Lymphodema

How to prevent or reduce the severity of lymphodema post-axillary clearance

 

I. Skin Care - Avoid trauma / injury to reduce infection risk

• Keep extremity clean and dry
• Apply moisturizer daily to prevent chapping/chafing of skin
• Attention to nail care; do not cut cuticles
• Protect exposed skin with sunscreen and insect repellent
• Use care with razors to avoid nicks and skin irritation
• If possible, avoid punctures such as injections and blood draws
• Wear gloves while doing activities that may cause skin injury (i.e., washing
dishes, gardening, working with tools, using chemicals such as detergent)
• If scratches/punctures to skin occur, wash with soap and water, apply antibiotic cream or ointment,,
and observe for signs of infection (i.e. redness)
• If a rash, itching, redness, pain, increased skin temperature, fever or flu-like
symptoms occur, contact your physician immediately for early treatment of
possible infection

 

II. Activity / Lifestyle

• Exercise regularly with a combination of activities including strength, flexibility and endurance exercises. Gradually build up the duration and intensity of any activity or exercise
• Take frequent rest periods during activity to allow for limb recovery
• Monitor the extremity during and after activity for any change in size, shape,
tissue, texture, soreness, heaviness or firmness
• Maintain optimal weight

 

III. Avoid Limb Constriction

• If possible, avoid having blood pressure taken on the at-risk extremity
• Wear clothing and jewelry that is not too tight and does not have a tourniquet effect on the at risk part


IV. Compression Garments

• Should be well-fitting. Sleeves may need to be worn with a gauntlet to avoid constriction.
• May consider wearing a compression garment for strenuous activity
• Consider wearing a well-fitting compression garment for air travel

 

V. Extremes of Temperature

• Cover the at risk part with protective clothing when exposed to extreme cold, which can be associated with rebound swelling or chapping of skin
• Avoid prolonged (greater than 15 minutes) exposure to extreme heat, particularly hot tubs and saunas. In very hot climates, use a spray bottle to cool off and drink water frequently.
• Avoid placing limb in water temperatures above 102°Fahrenheit (38.9°Celsius)


VI. Additional Practices Specific to Lower Extremity Lymphedema
• Avoid prolonged standing, sitting or crossing legs. Change position frequently. If sitting for extended periods, do ankle pumps.
• Wear proper, well-fitting footwear and hosiery. Clean inside of socks and slippers.

 

Preventing lymphodema

Pre-operative Strategies
• Consider need for axillary dissection. SLNB will reduce the necessity for ALND in 70%
of patients with breast cancer.
Operative stretegies
• The greater the extent of axillary dissection (ie level 3) the greater the risk and severity
of lymphoedema.
• Reduce the risk of post operative wound infection and haematoma by meticulous
surgery with haemostasis.
• Residual or recurrent cancer contributes to progressive lymphoedema – thorough
dissection with negative margins and complete micro and macroscopic clearance of
axilla increases the probability of local control and avoidance of lymphoedema.
Post-operative strategies
• Encourage early mobilization of arm with physiotherapy and adequate analgesia.
• Important to avoid any subsequent infection or cellulitis of arm which contributes to
lymphoedema – no BP cuffs placed on arm, avoid IV canulas in arm following previous
axillary surgery.
• If a patient does develop cellulutis in arm, early and aggressive IV abx is may help
reduce lymphatic obliteration from lymphangitis that contributes to late lymphoedema.
• Axillary radiotherapy – when XRT is combined with axillary dissection the risk of
lymohoedema increases from 8-10% to 30-40% and is more severe and debilitating.
Therefore it is important to avoid using both modalities unless there is an absolute
indication ie heavy burden of disease in axilla or extra-nodal extenstion.