If you have been through cancer treatment, especially breast cancer treatments, you may heard the term lymphedema. When large numbers of lymph nodes are removed the risk for lymphedema increases. For those unfamiliar with the term, lymphedema is a chronic disease where the extracellular fluid is retained and is protein-rich, creating a high risk of skin complications. It causes chronic inflammation, an increase in fat tissue and superficial skin changes (like hardening) and if not taken care of increases the risk of skin infections like cellulitis. Swelling does not reduce with elevation and there is usually a feeling of heaviness to the body part. Lymphedema can occur in one or multiple areas of the body and comes on gradually (1, 2).
Therapists can be trained in what is known as Complete Decongestive Therapy(CDT). This is made up of 4 parts: Manual Lymph Drainage-type of “massage”, compression wrapping, low impact exercise, and self care.
A trained therapist will know how to test for the difference. Edema is a symptom where fluid accumulates in extracellular space and after successful treatment there is complete resolution. Lymphedema is a chronic disease. However, even with post-surgical or post injury edema, a therapist trained in MLD can still help. The techniques of CDT work exceptionally well with post-surgical or post-injury edemas!
You are those highest at risk for developing lymphedema because of the location of the cancer and cancer treatment areas that are so close to large pockets of lymph nodes in the body(armpit region) (3,4).
Physical Therapy can offer 3 Phases of treatment:
Phase 1: Pre-Treatment Diagnosis: Seeing a Certified Lymphedema Therapist (CLT) prior to surgery is EXTREMELY helpful to take initial baseline measurements of the upper extremities and provide education to catch any changes early to avoid body part enlargement. Unfortunately, this service is not covered by insurance yet, however many offices do offer this as a complimentary service.
Phase 2: Pre-Radiation or Pre-Chemotherapy Phase: If a patient has difficulty positioning arm for radiation, we can mobilize scar tissue and increase the range of motion to allow the radiation position to be obtained. (We generally do not do treatments DURING radiation, the skin needs to be fully healed, appx. 6-8weeks, to begin Phase 3)
Phase 3: Post Radiation Phase: breast cancer patients- your shoulders will get tight from radiation fibrosis, scar tissue adhesions. Physical therapy can help to increase your shoulder function and decrease the pain of the shoulder and breast tissue as we work on the fibrotic and scar tissue. We will continually take girth/volume measurements to monitor for lymphedema/edema, aid in compression garment fitting/compression pumps if needed and continue education on lymphedema and special skin care. Breast cancer survivors who have received chemotherapy are 5 times more likely to experience a fracture due to risk of treatment induced osteoporosis. Physical therapy can provide guided weight bearing exercises can slow down the bone loss (5,6).
1. Klose, Gunter. 2021. Klose Training Lymphedema Certification Manual.
2. Foeldi M, et al. 2003. (First American Edition). Textbook of Lymphology. Munich, Germany: Urban & Fischer.
3. American Cancer Society (ACS). Cancer.org. Assessed in 2013.
4. Williams AF, Franks PJ, Moffatt CJ. Lymphoedema: Estimating the size of the problem. Palliat Med. 2005;19(4): 300-313.
5. Schmitz, K. 2011. “Physical Activity and Breast Cancer Survivorship.” In Physical Activity and Cancer: Recent Results in Cancer Research. Courneya, KS, Freidenreich CM, eds., Chapter 8. Springer-Verlag Berlin Heidelberg.
6. Ewertz M, Jensen AB. 2011. Late Effects of Breast Cancer Treatment and Potentials for Rehabilitation. Acta Oncologica 50:187-193.