Lymphedema and Breast Cancer

People who have been treated for breast cancer are at risk for developing lymphedema (limf-ah-deema). This pamphlet will give you information about lymphedema and its treatment.

When does BCRL usually occur?

Breast cancer-related lymphedema may appear weeks, months, or even years after breast cancer surgery or regional lymph node radiotherapy, but most of them occur within 3 years after surgery. If you are experiencing or have experienced treatment, you should seek professional advice for prevention and treatment of lymphedema.

What is the lymphatic system, and what is its function in the body?

Lymph fluid, lymphocytes (white blood cells), lymph vessels, and lymph nodes are part of the body’s lymphatic system. The lymphatic system removes cell waste and protects the body from infections and disease. It does this by collecting extra fluid, proteins, and other substances from the body’s tissues. It is moved through the body in tiny vessels that are much smaller than veins. Bean-shaped lymph nodes filter the fluid to remove waste and bacteria. Other lymph vessels carry the lymph back to the bloodstream.

What is lymphedema?

Lymphedema is a breakdown of lymphatic refluxes leading to the accumulation of protein-rich fluids in the stroma. When the lymphatic vessel load exceeds the transport capacity of the lymphatic system, it will cause the accumulation of filtrate, which will lead to lymphedema. Surgical removal of lymph nodes (lymph node resection) and radiotherapy are the main causes of lymphedema in breast cancer patients, but Breast Cancer-Related Lymphedema (BCRL) can also be caused by lymphatic or lymph node obstruction or by tumor cell infiltration (cancerous lymphangitis)

Some early symptoms of BCRL：

•Puffiness or edema in the hands or arms

•Clothes, underwear or jewelry feel tighter than before

•Grooves or marks are left on the skin when taking off jewelry or clothing

•A feeling of swelling in the breast, chest or arm

•Arms feels heavy

What are the risk factors for lymphedema?

Breast cancer and related treatments are the most common causes of upper limb lymphedema. The main risk factors for BCRL include the diagnosis of invasive cancer, axillary lymph node dissection/destruction, radiotherapy, local infection, and obesity, but other factors may also play a role.

We recommend the following precautions to protect affected limbs:

•Monitor limb condition, including measuring and recording upper limb size. Measurements should be taken at the palms of the hands (if edema is present), the wrists, and 10 cm below and above the elbow joint

•Carefully maintain skin hygiene and nail care to prevent infections that may cause cellulitis

•Protect exposed skin, including using sunscreen and wearing gloves when participating in activities that may cause skin damage

•Wear suitable graded pressure sleeves

•Avoid medical procedures that require puncturing the skin of affected limbs (e.g., vaccination, acupuncture, venous bleeding, venous catheterization, venography)

•Manage your weight

BCRL prevention advice for daily life:

•Exercise

Adhering to proper exercise habits can not only help blood circulation and maintain your ideal weight, but also control edema. It is recommended that exercise be carried out under the guidance of a medical professional.

•Repeated actions

For most people, some repetitive movements will not be a big problem, such as mopping the floor, using a vacuum cleaner, painting, or training on a rowing machine. However, some patients can develop lymphedema due to these repetitive actions. When you perform repetitive activities, please pay attention to how your arms and hands react. If you feel swelling or pain during or after the activity, you should immediately stop the activity, reduce its intensity, or shorten its length.

•Take a hot shower/bath or use a sauna

For some people, lymphedema could be caused by taking a hot shower or bath, or using a sauna. If you want to do any of these activities, start by doing it for a few minutes, paying close attention to possible edema reactions in your body.
Traveling by airplane

Before boarding the plane, during the flight, and after landing, you should drink plenty of water. Stretch your arms from time to time while you are waiting for the plane and during the flight. If you do not have lymphedema, it is not necessary to wear a pressure sleeve, but you must wear pressure sleeves when flying if you already have lymphedema. The selection and wearing of pressure sleeves needs to be carried out under the guidance of a physiotherapist.

Our Rehabilitation services for BCRL：

•Breast cancer postoperative posture correction training

•Breast cancer postoperative rehabilitation exercises

•Prevention of complications after breast surgery

•BCRL Risk Factors Screening

•Assessment of upper limb range of motion and muscle strength

•Multilayer compression bandage wrapping

•Detumescence exercises

•Kinesio Tape

•Intermittent Pneumatic Compression

•Customized home exercise plan for lymphedema prevention

The American Society for Cancer Research recommends that a majority of ahealthy diet should be composed of plant-based foods，with two-thirds ofeach meal being vegetables, fruits, whole grains or beans.The high levels offiber,vitamins,minerals and antioxidants in these foods helps fo improveimmunity and enhance physical health. Different colors 'of fruits andvegetables contain different kinds of unique phytochemicals (antioxidants),such as 3- carotene in orange and red fruits and vegetables, and resveratrolin blue and purple fruits and vegetables, which reduces cell oxygenation,helps with gene repair, reduces inflammation in the body, and thus reducesthe probability of cancer.It can also help slow the growth of cancer cells andcontrol the production of tumor hormones.

The high fiber content and very low density of plant food also supports breasthealth by preventing excessive weight gain. Celulose from plants can slowdown the time needed for food to pass through the digestive system,increase your sense of fulness, and make people less likely to be hungry.

Protein is also an important part of a healthy diet，and is essential tomaintaining the normal operation of human body and supporting theimmune system.High quality protein comes from meat, poultry, eggs, fish andseafood,'milk, beans， lentils,etc. You've probably heard that red meatincreases the risk of having colorectal cancer, pancreatic cancer, prostatecancer and breast cancer. The possible carcinogenic mechanism is thatcarcinogenic chemicals are produced during meat preservation processes(such as pickling and smoking). Meat also contains ferroheme,whichpromotes 'the production of carcinogens and increase the risk ofcarcinogenesis. Cooking meat under high temperature (such as frying,baking and barbecuing) also produce carcinogenic chemicals.The studyfound that the risk of developing hormone-related breast cancer is doubledamong women who consumed large amounts of red meat. Therecommended intake is no more than 500g cooked red meat per week. Theremaining protein needs can be obtained from a variety of other high-qualityproteins,such as chicken,duck,fish,，seafood，eggs，soybeans and soyproducts. ln addition,it is necessary to avoid processed meats,such assausage,bacon,preserved meat, ham, etc. , as they are high in salt andunhealthy saturated fatty acids.

Nowadays, the internet is full of different advice for dieting, especially dietsfor breast health and breast cancer.These often contain misleadinginformation and food myths that can confuse people, keeping them frommaking the right food choices and having a healthy diet.

Some common food myths:

Q1.can breast cancer patients eat dairy products?

Dairy products, including milk, cream, yogurt, cheese, etc., are good sourcesof protein , calcium and some vitamins.According to a report from the WorldCancer Research Foundation and the American Society for CancerResearch,there is no evidence that indicates dairy consumption increasesthe risk of breast cancer. Maintaining a healthy weight after treatmentreduces the risk of breast cancer recurrence, and some dairy products arehigh in fat and sugar, which contribute to weight gain. Dairy products withlow fat and less sugar are recommended.

Q2.Cancer cels feed on sugar, so you shouldn't eat any sugary foods

Sugar is one of the main energy sources for our body.People usually think ofwhite sugar, brown sugar , candies, chocolate, etc. as sugars. sugar also existsin more complicated forms in our diet.Carbohydrates are the colectivename for all different kinds of sugars.Cereals, potatoes, fruits, vegetables anddairy products are the main sources of carbohydrates. They are broken downinto simple sugars and used as energy by cells in our body.If all carbohydrateintake is restricted, the body breaks down muscle and fat tissue instead tomeet metabolic needs,resulting in malnutrition. At present，there is noevidence that indicates sugar infake is directly related to cancer.However,intake of added sugar can lead to weight gain, which increases the risk ofbreast cancer recurrence. So limiting foods and beverages with largequantities of added sugar is necessary, such as white sugar,brown sugar,candies,chocolate,cake, biscuits, soda, juice,etc.

3.Patients with breast or ovarian cancer shouldn't eat any soy products,because plant hormones stimulate the proliferation of breast cancer cells

Soybean contains a phytochemical caled isoflavone, which has anti-cancerand anti-oxidation effects. It is also called phytoestrogen because itschemical structure is similar to that of estrogen. The concentration ofisoflavones in natural soybean and soy food is not high. And weakestrogen-ike effects of isoflavone are not enough to change the estrogenlevels in your body. The current evidence shows that it is safe to havemoderate amounts of soy-based food in our diet, but concentrated soybeansupplements should be avoided.Choose non-genetically modified soybeansand soy products, as pesticides are commonly used on genetically modifiedproducts，which increases the risk of cancer. lsoflavone supplements areusually used to relieve menopause symptoms.These are not recommendedfor breast cancer patients, because there is insufficient scientific evidence toverify its safety.

How to maintain breast health and reduce the risk of breast cancer?

1.Plant food based diet, more fruits, vegetables and high quality protein

2.Maintain a healthy weight

3.Exercise at least 150 minutes every week

4.Quit smoking and limit alcohol intake

5.Breastfeeding

What Is Breast Screening

Regular breast screening is the first line of defense when it comes to early detection of breast lesions and breast cancer. Early detection of breast cancer can lead to improved cure rate, and regular breast self-examination, clinical examination by a breast specialist and breast imaging examination (breast ultrasound or mammography) form the foundation of early detection.

Who Needs Breast Screening

Women over the age of 20 should consider beginning breast screening to detect breast infections, benign and malignant tumors, and nipple abnormalities. Regular breast screening is even more important if you have any the following risk factors ¹  .

• Increasing age

• High weight and high body fat (BMI ≥30 kg/m2)

• Tall stature

• High estrogen levels

• Benign breast disease

• Dense breast tissue

• Earlier menarche or later menopause

• Nulliparity and multiparity

• Increasing age at first pregnancy

• Personal history of breast cancer

• Family history of breast cancer

• Inherited genetic mutations

• Alcohol

• Smoking

• Night-shift work

• Exposure to therapeutic ionizing radiation

Breast Screening Protocol For Average Risk Women

¹Source: UpToDate

For people under 40 years of age, automatic breast ultrasound scan (ABUS) is a suitable breast imaging examination. ABUS is used for breast screening in young populations or as a supplement to mammography for breast screening in populations with high breast density. 

* Under some specific circumstances, the doctor may choose to do a hand-held ultrasound examination.

Mammography is the clinically recommended screening method for people over the age of 40.

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