Treatment of breast cancer-related lymphedema has come a long way

When I had breast cancer surgery, followed by radiation treatments in 2000, there weren’t programs to monitor for a possible side effect called lymphedema in my arm. I didn’t develop lymphedema but those who did had only three treatment options at that time, which included manual lymphatic drainage, external compression garments and exercises.

Now, patients have the opportunity to be monitored for breast cancer-related lymphedema with more options for treatment.

“Lymphedema is an accumulation of protein-rich fluid in the tissues as a result of impaired lymphatic function,” said breast surgeon Jill S. Oxley, MD, FACS. “We usually think of it as a side effect of breast cancer treatments, especially with surgery to biopsy sentinel lymph nodes or removal of axillary lymph nodes under the arm. While lymphedema is not curable, it is highly treatable, especially if caught early.”

In 2021, the Cape Cod Healthcare Cuda Women's Health Center launched a lymphedema prevention program using a device called the SOZO, that provides data indicating the fluid levels and if they begin to rise.

“If there is any increase in the measurements, we immediately refer the patient to the lymphedema occupational therapist at Cape Cod Healthcare Rehabilitation Department for further evaluation and treatment,” said Dr. Oxley.

Judy Rumul of Sandwich is one of the many patients monitored by the lymphedema prevention program.

“I was diagnosed with right-side breast cancer in August 2024,” she said. “I had two lumpectomies to remove two different spots of cancer in my breast and biopsies of my sentinel nodes to check for cancer, followed by radiation therapy.”

She began SOZO testing every three months following her treatment and recently found out she has lymphedema in her right breast. She was referred to the Cape Cod Healthcare Rehabilitation Department for management of her condition.

Lymphedema Treatment

“The rehab department offers a lot in terms of treatment,” said Dr. Oxley. They include the following. which she called “the mainstay of therapy:”

• Manual lymphatic drainage: Light tissue compression through massage to reduce swelling.
• Pneumatic compression pumps: Intermittent compression pumps that have padded, inflatable sleeves, vest, or stockings attached to an external pump that provides intermittent pressure to the affected area.
• Low level laser therapy (LLLT) also known as photo biomodulation: It has an infrared light that assists with tissue regeneration, lymphatic fluidity and inflammation. The device that the therapists use has a targeted light specifically for breast and arm edema.
• Compression garments and bras: These are specially-designed sleeves, bras and stockings that provide pressure to help reduce lymphedema.
• Skin care education
• Exercise programs that are a combination of stretching, flexibility, strength training and aerobics.

Rumul goes to rehab once a week to see occupational therapist Brenna Quinn, OT, CLT, for manual lymphatic drainage, soft tissue mobilization, scar management, low-level laser therapy and stretching. She also does exercises at home.

“I am feeling very good, and the treatments are helping my lymphedema,” said Rumul.

Reducing Risk of Getting Lymphedema

Most women who are treated for breast cancer are now able to have less extensive lymph node surgery, according to Dr. Oxley.

“The older data showed that 50 percent of women who had axillary node dissection would get lymphedema,” she said. “Now, with axillary node dissection, the risk is about 20 percent, and sentinel node biopsy is between 5 and 7 percent.

“Sentinel node biopsy involves mapping the lymphatics to see which lymph nodes would be the first ones that cancer would spread to, and the average is about two. If we can find those first nodes, then most women don’t need further node surgery beyond that.”

Physicians also perform axillary reverse mapping, which involves injecting blue dye into the arm and when they do the lymph node surgery, they don’t remove any blue nodes unless they look suspicious, she added.

“Studies have shown that when this is performed with a sentinel node biopsy, the risk of lymphedema is less than 1 percent, and when done with an axillary node dissection, it is 6.5 percent,” she said.

“Lymphedema prevention and treatment is a constantly evolving field,” said Dr. Oxley.