope with lymphoedema as well.
If your arm is very swollen, it can affect your self esteem. You might feel less attractive and find it harder to go out and socialise.
If you are feeling very upset and sad about what has happened, do let someone know. Talk to someone you trust. Make an appointment to see your lymphoedema specialist nurse.
More information
The Lymphoedema Support Network (LSN) has more information about exercises for arm lymphoedema.
The British Lymphology Society (BSL) has a campaign called EveryBodyCan. It has information about lymphodema and activities you can do to keep your lymphatic system healthy.
