Breast Cancer Related Lymphoedema

Breast Cancer Related Lymphoedema Women’s Clinic The following information aims to address the concerns you may have during your stay in hospital.

We hope this information will help to give you more information about the condition.

It is still unclear why some people develop lymphoedema after breast surgery. Similarly, it is not entirely clear what worsens the condition.

This means that effective advice on care and management to prevent an aggravation is crucial.

The greatest risk of infection is in the arm. Certain clinical procedures may increase the risk of secondary lymphoedema. As skin is the most effective defence against a possible infection, conscientious care of the skin is essential.

The key procedures on the arm that are a cause for concern include: • Being given drugs intravenously • Having an intravenous (IV) drip inserted

• Having a tourniquet applied • Having your blood pressure measured • Having blood taken • Local excision • It is the patient’s choice in breast cancer treatment Intravenous therapy - inserting a drip into a vein and giving fluids or drugs - increases the potential risk of introducing an infection, but has not been clearly shown to increase the risk. The presence of lymphoedema indicates problems with fluid drainage from the limb.

Alternative sites for injection of drugs should be used to avoid a possible fluid build up in the region.

However, there are instances where the ability to induce fluids rapidly would be crucial as in the case of a life threatening blood loss.

There are occasions (chemotherapy is a common example) when drugs may need to be given through a vein. In the long run, this method

may be harmful to the veins as it increases the chances of using up the veins in the other arm or feet.

Where administration of lifesaving drugs is necessary, they should be given via the best possible route but if a need for repeated treatment arises, a more long-term intravenous access should be considered. This is usually a plastic catheter inserted through the skin into a deeper vein, typically in the neck. The catheter can be kept in place for weeks.

Surgery for the compression of nerves at the wrist (carpal tunnel syndrome) is common in lymphoedema and a tourniquet is routinely used in this form of upper limb surgery. There is no evidence that using a tourniquet for up to 10 minutes bears any long-term effect though it may excite temporary growth in lymphoedema.

Having blood drawn (venepuncture) from a vein carries little chances of introducing an infection in the limb. However, where there are alternative sites on the body, it is wiser to utilise those areas, even if it involves unusual locations such as the feet.

Measuring blood pressure involves a simple cuff on the arm which is inflated above the pressure in the arteries, and then rapidly deflated to record the blood pressure. There is no evidence that this makes any differemce at all to the risk of developing lymphoedema.

However, changes in the volume of the arm may affect the accuracy of the recording and for this reason using the other limb would be more sensible.

Frequently Asked Questions: 1. What makes me prone to developing lymphoedema?

For unknown reasons, up to a third of patients get lymphoedema after surgery affecting their axillary lymph nodes. This can take a year or more to develop. There are many suggestions of ways to avoid triggering lymphoedema.

However, there is a lack of evidence to support these suggestions.

2. If I have lymphoedema, what will make it worse?

Once lymphodema develops, there are several methods of trying to avoid aggravating the condition. The chances of any medical procedure on the

affected arm making it worse are 5. What if they want to insert a small, but where possible, the drip into my affected arm? affected or at-risk arm should The insertion of a cannula (plastic not be used. Some procedures tube) through the skin into a such as using a tourniquet during vein remains a potential source surgery may make it worse of infection until it is removed. temporarily but the effects are not Careful management of this is permanent. necessary to reduce the risk of cannula-based infection.

3. Will they take my blood pressure on my affected arm?

However, where it is necessary There is no evidence that having to give fluids or blood because your blood pressure measured of major injury or blood loss, on that arm will have any effect. life-saving measures will take It is unlikely to trigger the onset precedence over any other of lymphoedema and it will not considerations, including make established lymphoedema the small risk of triggering or worse. However, the procedure exacerbating lymphoedema. may become less accurate and more uncomfortable for you 6. What about injecting drugs if lymphoedema is present. It into an affected or at-risk arm? is for these reasons that using The absorption of drugs from an alternative limb would be the at-risk arm is less probable sensible. than if given through other veins in the alternative limb. If there is 4. Will they take blood from my a need to give drugs regularly, affected or at-risk arm? such as for chemotherapy, a This is one procedure that may more permanent IV catheter may increase the risk of triggering be inserted into a deeper vein, lymphoedema or aggravating making it more convenient and the condition. This is because of safe for you. the very small risk of infection.

As you would be in the hands of We would advise against injecting skilled operators, the chances of a into the at-risk arm or arm with problem arising would be small. lymphoedema unless in life-saving However, where possible, the at- situations where only the affected risk arm should be avoided. arm is accessible.

Lymphoedema Web Resources Living with lymphoedema after breast cancer www.breastcancercare.org.uk/server/show/nav.490 Reducing the risk of Lymphoedema www.breastcancercare.org.uk/server/show/nav.489 Management of cellulitis in lymphoedema, coping with lymphoedema following a mastectomy or a lumpectomy, what is cellulitis? www.lymphoedema.org/lsn Prevention of upper limb lymphoedema www.lymphoedema.org/lsn Lymphoedema, advice on self-management and treatment www.beaconsfield---publishers.co.uk Reducing the risk of lymphoedema www.breastcancercare.org.uk Lymphoedema awareness: reducing your risk, living with lymphoedema after breast cancer www.breastcancerhaven.org.uk Understanding lymphoedema www.be.macmillan.org.uk/ordes Lymphoedema, a guide for cancer patients www.royalmarsden.nhs.uk Risk of cellulitis www.thebls.com/concensus.php

Yishun Health is a network of medical institutions and health facilities in the north of Singapore, under the National Healthcare Group.

Admiralty Medical Centre • (65) 6807 8000 • www.admiraltymedicalcentre.com.sg Khoo Teck Puat Hospital • (65) 6555 8000 • www.ktph.com.sg Yishun Community Hospital • (65) 6807 8800 • www.yishuncommunityhospital.com.sg The information is correct at the time of printing and subject to revision without further notice.

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