Swollen Arms after Cancer Surgery? Beware of Lymphedema

Swollen Arms after Cancer Surgery? Beware of Lymphedema

Lymphedema or swollen arms often afflict breast cancer patients after undergoing surgery or radiation. Unfortunately, the disease attacking the lymph node system is often treated too late.

This was revealed by the oncologist at Surgical Oncology Department of Dharmais Cancer Hospital Jakarta, dr. Bayu Brahma, SpB (K) Onk. On ‘Breast Cancer Webinar Series: New Hopes for the Prevention and Treatment of Breast Cancer Lymphedema, Friday (7/10).

The webinar which was held in collaboration between the Indonesia Breast Cancer Foundation (YKPI) and doctors at Dharmais Cancer Hospital Jakarta, was opened by YKPI Chairperson Linda Agum Gumelar, and attended by around 200  participants from all over Indonesia.

Bayu explained there are generally two causes of lymphedema, namely primary and secondary causes. Primary cause is due to congenital abnormalities, which is rarely found; while others are the secondary causes.

“The secondary cause is most often founded, because it occurs due to cancer problems. This is because surgery for cancer is also carried out on the lymph node system, or it could be due to radiation process,” explained dr. Bayu.

As for breast cancer in particular, according to dr. Bayu, risk factors for lymphedema are the surgery of lymph node removal at the axillary area (armpit), radiation in the axillary and surrounding areas, obesity, and chemotherapy.

“So, based on our study, we see that lymphedema occurs more often to patients who have obesity or overweight problem.  That’ why it is important to have an ideal lifestyle,” said dr. Bayu.

He then explained how to measure an ideal bodyweight, which is by referring to body mass index: body weight divided by the square of the body height. “Look at the number, if it’s near 25, then you need to be careful,” he said.

The alumnus of Medicine Faculty of the University of Indonesia said that at least 30-40% patients did not aware that they had lymphedema in early symptoms. Patients generally only realize lymphedema when their arms start to swell.

According to dr. Bayu, in order to recognize lymphedema, we need to understand four stages of the disease. At stage zero, there are no signs of swollen arms. Complaints that arise are still subjective. Then the first stage, where arms begin to swell, but will disappear with the lifting of arms. When it reached to the second stage, the arms look swollen, and it will not disappear if the arms are lifted.

“The most typical symptom of the second stage is pitting edema: if we do pressure on the skin, it will show a basin that takes a while to return to normal. This is a typical sign,” dr Bayu said.

Next is the third stage, which occurs when the skin already contains a lot of irritating fluid in skin tissue. The liquid changes the structure of the skin to become hard.

“If it is severe already, abnormalities will occur in the skin, of of which lymph fluid from the skin,” he said.

Then, what steps need to do to prevent lymphedema?

For breast cancer, the most effective prevention measure is by doing early detection. If breast cancer is found at an early stage, then the cancer cells have not spread to the axillary glands.

As for surgery, lymphedema prevention is by performing sentinel lymph node surgery.

“If the sentinel gland is not indicated (exposed to cancer), then no need to undergo a biopsy. Otherwise, there is an increased risk of lymphedema,” explained dr. Bayu.

Meanwhile, YKPI Chairperson, Linda Agum Gumelar said that lymphedema is the most frequent complaint from breast cancer patients after undergoing surgery, radiation, or chemotherapy.

Therefore, Linda, who is also a survivor of breast cancer, said that both patients and survivors of breast cancer always seek information about lymphedema, in order to overcome the disease.

“We think information and knowledge about lymphedema is very important, because the disease is often found in breast cancer patients. Unfortunately, the case is often ignored, the symptoms are not realized, until there are swollen arms and fingers, which cause a heavy or stiff feeling,” said Linda.

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