Lymphedema. Patient Education. Information for women with breast cancer. What is lymphedema? Surgical Specialties Center

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1 Patient Education Information for women with breast cancer This handout describes what lymphedema is, the steps you can take to lower your risk, and what signs to look for. Women who have been treated for breast cancer may be at risk for lymphedema, arm swelling on the side of the body that is treated. Most women who have had breast cancer surgery will not develop this side effect. It is not possible to predict who will get lymphedema, but catching it early and treating it promptly is the best way to manage it. What is lymphedema? Our bodies have a network of lymph nodes and lymph vessels that carry and remove lymph fluid. This system is similar to the way blood vessels circulate blood to all parts of our body. Lymph fluid contains white blood cells, which help us fight infections. During surgery for breast cancer, the surgeon usually removes some of the lymph nodes from the underarm area to see if the cancer has spread. Some lymph vessels that carry fluid from the arm to the rest of your body are removed also, because they are connected to the nodes. Removing lymph nodes and vessels changes the way lymph fluid flows in the treated arm. This makes it more difficult for fluid in the arm to flow to other parts of the body. If the remaining lymph vessels cannot remove enough of the fluid in the breast and underarm area, the excess fluid builds up and causes swelling, or lymphedema. Radiation treatment also can affect the flow of lymph fluid in the arm and breast area in this way. Radiation also increases your risk of lymphedema. usually develops slowly over time. The swelling can range from mild to severe. It can develop soon after surgery or radiation treatment, or many months, or even years, later. Women who have many lymph nodes removed and radiation therapy may be at higher risk of developing lymphedema. But, we do not fully understand why some patients are more likely to have problems with lymphedema. Although there is much more to be learned about this condition, there are ways that you can care for your arm and breast area to reduce your chances of having problems.

2 Page 2 Axillary Lymph Nodes The illustration below shows the major muscle and lymph nodes in and around the breast area. A. Pectoralis major muscle B. Axillary lymph nodes: levels I C. Axillary lymph nodes: levels II D. Axillary lymph nodes: levels III E. Supraclavicular lymph nodes F. Internal mammary lymph nodes Lymph nodes in and around the breast area (Illustration used with permission from

3 Page 3 How to Watch for If you have had lymph nodes removed or radiation treatment, you may want to examine your upper body in front of a mirror and compare the size of the surgical side to the non-surgical side. If you see swelling on the treated side, call your doctor or nurse. Signs of Signs of lymphedema include: Your arm feels full or heavy. Your arm is swollen. Your skin feels tight. You have less movement or flexibility in your hand, wrist, elbow, or shoulder. It is hard to fit your arm into a jacket or shirt sleeve. Your ring, watch, and/or bracelet feels tight, but you have not gained weight. There is a burning or tingling feeling in your arm, or your arm feels like it is bruised. Ways to Prevent Each body reacts differently to lymph node removal and radiation. This means that the onset of lymphedema cannot be predicted. It is important that you keep your regular follow-up appointments with your doctor so that your condition can be monitored. The precautions listed below and on pages 4 and 5 are things to be careful about. But, there may be times when you or your doctor needs to override them to do a necessary procedure. is not a life-threatening condition. We do not advise you to follow a lymphedema precaution if it means refusing a possibly lifesaving treatment. Remember that precautions are things to be careful about, not things that you absolutely must not do. Always check with your doctor if you have questions. Hygiene Keep your skin clean. Wash your arm at least once a day. Do not use a loofah (a rough sponge made from a plant) to wash your arm. After washing, dry your hands thoroughly. Use lotion to keep the skin on your arm and hand moist.

4 Page 4 Avoid Injury and Infection Watch for signs of infection in your arm. Look for redness, pain, heat, swelling, or fever. Call your doctor right away if signs of infection occur. Tell your doctor about rashes if they develop. Use an electric razor for shaving your underarms. Use rubber gloves for housework when you are using cleaning products. Wear oven mitts or use hot pads when you are cooking. Wear cloth or leather gloves and long sleeves when you are gardening. Use a thimble when you are sewing. Wear gloves to avoid scratches from pets. Take good care of your nails. Push cuticles back (do not cut them). Avoid needles (shots, vaccinations, blood draws, IVs) into your treated arm. Use the opposite arm to test the temperature of water to avoid burns. Clean any breaks in your skin with soap and water right away, then use antibacterial ointment. Use caution when applying and removing tape and bandages on your skin. Avoid Constriction Wear jewelry and clothes that do not have tight bands. Do not use elastic wraps such as Ace bandages. Have blood pressure cuffs put on your other arm. Activity Avoid prolonged and strenuous work with your arm. Rebuild your strength gradually. Get regular exercise. Walk, swim or bike at least 5 times a week. Start out with a few minutes and build up gradually to 30 minutes each time. Carry your handbag on the opposite shoulder, or use a fanny pack instead.

5 Page 5 Avoid straining your arm by only lifting weights that are comfortable for you. We recommend that you use good judgment and that you avoid activities that might bother your arm. Avoid long baths, hot tubs, and saunas. Wear a compression garment on your arm during air travel to improve blood flow. Nutrition Eat a well-balanced, protein-rich, low-fat, low-salt diet. Maintain a healthy weight. People who are overweight are at higher risk for getting lymphedema. Drink plenty of water. Treatment cannot be cured, but prompt treatment may lessen the swelling. Please talk with your doctor about treatment options. These may include: Physical therapy. Use of a compression or elastic sleeve. Occupational therapy. Manual lymph drainage (type of massage performed by a trained therapist). Decongestive therapy to drain fluid. This may include massage, wrapping the limb, exercising the wrapped limb, and taking very good care of your skin. You may be taught to do these things at home. To Learn More To learn more about lympedema or other issues related to breast cancer, contact these organizations: American Cancer Society ACS-2345 ( ) National Cancer Institute Cancer Information Service CANCER ( )

6 Page 6 Questions? UWMC Surgical Specialties Nurse Advice Line: (weekdays 8 a.m. to 4 p.m.) SCCA Women s Center: (weekdays 8 a.m. to 5 p.m.) National Network Susan G. Komen for the Cure GO-KOMEN ( ) Y-ME National Breast Cancer Organization 24-Hour National Breast Cancer Hotlines: (English) (Spanish) After hours and on weekends and holidays, call and ask for the resident on call for Surgery to be paged. Or, ask for your surgeon to be paged: Dr. UWMC Box NE Pacific St. Seattle, WA University of Washington Medical Center 01/2005 Rev. 09/2010 Reprints on Health Online:

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