All you want to know about lymphedema

On a good day, Hema does not wake up to a “heavy arm”. A good day means there is no swelling on her left arm weighing her down, requiring her to wrap her entire arm in a compression sleeve, making her feel like a “mummy”.

But as she gets through the day — a teacher and a writer — she gets that now-familiar sense of being bloated and heavy on one side. “It is frustrating to have the “heavy arm” back by evening,” says Hema, who underwent breast cancer treatment five years ago.

Even when the debilitating effects of lymphedema, which might follow breast cancer treatment, becomes a daily battle, it is the thought of hundreds succumbing to the dreaded disease that keeps breast cancer survivors like Hema sober.

Lymphedema is a chronic condition that impacts many breast cancer patients who may have had their axillary nodes (lymph nodes in the axilla or armpit) removed as part of breast cancer treatment. A cancerous tumour spreads when cells break off from the tumour and enter the body’s blood or lymph fluid that drain into lymph nodes. These nodes can trap cancer cells moving through the lymph fluid and become enlarged.

A surgeon treating breast cancer might decide that it is safer to remove a number of lymph nodes from the arm pit (Axillary Lymph Node Dissection or ALND) to find out if the disease has spread to the nodes. But the resulting damage in the lymphatic system prevents the fluid from draining, causing it to accumulate in the arm. The condition is chronic and progressive. Though lymphedema can be managed with compression therapy, exercise and self-care means, it has a significant effect on the quality of life.

About 17-36 % of women who undergo cancer treatment are at risk of developing lymphedema.

Life-long risk of developing lymphedema after breast cancer treatment is related to the extent of axillary node involvement, the type of surgery, and whether radiation therapy was administered. “Surgeon’s expertise is crucial. He should be able to remove the nodes with minimal disruption to the lymphatic network, ensuring that some channels for fluid draining are maintained. For cases done at the RCC, we see lymphedema only in 5-10% cases ,” says Paul Augustine, Head of Surgical Oncology, Regional Cancer Centre (RCC).

Sentinel Node Biopsy

Of late, surgeons have adopted a technique called Sentinel Node Biopsy (SLNB) as a standard practice to stage breast cancer and assess the disease prognosis and this has reduced the burden of lymphedema. In SLNB, the surgeon injects a blue dye into the breast to stain the sentinel nodes. These nodes are removed and examined by a pathologist during surgery itself .

If the sentinel nodes are negative for cancer, then the cancer is unlikely to spread. Only if the node is positive, does the surgeon need to remove more lymph nodes. As fewer lymph nodes are removed, those women who underwent SLNB are less likely to develop lymphedema than those women in whom all axillary lymph nodes are removed. Early detection of breast cancer thus offers better clinical outcomes and better quality of life.

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Printable version | May 2, 2021 4:39:05 PM |

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