From the Guidelines
Lymphedema in women is most commonly caused by damage to or removal of lymph nodes during breast cancer treatment, particularly after mastectomy, lumpectomy with axillary lymph node dissection, or radiation therapy, as stated in the american cancer society/american society of clinical oncology breast cancer survivorship care guideline 1. The causes of lymphedema in women can be multifaceted, including:
- Damage to or removal of lymph nodes during breast cancer treatment
- Gynecological cancer treatments involving pelvic lymph node removal
- Venous insufficiency
- Obesity, which is a significant risk factor, and physicians should recommend weight loss for those who are overweight or obese 1
- Infections like cellulitis
- Genetic conditions such as Milroy's disease
- Trauma, surgery, and inflammatory conditions that can disrupt lymphatic flow
- Pregnancy, which may temporarily worsen lymphedema due to increased fluid retention and pressure on lymphatic vessels
Key Factors to Consider
The degree of swelling associated with lymphedema varies widely, even for those who receive similar surgery and/or radiation, and radiation treatment may cause or exacerbate lymphedema, especially radiation to the supraclavicular lymph nodes or axilla 1. Patients with lymphedema are also at greater risk for the development of cellulitis of the breast, arm, or chest, which, especially if not promptly treated with antibiotics, may exacerbate lymphedema.
Management and Prevention
Management typically involves complete decongestive therapy, including manual lymphatic drainage, compression garments, exercise, and meticulous skin care. Early intervention is crucial as lymphedema is a chronic condition that, while manageable, has no cure 1. Weight management, avoiding blood pressure measurements or injections in affected limbs, and prompt treatment of infections can help prevent complications. Additionally, supervised, slowly progressive resistance training is safe and effective for breast cancer survivors with regard to lymphedema development 1.
From the Research
Lymphedema Causes in Women
- Lymphedema is a chronic, progressive, and often debilitating condition that can be primary or secondary 2
- Secondary lymphedema is the result of obstruction or disruption of the lymphatic system, which can occur as a consequence of tumors, surgery, trauma, infection, inflammation, and radiation therapy 2
- Breast cancer surgery is a common cause of lymphedema in women, and manual lymphatic drainage (MLD) has been shown to have a beneficial effect on lymphedema related to breast cancer surgery 3
- However, whether MLD reduces the risk of lymphedema is still debated, and studies have shown conflicting findings 3, 4
Risk Factors for Lymphedema in Women
- Breast cancer surgery is a significant risk factor for lymphedema in women 3, 5, 4, 6
- Radiation therapy and tumor obstruction or disruption of the lymphatic system can also contribute to the development of lymphedema 2
- Age and intervention time may also play a role in the development of lymphedema, with women under the age of 60 years and those receiving MLD for a shorter duration (1 month) showing a significant reduction in lymphedema 3
Treatment and Prevention of Lymphedema in Women
- Complex physical decongestive therapy (CDT) is the standard therapy for lymphedema, comprising MLD, compression therapy, exercise therapy, skincare, and patient education 5, 6
- MLD has been shown to be effective in reducing lymphedema in some studies, particularly when applied intensively 5, 4
- However, other studies have reported no additional benefit of MLD as a component of CDT, and the effectiveness of MLD in preventing lymphedema is still unclear 3, 4, 6