Prevention of Lymphoedema: A Potential Side Effect of Cancer Treatment

Breast surgery may involve removing lymph nodes from the armpit on the same side as the operated breast. Cancer patients who have had their lymph nodes removed during treatment are at risk of developing lymphoedema, which is the accumulation of lymph fluid in soft body tissues causing the arm on the operated side to swell.

The lymph nodes and lymph fluid are part of the lymphatic system which helps the body fight infection. As it circulates throughout your body, lymph fluid carries harmful substances and waste products to the lymph nodes to be flushed out.

Lymphoedema typically occurs when there is an abnormal accumulation of lymphatic fluid in the tissue, causing oedema (swelling) in the affected body part. This malfunction can be caused by various factors such as infection, injury, or cancer treatment, affecting the lymphatic flow.

Primary lymphoedema is caused by abnormalities of the lymphatic system and is often inherited. It occurs with congenital conditions, as in the case of people born with lesser lymphatic vessels, lymph nodes and/or a compromised lymphatic system.

Secondary lymphoedema is caused by damage to an otherwise normal lymphatic system and can result from:

• Cancer cells: Growth of cancer cells near a lymph node or lymph vessel
• Cancer treatment: Surgical removal of lymph nodes during treatment for breast cancer, cervical cancer and prostate cancer, or radiation treatment
• Infection: Bacterial skin infection (e.g. cellulitis) or parasite infection
• Venous diseases: Deep vein thrombosis (DVT), varicose veins

Risk factors for lymphoedema include obesity, accidental trauma (severe burns, insect bites), and chronic venous insufficiency.

1. Good Skin Care is Essential in Preventing Infection and Subsequent Swelling

• Apply a body lotion regularly to keep your skin moisturised and healthy
• Avoid getting an injection or having blood taken from the arm on the operated side, whenever possible
• Be extra careful during food preparation to avoid cuts/wounds to your hands
• Be extra careful when manicuring your nails
• Wear protective gloves when gardening, coming into contact with strong chemicals or when immersing your hand in water for extended periods of time (e.g. jobs like dishwashing)
• Avoid exposing the affected arm to direct sunlight for prolonged periods of time (e.g. sun-tanning) to prevent sunburn. You may also apply sunblock to protect your skin from sunburn
• Treat any wounds with antiseptics. Consult your doctor if the wound is not getting better

2. Avoid Any Constrictions to the Arm as This Might Restrict the Flow of Lymph Fluid

• Do not wear tight jewellery or clothes with tight sleeves
• Avoid hanging heavy handbags or shopping bags over your forearm
• Avoid blood pressure taking on the arm on the operated side
• If you do go for a deep tissue body massage, request for the masseur to avoid exerting deep pressure on the arm on the operated side

3. Avoid Overuse or Fatigue of Your Arm Muscles

• Avoid carrying very heavy items, such as shopping bags or groceries over the forearm or elbow on the operated side
• Take more frequent rest breaks when scrubbing, mopping, cleaning, or while doing other vigorous or repetitive activities, especially if your arm feels tired, heavy, or achy

4. Avoid Extreme Heat to the Arm as This Can Trigger Arm Swelling

• Do not apply hot oil, heat-producing products (e.g. heat rub cream) or use hot packs on the arm, neck and back of the operated side
• Avoid hot springs, saunas and steam baths

5. Wear a Compression Arm Sleeve During Air Travel Due to the Drop in Air Pressure at High Altitude

• Consult your medical team or Occupational Therapist to obtain a suitable compression arm sleeve for air travel
• It is advised to obtain a compression garment closer to your date of travel (2 months before the travel is preferred)
• You are advised to don on the garment any time before the plane takes off and to keep it on throughout the flight. Remove it 1-2 hours after the plane has landed

• Persistent swelling of part or the whole arm
• Tightness or heaviness within the arm
• Decreased flexibility of the arm, wrist or hand
• Discomfort, pain or inflammation (e.g. redness, warm or painful to the touch. May be accompanied by a fever.) Consult your doctor if there is inflammation noted

Should you experience any of the above symptoms, please call and make an appointment to consult your Occupational Therapist or Breast Care Nurse as soon as possible.