Limiting Lymphedema

One of the primary goals of sentinel node biopsy is to reduce the need for axillary dissection to minimize a woman’s chance of getting lymphedema, a chronic buildup of fluid that occurs as a result of the body’s impaired ability to drain lymph fluid from tissue. Lymphedema, which can be managed but not cured, can leave a woman’s arm significantly enlarged, greatly affecting her quality of life.

According to statistics compiled by the American Cancer Society, the percentage of women who get lymphedema as a result of full node dissection and radiation ranges widely, from 6 to 48 percent. While studies concur that sentinel node biopsy reduces the risk of lymphedema, the rates vary depending on a number of factors, such as whether the woman received radiation. But it doesn’t eliminate the risk, says Wendy O’Rear, PT, a certified complete decongestive therapist at Presbyterian Hospital in Dallas.

The huge variation in statistics also reflects that whether someone gets lymphedema depends on a number of factors, including location of the tumor, body mass index, age, physical condition and other medical conditions that can contribute to unbalanced fluid levels in the body.

O’Rear treats women with lymphedema using complete decongestive therapy, which clears lymphatic pathways of fluid and decompress fluid-filled areas to allow the limb to return to normal or near-normal size. Patients then may use special compression garments to prevent the arm from re-swelling while learning exercises to help the arm eliminate fluid.

“Who gets lymphedema varies, and it’s multifactoral,” says O’Rear. “I have had women who had sentinel node surgery who swelled immediately, and then I have another patient who had surgery 38 years ago when they took all the nodes and followed it with radiation—and she just got lymphedema.”

Typically, O’Rear says, she sees fewer women with immediate problems if there were fewer than 10 nodes removed and there was no radiation. She emphasizes that it’s important for women to understand that the fluid in the tissue contains protein, which is inflammatory and produces scar tissue. When lymphedema is not controlled, it will increase in severity, she says. O’Rear emphasizes that women need to be vigilant for the rest of their lives and follow the guidelines from the National Lymphedema Network (www.lymphnet.org) to reduce their risk.

“We have had women tell us that someone told them that after five years they could begin getting blood pressure taken on the affected arm, and that isn’t true,” O’Rear says. In fact, she says, as women age and their tissue becomes more firm, particularly if they have had radiation, they can lose lymph function faster.