Managing Lymphedema After Breast Cancer with Physical Therapy
Women who undergo treatment for breast cancer are at a heightened risk of developing lymphedema as both breast cancer surgery and radiation therapy can disrupt the functioning of the lymphatic system. Lymphedema is a build-up of fluid under the skin due to inadequate drainage of the lymphatic system that leads to swelling in the affected area. Physical therapists play a key role in helping women manage breast cancer-related lymphedema, utilizing complete decongestive therapy, manual therapy, and therapeutic exercise to relieve pain, improve mobility and range of motion, and enhance overall quality of life. Mangiarelli Rehabilitation physical therapy assistant Sue is a certified lymphedema specialist who can provide complete decongestive therapy for women experiencing lymphedema after breast cancer.
What is the Lymphatic System?
The lymphatic system consists of a network of lymphatic vessels, channels, and nodes that collects and transports fluids from all tissues of the body back to the venous system. The lymph vessels act like blood vessels, running throughout the body carrying lymph, a milky fluid that contains white blood cells which helps fight infections. Lymph from tissues and organs drain into the lymph vessels and are carried to the lymph nodes where it is filtered. Lymph nodes are located throughout the entire body.
The lymphatic system is a vital part of the immune system, protecting the body from infection by producing and releasing white blood cells and destroying old and abnormal cells that the body does not need. The lymphatic system also maintains normal fluid levels in the body and absorbs fats and fat-soluble vitamins so they can make their way into the bloodstream.
Lymphedema After Breast Cancer
Lymphedema is a build-up of fluid under the skin due to inadequate drainage of the lymphatic system that leads to swelling in the affected area. Breast cancer-related lymphedema, or BCRL, can develop in 1 in 5 breast cancer survivors. Women who undergo treatment for breast cancer are at a heightened risk of developing lymphedema as both breast cancer surgery and radiation therapy can disrupt the functioning of the lymphatic system.
During a mastectomy or lumpectomy for breast cancer, some lymph nodes in the under arm (called the axillary lymph nodes) may be removed to check for cancer. When these lymph nodes are removed during surgery or are treated with radiation therapy, lymph vessels cam become blocked, which can prevent lymph fluid from leaving the tissue below the area where the lymph nodes were removed, leading to swelling in the chest and arm.
Symptoms of lymphedema can include:
Aching or feeling of heaviness in the affected limb
Repeated infections
Swelling in the arms, legs, hands, feet, or chest
Pitting in the tissues of the limb, which is an indentation that is made by pressing a finger on the skin that takes time to fill in after the pressure is removed
Mobility limitations in the affected limb
Joint pain
Skin that feels tighter, harder, or thicker than normal
There are four stages of lymphedema. During the initial stage (Stage 0), there are no noticeable symptoms but changes in lymph flow can be found. In Stage 1, there is visible swelling of the affected limb, which can be accompanied by pitting edema or heaviness or numbness in the arm. In the early stages, elevation of the affected limb can relieve symptoms. However, by stage 2, these symptoms persist and elevation does not relieve the symptoms. Stage 3 is the chronic lymphedema stage in which skin changes appear like hyperplasia, fibrosis, thickening, and swelling which can limit mobility and cause pain.
Physical Therapy Management of Lymphedema
The gold standard for breast cancer-related lymphedema is complete decongestive therapy performed by a qualified physical therapist. At Mangiarelli Rehabilitation, our certified lymphedema specialist, Sue, provides complete decongestive therapy (CDT), which involves four components: manual lymphatic drainage, compression bandaging, customized decongestive exercise program, and patient education.
Complete decongestive therapy involves:
Compression bandaging, using bandages or sleeves that apply pressure around the arm and help push lymph fluid out of the arm. Research has shown compression bandaging to be efficient in volume reduction and in preventing progression of the condition when done in the early stages of lymphedema.
Manual lymphatic drainage is a form of physical therapy in which a physical therapist gently applies pressure with slow, rhythmic movements on the patient’s body, starting with areas of the body unaffected with lymphedema and then moving on to the affected areas to get the lymphatic fluid to move through the lymphatic system and remove excess fluid from the affected area.
Therapeutic exercise: The physical therapist designs a customized decongestive exercise program to improve lymphastic circulation and maximize functional ability. Contracting the muscles of the arm and hand can help to move the accumulated lymph out of the affected area and into functioning lymphatic vessels and lymph nodes for filtration. Research has shown that gentle resistance exercises in the upper extremity, particularly during the early stages of lymphedema, can be beneficial in managing and preventing BCRL progression. Aerobic exercise is also implemented to improve circulation and blood flow throughout the body.
Patient education including self-management techniques, proper skin care to prevent infections, and tips to avoid exacerbating the condition, such as wearing a compression sleeve when swimming, cleaning the affected arm after swimming, and avoiding hot showers or hot tubs.
Studies have shown that complete decongestive therapy (CDT) is effective in reducing the volume of swelling in the affected limb, enhances the function and mobility of the limb, and improves quality of life. Another study specifically evaluating CDT effectiveness for BCRL revealed that CDT is effective in reducing pain and heaviness in the affected limb, improving arm and shoulder mobility, and reducing swelling volume in BCRL patients.
Another study assessed 1,217 women diagnosed with unilateral breast cancer who underwent tumor resection and axillary lymph node dissection who were divided into 3 groups for various treatments. Group 1 received no education or physical therapy after surgery, Group 2 received education on BCRL the first week after surgery, and Group 3 received education on BCRL in the first week post-surgery and subsequent physical therapy. Of the 1,217 women, 188 developed lymphedema: 77 in Group 1, 101 in Group B, and 10 in Group C. The study shows that patient education on BCRL and targeted physical therapy is effective in reducing the risk of BCRL in women with breast cancer.
Are you a breast cancer survivor or are currently undergoing treatment for breast cancer? Our lymphedema therapist is here to help you prevent and address lymphedema early on and safely support your physical recovery from cancer.
