Lymphoedema Q&As

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0 height="100%"><tr> <td valign="top" width=200 BGCOLOR="#003333" TEXT="#F7F7FF" background="067d8c00dduajq.jpg"> <div> <A HREF="id200.htm" TARGET="_top" TITLE="Fatigue QAs"><U>Fatigue Q&As</U></A></div> <div> <B>Lymphoedema Q&As</B></div> <div> <A HREF="id202.htm" TARGET="_top" TITLE="Pain QAs"><U>Pain Q&As</U></A></div> <div> <A HREF="id201.htm" TARGET="_top" TITLE="Nausea QAs"><U>Nausea Q&As</U></A></div> <div> <A HREF="id204.htm" TARGET="_top" TITLE="Other QAs"><U>Other Q&As</U></A></div> <bR> <bR> <DIV ALIGN="LEFT"></DIV> <div> Click on the question to go to the answer</div> <div> Click on Top to return to questions</div> </td> <td valign="top" BGCOLOR="#FFFFFF" TEXT="#080000"> <div> <FONT SIZE="5" COLOR="#0066FF" FACE="Arial" ><B>Don't Say That Word</B></FONT><FONT SIZE="1" COLOR="#333399" FACE="Arial" >   </FONT>  |     <A HREF="index.htm" TARGET="_top" TITLE="Dont Say That Word"><U>home</U></A></div> <div> back to  <A HREF="id166.htm" TARGET="_top" TITLE="Living With Cancer QA"><U><B>Living With Cancer Q&A</B></U></A></div> <div> Lymphoedema Q&As</div> <div> <B> <A NAME="home"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></B><B>Questions</B></div> <bR> <div> <A HREF="#1__lymphoedema_develops_in_the_arm_when" TITLE="Lymphoedema QAs"><U><U>1. I have been diagnosed as having lymphoedema as result of having my lymph glands under the arm removed when I had breast cancer surgery. Can you tell me what treatments they use for this? </U></U></A></div> <bR> <div> <A HREF="#2___lymphoedema_of_the_arm_is_swelling" TITLE="Lymphoedema QAs"><U><U>2. I had a mastectomy for a breast cancer two years ago. I am now getting some swelling of my arm on that side which I understand is lymphoedema. Does this mean the cancer is coming back? </U></U></A></div> <bR> <div> <A HREF="#3___yes_it_is_perfectly_safe_for_you" TITLE="Lymphoedema QAs"><U><U>3. I've got lymphoedema in my arm (from breast cancer). Can I still have acupuncture if the needles go elsewhere? </U></U></A></div> <bR> <div> <A HREF="#4___with_breast_cancer_treatment_in_the" TITLE="Lymphoedema QAs"><U><U>4. I am going to have surgery for a breast cancer and have been told I will need a full 'axillary clearance' of the lymph nodes under my arm. They also say I will need radiotherapy. Does this mean I will get a swollen arm?</U></U></A></div> <bR> <div> <B>Answers</B></div> <bR> <div> <B> <A NAME="1__lymphoedema_develops_in_the_arm_when"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></B><B>1. </B>Lymphoedema develops in the arm when the drainage of lymph fluid from the tissues in the arm is impaired, causing lymph fluid to accumulate in those tissues, which makes the arm swell. The lymph drainage, through the lymph glands under the arm, can be affected either by removal of glands at operation or sometimes by scarring, caused by radiotherapy or surgery, or by the presence of tumour in the glands. </div> <div> Once the lymph drainage has been damaged it never completely goes back to normal so it is unusual to get rid of all traces of lymphoedemBut a variety of things can be done to help reduce and control the swelling. These include: </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">good skin care: gently moisturising the skin each day with a non-perfumed cream or oil and avoiding any risk of infections in the arm (from cuts, burns etc). </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">compression garments: these are stretchy sleeves which gently squeeze the swollen tissues, preventing fluid from building up and giving the muscles support. They do need to be expertly measured and fitted. Sometimes if there is a lot of swelling special multi-layered bandages will be used at first, to reduce the swelling sufficiently for a sleeve to be fitted. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">limb positioning: gravity affects the amount of swelling in the arm. If you can keep your arm up on a cushion when sitting down, or slightly elevated on a pillow in bed at night this will help. Also avoid carrying heavy shopping or other loads with your affected arm. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">exercises: gentle exercises will help your muscles to work with the compression sleeve to move fluid out of the arm. n massage: this is an important part of treatment for lymhpoedema and there are several techniques, so you do need specialist advice. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">compression pumps: these are only occasionally used and are electrically powered to gently squeeze the arm and help to move the fluid n for those people whose lymphoedema is caused by tumour in their lymph glands then further treatment with chemotherapy or hormones may well help to ease the problem.</div> <bR> <div> As you can see, although a lot can be done the treatment of lymphoedema needs special skills and expert help. In most hospitals that treat breast cancer either the Breast Care Nurses are trained to give advice or, often, there are special Lymphoedema Clinics with Nurse Practitioners who specialise in managing the problem. So do have a word with your local breast cancer team and they will ensure you get to see the right person to help you.</div> <bR> <div> Lymphoedema develops in the arm when the drainage of lymph fluid from the tissues in the arm is impaired, causing lymph fluid to accumulate in those tissues, which makes the arm swell. The lymph drainage, through the lymph glands under the arm, can be affected either by removal of glands at operation or sometimes by scarring, caused by radiotherapy or surgery, or by the presence of tumour in the glands. </div> <div> Once the lymph drainage has been damaged it never completely goes back to normal so it is unusual to get rid of all traces of lymphoedemBut a variety of things can be done to help reduce and control the swelling. These include: </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">good skin care: gently moisturising the skin each day with a non-perfumed cream or oil and avoiding any risk of infections in the arm (from cuts, burns etc). </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">compression garments: these are stretchy sleeves which gently squeeze the swollen tissues, preventing fluid from building up and giving the muscles support. They do need to be expertly measured and fitted. Sometimes if there is a lot of swelling special multi-layered bandages will be used at first, to reduce the swelling sufficiently for a sleeve to be fitted. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">limb positioning: gravity affects the amount of swelling in the arm. If you can keep your arm up on a cushion when sitting down, or slightly elevated on a pillow in bed at night this will help. Also avoid carrying heavy shopping or other loads with your affected arm. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">exercises: gentle exercises will help your muscles to work with the compression sleeve to move fluid out of the arm. n massage: this is an important part of treatment for lymhpoedema and there are several techniques, so you do need specialist advice. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">compression pumps: these are only occasionally used and are electrically powered to gently squeeze the arm and help to move the fluid n for those people whose lymphoedema is caused by tumour in their lymph glands then further treatment with chemotherapy or hormones may well help to ease the problem.</div> <bR> <div> As you can see, although a lot can be done the treatment of lymphoedema needs special skills and expert help. In most hospitals that treat breast cancer either the Breast Care Nurses are trained to give advice or, often, there are special Lymphoedema Clinics with Nurse Practitioners who specialise in managing the problem. So do have a word with your local breast cancer team and they will ensure you get to see the right person to help you.</div> <bR> <div> <A HREF="#home" TITLE="Lymphoedema QAs"><U><B>[Top]</B></U></A></div> <bR> <div> <B> <A NAME="2___lymphoedema_of_the_arm_is_swelling"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></B><B>2. </B> Lymphoedema of the arm is swelling of the arm due to a build up of lymphatic fluid in the tissues of that arm. </div> <div> Normally lymphatic fluid would be drained from the arm by the lymph glands (or, lymph nodes) in the armpit (or, axilla). </div> <bR> <div> In women who have had breast cancer the lymph glands in the axilla can be affected in a variety of ways: </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">they may be completely removed surgically (an 'axillary clearance') as part of the initial treatment of the cancer </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">some, but not all, of the gland may be removed (an 'axillary sampling') as part of the initial treatment </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">they might become scarred or damaged as a result of radiotherapy treatment to the axilla after surgery </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">they might be damaged or even destroyed by breast cancer cells which spread to the glands </div> <bR> <div> Usually when lymphoedema develops after treatment for a breast cancer it is due to either previous surgery or previous radiotherapy (or a combination of the two). Only very occasionally is it actually a sign of the cancer coming back. </div> <bR> <div> Temporary lymphoedema is quite common in the month or so after initial surgery and radiotherapy but this usually settles on its own. </div> <bR> <div> Lymphoedema due to scarring, or damage, to the glands as a result of treatment usually appears later. Sometimes it will be some years before it begins to become apparent. </div> <bR> <div> It is very unlikely then that the lymphoedema you have noticed is a sign of the cancer coming back. But you should see your doctor to get this checked: partly to make sure that there is no cancer there but also because a lot can be done to control the lymphoedema and reduce the chances of it becoming a problem. </div> <bR> <div> <A HREF="#home" TITLE="Lymphoedema QAs"><U><B>[Top]</B></U></A></div> <bR> <div> <B> <A NAME="3___yes_it_is_perfectly_safe_for_you"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></B><B>3. </B> Yes, it is perfectly safe for you to have acupuncture although, as you have realised, it is best to avoid any needles in your affected arm. </div> <bR> <div> You are right, however, to recognise that you do need to take good care of the skin of your affected arm. Things like gently moisturising the skin each day with a non-perfumed cream or oil and avoiding any risk of infections in the arm (from cuts, burns etc) will help reduce any likelihood of increasing the lymphoedema and so are wise precautions. </div> <bR> <div> <A HREF="#home" TITLE="Lymphoedema QAs"><U><B>[Top]</B></U></A></div> <bR> <div> <B> <A NAME="4___with_breast_cancer_treatment_in_the"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></B><B>4.  </B>With breast cancer treatment in the past it was common for surgeons to try and take away as many lymph nodes as possible from under the arm and for this to be followed by radiotherapy to the remainder of the breast (or the wall of the chest, if a mastectomy had been performed) AND the tissues under the arm (the axilla). This very often led to swelling of the arm (lymphoedema). </div> <bR> <div> It is now recognised that if the surgeon clears most of the glands from under the arm then radiotherapy to the axilla is not necessary. National guidelines from the Royal College of Radiologists say that if more than 10 lymph glands have been removed from under the arm then radiotherapy to the axilla is not needed, even if some of the glands contained seedlings of tumour. The only exception to this is if there are signs that there was tumour in the glands which has actually broken through the capsule to the lymph nodes and started to spread into the surrounding fatty tissues, in this case radiotherapy is still recommended - but this is very uncommon. </div> <bR> <div> There is still a risk that some swelling of the arm might develop following an axillary clearance but the chances of this happening should be less than 1 in 20 and this is much less than used to be the case when both surgery and radiotherapy were used.</div> <bR> <div> <A HREF="#home" TITLE="Lymphoedema QAs"><U><B>[Top]</B></U></A></div> <div> <B> </B></div> <bR> </td> </tr></table></body>