From the Guidelines
You should be concerned a lot about arm swelling after chemotherapy, as it can be a sign of lymphedema, a common condition among breast cancer survivors. According to the American Cancer Society/American Society of Clinical Oncology breast cancer survivorship care guideline 1, lymphedema is a risk for all breast cancer survivors who undergo breast surgery and/or radiation, with an estimated incidence of over 40%. This condition can cause arm, breast, or chest wall swelling, leading to retention of fluid and swelling, and may occur immediately after treatment or develop after many years.
Some key factors to consider when assessing your risk of lymphedema include:
- The type of surgery you had, with sentinel lymph node dissections carrying a lower risk than full axillary lymph node dissection
- Radiation treatment, particularly to the supraclavicular lymph nodes or axilla, which may cause or exacerbate lymphedema
- Your weight, as obesity is a risk factor for lymphedema, and maintaining a healthy weight is recommended 1
- Your physical activity level, as supervised, slowly progressive resistance training may be safe and effective for reducing the likelihood of arm swelling 1
It's essential to watch for symptoms of lymphedema, such as:
- Heaviness or tightness in the arm
- Reduced movement or flexibility
- Aching or pain
- Visible swelling If you notice any of these signs, contact your healthcare provider promptly, as early intervention is most effective. To reduce your risk, it's recommended to:
- Avoid blood draws, injections, or blood pressure measurements in the affected arm
- Protect your skin from cuts and burns
- Exercise gently
- Maintain a healthy weight
While lymphedema can't be cured, it can be managed with compression garments, specialized massage, exercise, and careful skin care, as noted in the guideline 1.
From the Research
Arm Swelling After Chemotherapy
- Arm swelling is a potential complication of breast cancer treatment, and its incidence can be significant, with a 3-year cumulative incidence of 60.3% by volume increase and 75.4% by circumference increase 2.
- Symptoms of arm swelling and heaviness can decrease over time, but the 3-year cumulative incidence of these symptoms can still be around 26.0% and 30.9%, respectively 2.
- The use of compression sleeves has been shown to reduce the incidence of early postoperative swelling and lymphedema manifestation after axillary lymph node interventions in breast cancer patients 3.
- Factors associated with arm swelling after breast cancer surgery include age, axillary node dissection, chemotherapy, and high household income, while treatment for high blood pressure may have a protective effect 4.
Prevention and Management
- Compression sleeves with a pressure of 15-21 mm Hg can be an effective option for preventing postsurgical arm swelling and development of lymphedema 3.
- HeRO graft conversion has been shown to have more durable results than stent deployment in alleviating arm swelling in patients with central vein stenosis and ipsilateral arteriovenous access 5.
- Prophylactic anticoagulation during induction and consolidation chemotherapy in adults with acute lymphoblastic leukemia can reduce the cumulative incidence of venous thromboembolic complications, but its effect on arm swelling is not directly addressed 6.
Key Findings
- Lymphedema incidence rates can vary depending on the definition used, and the use of a ≥ 10% volume change criterion is recommended for lymphedema evaluation 2.
- Symptom assessment and limb measurements are important for evaluating lymphedema, but there may be limited agreement between these two measurements 2.
- Further research is needed to understand the role of treatment for high blood pressure and weight as modifiable lymphedema risk factors 4.