Therapist discusses lymphedema and other complications of cancer
Cancer, without doubt, is a devastating disease, and many of the side effects of treatment are well know. Pain, hair loss, and loss of appetite are just a few.
One that may not be as well known or understood by patients is lymphedema, swelling caused by an accumulation of lymphatic fluid most often in the arms or legs but also in other parts of the body, including the chest and breast. The type of lymphedema experienced by cancer patients can result from surgeries during which lymph nodes are removed. It can also result from trauma, such as a burn or cut, to an affected area.
To explain how to prevent or lessen the effects of lymphedema, Laura Yarish spoke with members of the Breast Cancer Survivors Support Group Tuesday evening, April 14, at Wilton Library. Yarish is a physical therapist and certified lymphedema specialist with the Ahlbin Center for Rehabilitation Medicine at Bridgeport Hospital, with an office in Southport (203-259-7117). She spoke about two other conditions that also often affect breast cancer patients, cording and frozen shoulder.
Nina Marino, clinical director of the Breast Cancer Survival Center, which sponsors the support group, said these issues come up frequently at meetings. “It’s an important topic for cancer survivors to be aware of,” she said.
Lymphedema, Yarish said, can develop weeks or months after surgery, depending on the number of lymph nodes removed and the damage done by surgery.
It is more common in late-stage cancer patients and when numerous lymph nodes are removed or if a sarcoma develops.
It will continue to get worse without treatment, Yarish said, and “once you have it you always have it.”
Early symptoms of lymphedema can be subtle, such as a full sensation in the affected limb, tight-feeling skin, noticing your clothes, or a ring or a watch feeling tight.
“At first the swelling may not be noticeable, but your arm may feel heavy or tight,” she said, adding that as soon as a patient notices it the person should seek treatment.
Lymphedema can be complicated by many things, including:
- Radiation, which can add to scar tissue, especially above the collarbone, where many lymph nodes are found.
- Injury to an affected area, such as a burn, including sunburn, or cat scratch, but even something as minor as a mosquito bite. Injuries stimulate the lymphatic system and can cause an overflow of fluid.
- Wearing anything tight around the wrist.
Treatment for lymphedema includes gentle, manual massage of the area to promote drainage, bandaging, and skin care. The latter includes applying moisturizers to prevent chafing and chapping, avoiding clipping nail cuticles, as this can result in infection, and preventing injuries as well as avoiding injections or blood draws in the affected limb.
Breast cancer patients who want to fly are advised to wear a compression sleeve, which is also beneficial when exercising. Lymphedema can occur with sudden, heavy exercise that strains muscles, thus overworking the lymphatic system.
A surgeon or oncologist can write a prescription for a sleeve, which costs around $90 or $100. Medicare will not pay for the sleeves, Yarish said, and some insurance companies will not pay without a diagnosis. Medicare does pay for compression gloves and compression bras, she added.
Axillary web syndrome, more commonly known as cording, is another complication of disruption of the lymphatic system. It is essentially a clot that forms in a lymphatic vessel after sentinel lymph node biopsy or lymph node resection. True to its name, those who have it will see or feel a web of thick, taut cords in their armpit, a “cord” running down the inner arm.
“It usually shows up within the first eight weeks after surgery,” Yarish said, and it can make it difficult to lift the arm higher than the shoulder or fully extend the elbow. It can be relieved with gentle stretching, she said.
Aptly named, frozen shoulder is a painful condition that causes stiffness and makes it difficult to move the shoulder. The connective tissue around the shoulder joint becomes thick and tight and the amount of synovial fluid that lubricates the joint lessens.
The cause of frozen shoulder is not known, but most patients are women in their 50s and 60s, and it occurs most often after an injury to the shoulder or after prolonged immobilization. Radiation can damage the connective tissue, and tamoxifen, a drug often given to breast cancer patients, is known to cause joint problems.
Risk factors for frozen shoulder include diabetes, thyroid disease, heart problems, a weakened immune system, and Parkinson’s disease.
There are three stages of frozen shoulder:
Freezing — This is the most painful stage, when the shoulder becomes very stiff.
Frozen — The shoulder becomes increasingly stiff and range of motion is very limited. Pain may subside.
Thawing — Shoulder motion gradually improves.
Each stage can last three to six months and it may take up to two years for the condition to significantly improve. It is generally treated with stretching and anti-inflammatories.
The Breast Cancer Survivors Support Group meets the second Tuesday of every month, except in summer, at Wilton Library. The next meeting, which is a discussion for group members only, will be May 12 from 6 to 8.
Marino said she expects to have another speaker at the June meeting, which will be open to the community. Discussion topics this year include nutrition, genetics, belly dancing for flexibility and strength, and insurance and the rights of cancer patients.