Lymphoedema (treatment following breast cancer treatment)

• lymphoedema related to breast cancer can be due to lymphatic vessel compression, obstruction or more frequently due to breast cancer therapy (surgery or radiotherapy) (1)
• lymphoedema of the arm is a common, incurable complication of breast cancer treatment
• this complication seems especially likely if the treatment has included axillary surgical clearance or radiotherapy in addition to surgery to the breast itself
• some studies have revealed that the risk of developing lymphoedema is higher in women treated with both axillary dissection and adjuvant axillary radiotherapy compared to women treated with radiation to an undissected axilla (1)
• evidence relating to the effectiveness of treatments of lymphoedema following breast cancer treatment is limited - general measures include arm elevation, compression bandaging, exercise and massage - there is evidence that in patients with unilateral lymphedema of an upper arm or lower limb, that a course of multilayer bandaging followed by compression hosery led to a greater percentage reduction in excess limb volume than hosiery alone (2)
• it is important to maintain good skin hygiene
• antibiotics are used if infection is present

NICE state (3):

Inform people having breast cancer treatment about their risk of developing lymphoedema after treatment. Before treatment starts, give them information in a suitable format to take away and refer to. This should include:

• information on:
  • risk reduction strategies, such as maintaining a healthy body weight, ways to reduce their risk of infection, and advice on skincare (for example, use of moisturiser and sunscreen) and physical activity
  • early signs and symptoms, such as signs or sensations of swelling, or signs of infection
  • awareness of skin changes, such as changes in skin colour and appearance of rashes
  • how to self-monitor and identify these signs and symptoms
  • how to collect baseline measurements of the limb
  • that there is no consistent evidence of increased risk of lymphoedema associated with air travel, travel to hot countries, manicures, hot tub use or sports injuries
  • that there is no consistent evidence of increased risk of lymphoedema associated with medical procedures (for example, blood tests, injections, intravenous medicines and blood pressure measurement) on the treated side
• ensure people who are at risk of, breast-cancer-related lymphoedema are aware that
  • physical activity may improve their overall quality of life, and
  • there is no indication that physical activity causes, or worsens, lymphoedema
• do not offer compression therapy as a risk-reducing measure to people who are at risk of breast-cancer-related lymphoedema
• ensure that people with breast cancer who develop lymphoedema are referred to a specialist lymphoedema service for further assessment, and to discuss possible management options (for example, conservative management, surgical options), as soon as possible
• principles of lymphoedema mananagement:
  • assess people with lymphoedema for other treatable underlying factors (for example, nodal disease and cellulitis) before starting any lymphoedema management programme
  • offer compression therapy as the first stage of lymphoedema management. Make a shared decision with the person about the form of compression that is best for them
  • if compression therapy is not appropriate or not comfortable, some people might wish to try kinesiology tape
  • reassure people that there is no evidence that physical activity (including upper limb exercise) will worsen their lymphoedema and explain that it may improve their overall quality of life.

Reference:

• (1) Morrell R.M et al. Breast Cancer-Related Lymphedema. Mayo Clin Proc. 2005;80(11):1480-1484
• (2) Badger CM, Peacock JL, Mortimer PS (2000). A randomized, controlled, parallel-group clinical trial comparing multilayer bandaging followed by hosiery versus hosiery alone in the treatment of patients with lymphedema of the limb. Cancer, 88, 2832-7.
• (3) NICE (February 2025). Early and locally advanced breast cancer: diagnosis and management.