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Lymphedema is a condition in which excess lymph collects in tissue and causes swelling. It may occur in the arm or leg after lymph vessels or lymph nodes in the underarm or groin are removed or treated with radiation.
Following surgery, there is a chance that the cancer can return or spread even years later. Factors known as prognostic indicators help physicians and patients estimate the risk of recurrence over time. These include whether the cancer has spread to the lymph nodes and the size of the tumor. In addition, the histological grade (how much the cancer resembles normal tissue) and the presence of hormone receptors are considered.
When chemotherapy or hormone therapy is administered following surgery, this is called adjuvant therapy. The risk of distant recurrence can be lowered by chemotherapy or hormone therapy. Hormone therapy can be effective if either of the hormone receptors for estrogen or progesterone is present.
For patients who are already at a low risk for recurrence, adjuvant therapy, especially chemotherapy, will not be necessary since the side effects outweigh the small reduction in risk achieved with therapy.
Common problems occurring soon after lumpectomy or mastectomy include decreased ability to move the arm due to pain or tightness, mild weakness due to postsurgical discomfort, and postsurgical swelling of the lower arm. Early physical therapy for these problems can help return you to normal health and function as quickly as possible after surgery.
Our physical therapists begin with an hour-long evaluation session. During this evaluation, the therapists assess your pain complaints, range of motion, posture, strength, joint mobility, incision-site healing, ability to reach, and nerve mobility. If you have had lymph node surgery, we measure your arms and counsel you on skin care and the prevention of lymphedema.
Physical therapy treatments include gentle stretching, massage (to improve incision site healing and range of motion), joint mobilization, postural re-education, strengthening, nerve gliding, and home exercise programs.
Physical Therapy for Lymphedema
Lymphedema is a swelling condition that sometimes occurs following surgical removal of lymph nodes. Early treatment of this swelling helps to reduce the amount of therapy needed and limits the discomfort and disruption of your daily life.
A physical therapist certified in the treatment of lymphedema can offer complete decongestive therapy, including manual lymphatic drainage, short-stretch compression bandaging, an exercise program, and skin care. The therapy includes counseling on long-term self-management of lymphedema, including the use of compression garments and self-bandaging, as well as additional education.
Prevention of Lymphedema
The National Lymphedema Network (www.lymphnet.org) offers the following guidelines for patients who are at risk of developing lymphedema and patients who have developed lymphedema.