Common side effects of breast cancer treatment – 2

Lymphoedema

Damage to the lymph transport system can occur after surgery or radiotherapy which can lead to accumulations of lymph fluid, known as secondary lymphoedema. Lymph is a thin, clear fluid that circulates throughout the body to remove waste, bacteria and other substances from tissues. Oedema is the build-up of excess fluid. Lymphoedema occurs when too much lymph collects in any area of the body – it tends to affect the arm and hand, but sometimes can affect the breast, underarm, chest, trunk, and/or back and can occur months or years after cancer treatment ends. Patients with early signs of lymphoedema may experience a feeling of heaviness or tightness in the arm, with or without swelling compared to the opposite arm (see figure below).

One of the main risk factors for developing lymphoedema is complete or partial removal of the lymph nodes that drain fluid, thus women having axillary node clearance are at increased risk of lymphoedema. Many women need radiation therapy to the chest area and/or axilla which can also damage the nodes and vessels through which lymph flows. Over time, the flow of lymph can overwhelm the remaining pathways, resulting in a backup of fluid into the body’s tissues causing swelling.

Postoperative wound infection and high volumes of wound drainage or seroma may also increase the risk of developing lymphoedema.

However, there is good evidence to show that it is safe for women to start upper limb exercises (restricted to 90 degrees) in the first week as this does not increase the risk of lymphoedema. Evidence suggests that gradual return to full functional use supported by moderate intensity progressive resistance training for the upper limb may also protect against lymphoedema.

If you would like to do more reading then we have provided the list of papers used to write this section. They are downloadable below.