Gabriella Kourie BSc OT(WITS)
In the world of oncology, patients are faced with multiple side effects that can trigger from the various treatments they receive. One of the more common secondary side effects associated with cancer removing surgeries, and in particular breast cancer, is the onset of lymphoedema.
Like any disease, the sooner a patient detects it and gets treatment, the less intense and the greater the treatment outcomes are. Lymphoedema is not different! The factors that are important in treating and controlling the condition are:
- What is Lymphoedema and how is it caused?
- Am I a risk patient for developing lymphoedema?
- What do the developing and/or early stages look like?
And ultimately, using the above information to determine…
- When do I need to see a therapist.
Starting at the beginning, what is Lymphoedema? The official definition of Lymphoedema is: the build-up of excess fluid in soft tissue that is caused by a blockage or gap in the lymphatic system. The main function of the lymphatic system is to help fight infection and other diseases by carrying lymph throughout the body. Our lymph travels throughout the body via a network of thin tubes called lymph vessels. In the case of a cancer patient the reasons that it develops are mostly due to: 1. Surgery – during which lymph nodes may be removed causing a gap in the lymphatic system; 2. radiation therapy – the main effect of radiation being inflammation which places tension on the lymphatic system and 3. blockage on the lymph nodes and/or lymph vessels due to the spreading of the cancer.
Patients that have any of the above procedures are at risk of developing lymphoedema. The chances of the risk being high or low depend heavily on external factors such as: weight, smoking status, level of exercise and existing comorbidities. Another big risk factor is the amount of lymph nodes removed during the surgery. On a global scale, if a patient has had five or less lymph nodes removed, many practitioners believe that they are considered no risk at all for developing a lymphoedema; however there have been cases of patients with (as an example) three nodes removed that have other external risk factors and have developed a lymphoedema. Regardless of the patient, every breast cancer patient should have access to knowledge on what lymphoedema is and how to prevent and/or treat it early.
The main warning signs or indications that a lymphoedema is developing are as follows:
- There may be some initial skin changes such as hardening or thickening of the skin.
- The limb, on the side where the nodes have been removes, or trunk and genitalia may start to feel heavy and tight and range of motion in the arm or leg may reduce
- There may be a reoccurring tissue infection called cellulitis
- Fluctuating swelling in the arm, leg or trunk (depending on the cancer and location of where lymph nodes have been removed or areas where the cancer has metastasised).
In most cases, patients seek guidance and advice from their oncology specialists and or GPs but the sad reality is that there are doctors that have poor insight into the treatment of lymphoedema and will often tell patients “There is nothing that can be done.” This could not be further from the truth! Although the intensity and success of treatment depends heavily on the stage of the disease and the prognosis of the patient, there is a form of intervention for lymphoedema at any stage.
I urge all patients that have had any cancer surgeries, with lymph node removal to seek out guidance and intervention from a certified lymphoedema therapist. Prevention is better than cure and if caught early enough the progression of lymphoedema can be fully controlled. The last and most important point is to make sure you are seeking guidance from the correct healthcare professional. All certified lymphoedema therapists in the country can be found on the LAOSA website under the “find a therapist” page: Find a therapist – Lymphoedema Association of South Africa