Lymphoedema

All of the cells and tissues of the body are bathed in a watery fluid known as tissue fluid or lymph. This is continually refreshed and excess lymph from the tissues is collected into lymph vessels where it is filtered through lymph nodes. Both of these form the lymphatic system. Lymph nodes remove bacteria and other harmful substances before the lymph drains back into the bloodstream.

Lymphoedema describes an abnormal build-up of fluid that occurs when parts of the lymphatic system are missing or damaged. This leads to swelling in the arm or leg nearest to the damage, or in the main part of the body. There are two types of lymphoedema:

• Primary lymphoedema, when the problem in the lymphatic system is present from birth
• Secondary lymphoedema, when the problem develops later in life, such as after lymph nodes have been removed during breast cancer surgery

Symptoms of lymphoedema include swelling in all or part of the limb or in the chest. In the arm, this creates a full or heavy sensation in the limb and the skin feels very tight.

It can become more difficult to move your hand, and cuffs, sleeves and jewellery can become very uncomfortable. Left untreated, lymphoedema can cause severe swelling and a hardening of the limb, which can really have an impact on quality of life.

You are at risk of developing lymphoedema if you have had any of the following types of breast cancer treatment:

• Breast cancer surgery: simple mastectomy, modified radical mastectomy or lumpectomy in combination with axillary (armpit) lymph node removal
• Radiotherapy: particularly when directed at a lymph node region, including the armpit, neck, pelvis, groin or abdomen, either in combination with surgery or alone

Lymphoedema can occur within a few days after surgery. It is important to remember that some swelling after surgery is normal for the first few weeks, and this does not necessarily mean you have lymphoedema.

It may be that this initial swelling goes down and doesn’t return. In some people, however, lymphoedema can start unexpectedly several years later.

Your specialist or oncologist will assess your limbs for signs of lymphoedema following surgery and you should seek advice promptly if you experience any symptoms.