What is lymphedema post breast cancer? - Part 1

Among the treatment options for treatment for breast cancer is chemotherapy, radiation therapy and surgical intervention. Other treatment options will include physiotherapy either pre-operatively or post operatively either early on to manage the immediate issues following medical intervention or later among other things to manage potential complications, such as lymphedema. Individuals who have had breast cancer treatment with radiation and/or surgical intervention with or without lymph nodes removal usually in the armpit carry a lifelong risk to develop lymphedema. Lymphedema is a special type of swelling that occurs when there is excessive build of fluid that is rich in protein that is to become lymph due to an impairment in the transport of this fluid anywhere enroute to its final drainage site in the neck. Removal of lymph nodes, for example, causes scarring which becomes a physical barrier that impedes flow resulting in fluid collection (lymphedema). Radiation therapy can cause scarring/radiation further worsening impediment of fluid flow. This fluid collection is usually found in fingers, hand, arm and upper chest area of the affected side. Things that can help one to become suspicious of lymphedema are a feeling of tightness, fullness when wearing clothing/jewellery or when attempting to bend the affected body part, the affected side looking bigger in size compared to the non-affected side. Lymphedema is staged to assign its severity Stage 0 - is characterised by no swelling despite the risk factor, for example, lymph nodes removal. This state can exist for months or years before the onset of edema. Scarring/fibrosis as a consequent of radiation therapy should be managed to contribute to the delay in progression of this stage. Stage 1 - is early onset of swelling which subsides with elevation. The swelling is also soft and one usually wakes up in the morning it has also subsided. Stage 2 - elevation is ineffective to reduce the swelling, as now the tissues are feeling a bit rigid (tissue fibrosis from accumulation of protein rich fluid). Stage 3 - the skin can be lumpy, bumpy or have fibrotic wart-like projections (papillomatosis), hard crust-like skin resembling crocodile hide (hyperkeratosis), recurrent skin infections (cellulitis due to excessively protein rich environment), edematous legs with square shaped toes. This stage negatively impacts the quality of life of an individual. Lymphedema management is divided into two phases: Phase I (Congestive/acute phase) whose goal is to achieve the greatest decrease in volume of lymphedema and Phase II (Maintenance phase) whose purpose is long-term maintenance to ensure sustenance of goals achieved in Phase I. Lorato Mosetlhi-Molelowatladi is a physiotherapist at Physiotherapy Touch