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Cancer's Best Kept Secret

boudoir and breast cancer cancer lower body extremity lymph nodes lymphedema radiation removal upper body extremity Feb 18, 2021

One of the potential side effects of having lymph nodes removed and/or radiation is lymphedema. Unfortunately, I have found, myself, and with other survivors that this is not often discussed between the physician and the patient, making it, what I like to call, "Cancer's Best Kept Secret".

Lymphedema is swelling produced by an accumulation of lymph fluid in the tissue. The job of the lymphatic vessels is to drain fluid from the tissue cells in the body, along with protein-rich fluid, called lymph once it is in the lymphatic system, travels in one direction; toward the heart. It is transported through the lymphatic vessels to the lymph nodes, where it is filtered and cleansed before returning to the venous system and moving on to the heart. In the heart, the fluid is simply returned to the blood to be recirculated by the body.

If the lymphatic system has been injured, as in the case of lymph node dissection or radiation therapy, the lymph can become backed up (think traffic jam in New York City or I-5 in California).

If it is left untreated, the backed- up fluid can provide a breeding ground for bacteria that can result in infection and delay wound healing, decreased function, range of motion, numbness, and swelling of the affected area. In addition, this damage may result in pain and tightness in the area as the lymph-vessels close-up, tighten, and sometimes snap.

You are at risk for upper body extremity lymphedema if you have had lymph node dissection and/or radiation therapy in the head or neck area, chest area, or breast(s). For breast cancer survivors, it occurs in the arm of the affected side due to damage to the lymph vessels in the armpit area caused by the removal of the axillary lymph nodes or from radiation to that area. It can occur any time after surgery, and can be prevented and/or controlled with proper care.

You are at risk for lower extremity lymphedema if you have had lymph node dissection at or below the abdomen causing potential swelling in the abdomen, pelvis, or in either leg or foot. 

With proper education and care, lymphedema can be avoided, or, if it develops, kept well under control. Older individuals and those with obesity and poor nutrition have an increased risk, as do those with infections due to a cut, bug bite, scratches, burns, and even over heating.

Lymphedema may worsen with time if it is not attended to. It can become disabling by stiffening the joints or making the limbs heavy.

Here are the 4 stages of Lymphedema and symptoms to look for:

Stage 0- Also known as latent or preclinical stage since swelling or other viable evidence of impaired lymph transport is present. It may exist for months or years before edema becomes evident.

Stage 1-This is the mild stage. When the skin is pressed the skin develops pitting which takes some time to fill back up again. This is the early accumulation of fluid relatively high in protein content. There is little or no fibrosis at this stage and is usually reversible. Sometimes it can be reduced by elevating the limb for a few hours.

Stage 2- This is a more moderate stage. Pitting may or may not occur and when the limb is elevated it does not reduce the swelling much. If left untreated, the tissue of the limb gradually hardens and becomes fibrotic.

Stage 3- This is a severe stage. The lymphedema is often referred to as lymphatic elephantiasis. Tissue is hard (fibrotic) and there is no evidence of pitting. The skin becomes thick, hyperpigmented, and there is increased skin folds, fat deposits and wary overgrowth. At this stage it is rarely reversible.

If you develop any of these symptoms, seek medical attention immediately. 

If you are exercising with a trainer, make sure he/she is aware of lymphedema, the signs to look for, the proper protocol should you develop it, and the next steps to take.

If you would like further information, such as the proper protocol, baseline measurements, and even the lymphatic drainage exercises, please contact: Shannon at [email protected] 


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