The chronic swelling and discomfort characteristic of lymphedema is caused by an abnormal collection of too much tissue protein, fluid (edema), chronic inflammation, and thickening and scaring of connective tissue. There is no way to predict who will develop lymphedema or when. If left untreated, lymphedema can lead to infection, disfigurement, and debilitation or weakening of the arm.

"This is a very frightening condition because symptoms are unpredictable," said Saskia Thiadens, RN, founder and executive director, National Lymphedema Network (NLN). Symptoms can occur immediately after surgery, or weeks, months, even years later, she explained, and once lymphedema develops, it becomes a chronic condition demanding daily treatment.

The Warning Signs

Early diagnosis and treatment improves the prognosis of lymphedema. People at risk for lymphedema should be identified early, monitored regularly, and taught self-care procedures. According to the December 15, 1998 supplement of the journal Cancer, the first signs of lymphedema can be a change in patient?s arms (or legs).

Lymphedema in women with breast cancer can develop in the arm on the side where the cancer occurred. Early symptoms of lymphedema may include:

• A full sensation in the arm on the side where the breast cancer occurred
• A feeling of tightness around the arm on the same side that was treated for breast cancer
• Decreased flexibility in a hand, elbow, wrist, fingers
• Difficulty fitting into clothing in one specific area
• Tight fit of a ring, wristwatch, bracelet
• Weakness, pain, aching or heaviness in the arm
• Skin that looks shiny, has fewer folds, and feels stiff or taut

It can be very difficult to diagnose lymphedema. Diagnosis can be made by measuring each arm and noting the difference in arm size. It is also possible for minimal lymphedema to exist without a measurable difference. Any symptom of persistent swelling or tightness in the arm or hand should be reported as soon as possible.

How to Treat Lymphedema

Women who have lymphedema can ease swelling by elevating the arm and wearing loose-fitting clothing and a lightweight breast form to reduce pressure on the shoulder. Treatment options for lymphedema include:

• Wearing a compression sleeve
• Massaging the arm to direct and stimulate drainage (NLN encourages massage by an expert trained to treat lymphedema)
• Using a pump which reduces swelling by applying pressure to the arm in timed cycles

Lymphedema Care

There is no cure for lymphedema, but with proper education and care, it can be avoided or kept under control. The following are suggestions for care. Since each situation is unique, check with your health care team to see which recommendations are best for you.

• Never allow blood pressure checks or injections in the at-risk arm.
• Avoid heavy lifting with the affected arm - never carry heavy handbags or bags with over-the-shoulder straps.
• Wear gloves while working in the garden or in the kitchen to protect hands and prevent infection.
• Avoid cuts, scratches, pinpricks, hangnails, insect bites, burns, and strong detergents.
• Keep the affected arm clean - wash twice daily if you get dirty or perspire. Avoid vigorous scrubbing and dry your arm thoroughly.
• Moisturize your skin if it tends to dry and/or crack.
• Use an electric shaver because razors are more likely to cut the skin. ? Maintain your ideal weight through a well-balanced, nutritious diet.
• Exercise regularly, but discuss your exercise program with your health care team; do not fatigue the affected arm.
• Wear loose-fitting clothing, avoiding anything (tight sleeves, watchbands) that will constrict your hand or arm.
• Report any swelling, redness, tightness or sign of infection immediately to your doctor.

The key is to avoid any trauma to the at-risk arm, explained Thiadens. Trauma includes extreme temperature changes, repetitive movements against resistance (pushing or pulling), heavy lifting, and excessive exercise.

Heightening Lymphedema Awareness

An international conference on lymphedema was held by the American Cancer Society in February 1998 in New York City. It included 60 of the world?s leading experts in the field and was preceded by a public forum attended by more than 250 breast cancer survivors, leaders of breast cancer advocacy groups, and members of the media. The proceedings plus a lymphedema resource guide are available as a book from the ACS through the ACS Bookstore.

• Breast Cancer
• Lymphedema Resources
• Living with Lymphedema