Breast Cancer Related Lymphoedema

Arm lymphoedema (swelling of the arm) in breast cancer patients can occur months or years after their treatment. It is a chronic condition and occurs when there is a disruption to the lymphatic flow during breast cancer treatment. It can affect up to 40% of breast cancer patients.

To find out about other conditions listed, please visit Breast Conditions on www.kkh.com.sg.

The main symptom is swelling of the arm on the same side of the breast cancer. There may also be associated feeling of tightness and heaviness of the arm and hand.

In severe cases, the ability to move the affected arm can be restricted. In addition, there is an increased risk of skin infection which can lead to skin breakdown and changes.

After breast cancer treatment,

• Avoid the administration of intravenous therapy on the arm at risk of lymphedema - inserting a drip into a vein and giving fluids or drugs increases the potential risk of introducing an infection, but has not been clearly shown to increase the risk of lymphedema. As the current evidence is limited, avoid the administration of intravenous therapy on the at risk arm unless it is in a life threatening situation when life-saving drugs or fluids need to be immediately given and no alternative intravenous access is available. In cases when repeated administrations of drugs/fluids have to be given regularly, such as in chemotherapy, a more long-term intravenous access should be considered. This is usually a plastic catheter inserted through the skin into a deeper vein, typically in the neck. The catheter can be kept in place for weeks.
• Having blood drawn (venepuncture) from a vein carries little chances of introducing an infection in the limb. However, where there are alternative sites on the body, it is wiser to utilise those areas.
• Good skin care of the affected arm
  

Measuring blood pressure involves a simple cuff on the arm which is inflated above the pressure in the arteries, and then rapidly deflated to record the blood pressure. There is no evidence that this makes any difference to the risk of developing lymphoedema or worsen an established lymphedema. However, if you have established lymphedema, the changes in the volume of the arm may affect the accuracy of the recording and for this reason, using the other arm would be more sensible.

Arm lymphedema can occur secondary to breast cancer treatments such as undergoing an axilla surgery especially axillary clearance (removal of all the axilla lymph nodes) and/or radiotherapy.

Obesity and arm infection can also increase the risk of development of lymphoedema.

This is established from your history and physical examination. Imaging tests, measures of volume tests etc may be conducted.

• Conservative measures such as compression bandages, massage, elevation of the affected limb, skin care, arm exercises, weight management etc
• In some cases, surgery such as lympho-venous anastomosis or lymph node transfer etc to divert the affected lymphatic flow may be needed

You will be referred to a plastic surgeon for further discussion of the surgery if you are a suitable candidate.