Lymphedema can be a potential complication of breast cancer treatment, particularly in cases where lymph nodes are removed in the underarm

Survivors of Breast Cancer need to be alert to bodily changes that can be indicative of a recurrence of cancer. This includes checking their body for lumps, being alert to new spots on their body, occurrence of aches and pains and maintaining follow-up appointments with the doctor. No matter what treatment they undergo to battle and destroy their cancer, there are bound to be a few side effects that need constant care and attention. Lymphedema is one of them.




Lymphedema is a medical condition characterized by the swelling of body parts, typically the arms or legs, due to the accumulation of lymphatic fluid. The lymphatic system is a part of the circulatory system that helps remove waste products and excess fluid from the body’s tissues. Lymphedema occurs when there is a disruption or damage to the lymphatic system, leading to the impaired drainage of lymphatic fluid and the swelling of affected areas.


There are two main types of lymphedema:


  • Primary Lymphedema: This type of lymphedema is often present at birth or may develop later in life due to genetic factors or abnormalities in the lymphatic system. Primary lymphedema is relatively rare.
  • Secondary Lymphedema: Secondary lymphedema is more common and typically occurs because of damage to the lymphatic system. Common causes of secondary lymphedema include surgery (such as lymph node removal during cancer treatment), radiation therapy, infection, trauma, or other medical conditions that disrupt the normal flow of lymphatic fluid.



Lymphedema can cause a range of symptoms, including:


  • Swelling in the affected limb or body part.
  • A feeling of heaviness or tightness in the affected area.
  • Reduced flexibility and mobility in the affected limb.
  • Recurring infections in the affected limb.
  • Hardening or thickening of the skin in the affected area



Breast Cancer itself does not directly cause lymphedema; rather, lymphedema can occur because of cancer treatment or due to the physical presence of a tumour that obstructs lymphatic flow. The connection between lymphedema and breast cancer is primarily related to the treatment of breast cancer, specifically surgical procedures, and radiation therapy. Lymphedema can be a potential complication of breast cancer treatment, particularly in cases where lymph nodes are removed, or radiation therapy is administered in the underarm area.


Here are the primary ways in which cancer and its treatment can lead to lymphedema:


  • Surgery: Lymphedema can develop because of surgical procedures used to treat cancer. For example, during cancer surgery, lymph nodes may be removed or damaged, which can disrupt the normal flow of lymphatic fluid. This is particularly common in breast cancer surgery, where axillary lymph node dissection or sentinel lymph node biopsy is performed to assess the extent of cancer spread.
  • Radiation Therapy: Radiation therapy, which is often used to target and kill cancer cells, can also damage the lymphatic system. If radiation is directed at or near lymph nodes, it can lead to fibrosis (thickening and scarring of tissues) and lymphatic vessel damage, impairing lymphatic drainage and potentially causing lymphedema.
  • Tumour Compression: In some cases, cancerous tumours themselves can physically compress or obstruct the lymphatic vessels or nodes. This compression can impede the normal flow of lymphatic fluid, leading to localized lymphedema in the area near the tumour.

Not all cancer patients will develop lymphedema, and the risk varies depending on the type and stage of cancer, the extent of surgery and lymph node removal, the location and dosage of radiation therapy, and individual patient factors.




Here are some key factors that influence the risk of lymphedema after mastectomy:


  • Type of Mastectomy: The risk of lymphedema is generally lower in patients who have undergone a simple or total mastectomy, which involves the removal of the entire breast but leaves the lymph nodes in the underarm area intact. However, in cases of a modified radical mastectomy, which involves removing both the breast tissue and some lymph nodes, the risk increases.
  • Axillary Lymph Node Dissection: If a patient has had removal of multiple lymph nodes from the underarm area, there is a higher risk of lymphedema compared to those who have not had extensive lymph node removal.
  • Radiation Therapy: Radiation therapy, especially when directed at the axillary lymph nodes, can increase the risk of lymphedema. It can damage the lymphatic vessels and nodes in the treated area, impairing lymphatic drainage.
  • Body Weight: Being overweight or obese can increase the risk of lymphedema after mastectomy. Excess body weight can put additional pressure on the lymphatic system and make it more difficult for lymph fluid to flow.
  • Other Factors: Other factors that can influence the risk of lymphedema include the presence of pre-existing lymphatic issues, the use of certain medications, and the presence of other medical conditions.

It is important to note that not all breast cancer patients who undergo mastectomy will develop lymphedema. Many do not experience this complication, especially if they have had a less extensive surgery and do not undergo radiation therapy.




However, patients need to be educated on what they can do to minimize the risk of lymphedema. These measures may include:


  • Avoiding blood pressure measurements, injections, or drawing blood on the affected arm.
  • Protecting the arm from injury, such as avoiding heavy lifting or trauma.
  • Practicing good skincare to prevent infections.
  • Gradual and appropriate exercise to encourage lymphatic flow.

Prof. Consultant - Medical Oncologist at Dr.Kamakshi Memorial Hospitals
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