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Arm Lymphedema (pronounced lim-fe-DEE-ma) is a side effect that can begin during or after breast cancer treatment. It isn't life threatening, but it can last for an extended amount of time. This condition involves swelling of the soft tissues of the arm or hand. The swelling may be accompanied by numbness, discomfort, and sometimes infection.

There's no reliable way to find out your risk for lymphedema, but by taking proper precautions you CAN greatly reduce your chances of developing the condition.

Lymphedema of the arm is defined as an accumulation of lymph fluid in the soft tissues of the arm, with accompanying swelling (also called edema). To understand how it happens, you have to know a little bit about how blood and lymphatic fluid move around your body.

Fluid has to keep moving within networks of vessels and channels otherwise it backs up and gets clogged. Blood travels from your heart to your arm in arteries and capillaries (the small blood vessels that connect arteries to veins). As blood moves through the capillaries, it delivers important supplies to the cells in your arm: oxygen, nutrients, and a clear, colorless fluid called lymphatic fluid. The used blood keeps moving and travels back to the heart and lungs, where it gets refreshed. With every beat of your heart, fresh blood returns to your arm with fresh supplies.

Lymph fluid also has to keep moving through the tissues of the arm back into the bloodstream. This fluid flows in another type of vessel, called lymphatics.

The muscles in your arm and contractions in the walls of the lymphatic channels push lymphatic fluid up your arm. Valves in the lymph vessels keep fluid moving forward. The lymphatic channels pass through bean-shaped structures called lymph nodes, which are located under the arm, and in the neck, groin, and other areas. Lymph nodes filter out bacteria, waste products, and toxic substances from the lymphatic fluid. The trapped material is broken down and excreted from the body. Eventually, the used lymphatic fluid leaves the arm, joins the used blood within the veins, gets refreshed in the lungs, and is then pumped back to the tissues by the heart.

Lymphatic fluid contains lots of nutrients. It's an easy target for bacteria that may find their way past the protection of the skin. Bacteria can get in even through something as innocent as a torn cuticle. If bacteria do get in, they can cause infection. Infection results in increased blood flow to fight the bacteria — and more lymphatic fluid accumulating and needing to be drained away.

You can think of lymphedema as a plumbing problem: Veins and lymphatic channels are like pipes and drains that can handle the normal load of lymphatic fluid. If lymph nodes and channels are removed, there might not be enough pipes and drains to handle all the fluid.

This lack of pipes and drains can become a problem when blood flow to your arm increases because of an infection, a burn, overusing the muscles of the arm, or even a bug bite. In these situations, the increased amount of lymphatic fluid flowing in can sometimes be too much for the arm's lymphatic vessels. If the fluid channels can't keep up with all that extra fluid, the fluid begins to back up and gather in the spaces between the cells of your arm's soft tissues. These tissues include the skin, fat, muscle, nerves, blood and lymphatic vessels, and connective tissue. The swelling resulting from this buildup of lymphatic fluid is called arm lymphedema.

Lymphedema can affect the whole arm or only a limited portion, such as the hand, the wrist area, the area below the elbow, or, much less often, only the area above the elbow. Lymphedema can also affect the breast area, because the fluid from that area also needs to drain through the underarm to get back into circulation.

Some women have mild lymphedema, which is hardly noticeable. Some develop moderate lymphedema that may be noticeable, tends to persist, and gets worse when aggravated. Others have severe lymphedema that is very uncomfortable and even disabling. For all of these cases, there are treatments that can help ease the discomfort and lower the swelling.

The best advice for preventing lymphedema boils down to one rule: avoid injury or irritation to the arm most likely to become affected.

Common sense should guide you in helping yourself but the following is a list of "do's and do not's" that may also reduce the risk.

  • Do wear sunscreen to protect your arm from sunburn
  • Do wear an insect repellant to avoid insect bites
  • Do wear gloves when gardening or doing other yard work
  • Do get regular exercise, but avoid repetitive motion with your arm to the point of muscle fatigue
  • Do Not expose your at-risk arm to the extreme heat of hot tubs
  • Do Not play sports which may result in injury to your arm
  • Do keep your arm clean and apply moisturizing cream regularly
  • Do thoroughly clean and apply an over-the-counter antibiotic and bandage to any scratch or cut
  • Do Not bathe in extremely hot water
  • Do wear a soft bra with padded shoulder straps if possible
  • Do Not shave under your arms with a disposable razor. Use a well-maintained electric razor with clean heads instead.
  • Do Not cut your cuticles. If you're treating yourself to a manicure, ask them not to cut them.
  • Do Not wear tight jewelry
  • If you wear a breast prosthetic, Do wear a lightweight form
  • Do Not hang a heavy purse, bag, or briefcase over the shoulder of your at-risk arm
  • Do wear a compression sleeve anytime you travel by plane to compensate for pressure changes (you can usually find these at medical supply stores)
  • Do Not allow blood to be drawn from an at-risk arm
  • Do Not allow vaccines or other shots to be given in your at-risk arm
  • Do call your physician if you see any sign of infection

Weiss, M. and Weiss, E. Living Beyond Breast Cancer: A Survivor's Guide for When Treatment Ends and the Rest of Your Life Begins. New York: Three Rivers Press; 1997.

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