In the realm of cancer, specifically breast cancer, lymphedema is rarely discussed. Nonetheless, lymphedema of the arm is one of the most common and underestimated side effects of breast cancer treatment. It is quantitatively known to negatively affect the quality of life in breast cancer survivors.
Chemotherapy. Radiation. Surgery. Conventional medicine will have you believe those are the only three treatments for cancer. It's the “poison, burn, cut” theory that too often leaves patients with a toxicity immensely worse than cancer.
The fact is, side effects of chemo, radiation, or surgery are not minor. While some patients may experience mild side effects, these may last months or even years. And there is the real chance for more severe side effects.
The American Cancer Society lists these as the most common side effects of chemo:
- Hair loss
- Easy bruising and bleeding
- Anemia (low red blood cell counts)
- Nausea and vomiting
- Appetite changes
- Mouth, tongue, and throat problems such as sores and pain with swallowing
- Nerve and muscle problems such as numbness, tingling, and pain
- Skin and nail changes such as dry skin and color change
- Urine and bladder changes and kidney problems
- Weight changes
- Chemo brain, which can affect concentration and focus
- Mood changes
- Changes in libido and sexual function
- Fertility problems
As for radiation, the ACS is more … general: Radiation therapy can cause early and late side effects.
Early side effects happen during or shortly after treatment. These side effects tend to be short-term, mild, and treatable. They’re usually gone within a few weeks after treatment ends. The most common early side effects are fatigue (feeling tired) and skin changes. Other early side effects usually are related to the area being treated, such as hair loss and mouth problems when radiation treatment is given to this area.
Late side effects can take months or even years to develop. They can occur in any normal tissue in the body that has received radiation. The risk of late side effects depends on the area treated as well as the radiation dose that was used. Careful treatment planning can help avoid serious long-term side effects. It’s always best to talk to your radiation oncologist about the risk of long-term side effects.
However, there is a serious issue that can occur after breast surgery — a “late side effect”: lymphedema.
The Institute of Medicine of the National Academies published a report in 2006 recommending a “survivorship care plan” for cancer patients that incorporates information about late effects of treatment, health management behaviors, disease management, and recurrence monitoring.
It was noted that lymphedema is one of the most poorly understood, relatively underestimated, and least researched complications of cancer or its treatment.
The Institute of Medicine also highlighted critical shortfalls in the transition to survivorship, particularly in providing education about late effects of treatment.
There have been several studies to develop a protocol to address lymphedema. In 2007, a surgical oncologist, Dr. John B. Hamner, studied 135 breast cancer patients with lymphedema. They were provided a protocol for complete decongestive therapy (CDT): manual lymphatic drainage, compression garments, skin care, and range-of-motion exercises.
Dr. Hamner reported: “Despite recent advances in breast-conserving surgery, upper-extremity lymphedema remains a problem for patients after the treatment of breast cancer.”
What is lymphedema?
Lymphedema is an abnormal collection of high-protein fluid just beneath the skin. In the case of cancer, notably with radiation, lymphedema may develop when lymph nodes are removed. This swelling, or edema, most commonly occurs in the arm or leg. However, it also may occur in the breast or trunk, head and neck, or genitals.
The National Lymphedema Network notes:
Specific cancer-related surgeries such as surgical resection of melanoma, breast, gynecological, head and neck, prostate or testicular, bladder, or colon cancer may require the removal of lymph nodes. These surgeries put patients at risk of developing secondary lymphedema.
The Lymphatic Education & Research Network estimates up to 10 million people in the United States, and hundreds of millions worldwide, suffer from lymphedema and lymphatic diseases. More people in the U.S. suffer from these diseases than suffer from multiple sclerosis, muscular dystrophy, ALS, Parkinson's disease, and AIDS — combined.
All cancer treatment survivors, including those with melanoma, prostate, and ovarian cancer, are susceptible to developing lymphedema. Breast cancer survivors can be at a high risk for developing lymphedema and 100 percent of those treated for head and neck cancer will develop the disease. Physical trauma also can result in lymphedema. This is a major cause of lymphatic disease among wounded veterans.
Complete decongestive therapy (CDT) remains the go-to for treating lymphedema. The Mayo Clinic recommends:
- Elastic bandage — stretchy bandages used to wrap sprains and strains. Provides support and compression during recovery.
- Compression stockings — elastic hosiery that squeezes blood up the legs to prevent swelling and blood clots.
- Physical exercise — aerobic activity for 20-30 minutes 5 days a week improves cardiovascular health. If injured, pursuing an activity that avoids the injured muscle group or joint can help maintain physical function while recovering.
- Moisturizer — hydrates and protects skin from damage.
- Stretching — stretching exercises can improve flexibility and improve physical function.
There are natural herbs that can alleviate swollen lymph nodes and problems associated with lymphedema. Butcher’s broom, ginger, and clover are used to treat the associated issues of lymphedema and relieve swelling. These herbs also stimulate the lymph system and offer treatment of the underlying issues.
Butcher’s broom contains ruscogenin, a compound with anti-inflammatory and vein-constricting properties. These properties offer relief of swollen lymph glands and reduce swelling. The herb is used as supportive therapy for the discomfort of chronic venous insufficiencies, such as pain and heaviness, as well as cramps in the legs, itching, and swelling.
Ginger contains anti-inflammatory agents, which relieve discomfort associated with lymphedema. The herb also stimulates sweating and lymphatic flow, which boost the immune system. Several small-scale research studies found that ginger reduces muscle pain after exercise. This is because of a potent anti-inflammatory action.
Sweet clover contains coumarin, a compound that stimulates lymph flow. Clover ointment triggers lymphatic functioning, and coumarin strengthens blood and lymph vessels. Its anticoagulant action reduces the risk of thrombosis. It also offers support for lymphatic congestion as well as period pain related to congestion.
Signs of lymphedema
After radiation or surgery, swelling associated with lymphedema generally occurs in the arms or legs. It also can occur on the sides of the body. The swelling can be several times its normal size.
Another sign of lymphedema is if you have difficulty fitting into clothing or your jewelry is tighter in your fingers or wrists. If the swelling continues, you may become fatigued.
Other symptoms can accompany the swelling of lymphedema including:
- Warmth, redness, or itching
- Tingling or burning pains
- Fever and chills
- Decreased flexibility in the joints
- Aching, pain, and fullness of the involved area
- Skin rash
MedicineNet.com notes: “The long-term accumulation of fluid and proteins in the tissues leads to inflammation and eventual scarring of tissues, leading to a firm, taut swelling that does not retain its displacement when indented with a fingertip (nonpitting edema). The skin in the affected area thickens and may take on a lumpy appearance described as an orange-peel (peau d'orange) effect. The overlying skin can also become scaly and cracked, and secondary bacterial or fungal infections of the skin may develop. Affected areas may feel tender and sore, and loss of mobility or flexibility can occur.”
NPR's Morning Edition featured Virginia Harrod, who was diagnosed with Stage III breast cancer in 2014. She had a double mastectomy and 16 lymph nodes were removed under her arm and around her breast. “Cancer was a piece of cake,” Harrod said. “It was the lymphedema that almost killed me.”
Nine months after surgery, Harrod's cat scratched her hand. The next day, “My right arm started itching terribly,” Harrod said, “and these bizarre little red blisters were forming.”
She went to see a doctor, who diagnosed Harrod with cellulitis. The prescribed treatment was IV antibiotics. Ultimately, she was in the hospital for eight days; it was lymphedema.
The NPR report noted:
- Having even one lymph node removed conveys some risk of lymphedema — perhaps 5 to 7 percent.
- Cancer patients who have many more nodes removed — about a 20 percent likelihood of developing lymphedema.
- Undergoing radiation therapy can increase the risk of lymphedema in those patients to 40 percent.
Think twice before considering lymph node removal
Dr. Véronique Desaulniers notes that the premise behind lymph node removal is that cancer cells in the mammary area will tend to spread to sentinel lymph nodes closest to the tumor before they possibly spread to axillary nodes and then to the rest of the body.
However, she points to a 2011 study conducted by the John Wayne Cancer Institute in Santa Monica, California. Its research stated that for approximately 20 percent of all U.S. breast cancer patients (40,000 women a year), removing cancerous nodes proved to have no advantage. Survival rates did not improve. Cancer was not less likely to re-emerge.
The research was consistent with patients who had the following disease characteristics:
- Early-detected tumors in stage T1 or T2;
- Tumors that were not large enough to be felt during an exam;
- Lumpectomy as the primary conventional treatment and, in some cases, chemotherapy and/or radiation;
- Cancer tumors that had not spread elsewhere in the body.
Nonetheless, Dr. V said if you chose traditional therapies for breast cancer that included lymph node removal, consider natural healing modalities to restore and maintain the health of your lymphatic system:
- Practice a daily routine of dry brushing your skin;
- Consider thermography and breast self-exam in order to protect sensitive tissue in the breast and lymph node area;
- Boost your immune system by healing the digestive system;
- Get rid of your antiperspirant and use non-aluminum, all-natural deodorants instead;
- Gently move your body. Lymph fluid is designed to flow and cannot do that if the body remains stagnant for too long;
- Consider massage which can contribute to lymphatic flow, the removal of toxins and improve circulation;
- Drink lots of fresh, filtered water;
- Consider EFT or “tapping,” which not only massages key lymphatic points but can also help you heal the emotional blocks to healing.