Glossary:
Axillary surgery: the removal lymph nodes in the armpit region
Sentinel lymph node biopsy: the removal of the first lymph node where the cancer has most likely spread to from a primary tumor, and can involve multiple nodes
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What Patients with Breast Cancer Need to Know About Lymphedema Risk
Key Takeaways
- Lymphedema risk is linked to lymph node removal, not breast surgery, with axillary dissection and radiation being key factors.
- Maintaining full arm mobility, strength, and tissue health is crucial in reducing lymphedema risk.
CURE® spoke with a physical therapist specializing in oncology to find out more about this condition some patients with cancer are at risk for.
There are a number of factors that patients with breast cancer need to keep in mind regarding lymphedema, as one expert detailed in an interview with CURE®.
A condition where protein-rich fluid builds up in the space between the skin and muscle of a body part, lymphedema is of particular concern for patients with cancer who have lymph nodes removed.
Leslie Waltke, a physical therapist who specializes in oncology, founder of the Waltke Cancer Rehabilitation Academy and a member of the CURE advisory board, discussed topics including who is at risk for lymphedema, how precautions are changing around it and the work she does with patients with lymphedema.
Transcript:
CURE: Is there anything that patients with breast cancer specifically should keep in mind regarding lymphedema?
Leslie Waltke: Well, first of all, updating their knowledge of what is their actual specific risk. Because again, it's not the breast surgery that causes the risk, it is their lymph node removal during the axillary dissection or the sentinel lymph node biopsy that puts you at risk. So, if you have a mastectomy but [have] no lymph nodes removed, you are not at risk for lymphedema. So, it's not the breast surgery, it's the axillary dissection, and radiation to the armpit can change that just a little bit as well. So those are the two factors. What is your specific risk? That, you're going to get that from your surgeon.
And again, [there are] the changing precautions of if somebody comes to me and they're at risk, the first thing I'm going to do is have them stretch out their armpit, make sure that arm is fully mobile, that the skin moves well, the range motion of the shoulder is completely normal, and that they are have normal strength again, because that, again, protects the limb from swelling problems. And then after that's all good, so that arm is 100% range of motion, 100% strength, 100% tissue mobility, it's happy, then I'm going to say to that person, “OK, I want you exercising regularly. I want you taking walks or bicycle rides five times a week. I want you lifting weights twice a week.” Because that, in addition, will significantly decrease lymphedema risk.
And then again, making sure that you're following actually evidence-based precautions [is important]. There is no evidence that if you fly it increases your risk of lymphedema. There is no evidence that getting a blood pressure [check] on your involved arm or getting a blood draw on your involved arm increases risk, if you are at risk for lymphedema but don't have it. So just understanding really what your risk is and what the true precautions are, and then again, making sure you're getting into physical therapy and making sure that that limb should be as good as it was, if not better than before surgery.”
Transcript has been edited for clarity and conciseness.
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