Lymphoedema: causes, symptoms and treatment

1. What is lymphoedema?
2. Symptoms of lymphoedema
3. What causes lymphoedema?
4. Treatment for lymphoedema
5. Reducing your risk

1. What is lymphoedema? 

Lymphoedema is swelling caused by a build-up of fluid in the body’s tissues. Some people develop lymphoedema after treatment for breast cancer.

The swelling commonly affects the arm and can include the hand and fingers. Swelling can also affect the breast, chest, shoulder or the area on the back behind the armpit. 

It can occur as a result of damage to the lymphatic system, for example because of surgery or radiotherapy to the lymph nodes under the arm and surrounding area. Lymphoedema only affects the side of the body that was treated. 

Lymphoedema is a long-term condition, which means that once it has developed it can be controlled but is unlikely to ever go away completely.

2. Symptoms of lymphoedema 

Symptoms of lymphoedema include:

• swelling
• discomfort
• tightness
• dry skin
• arm stiffness
• hardness or firmness (fibrosis)

Contact your breast care nurse or treatment team as soon as possible if you notice any of these symptoms.  

Swelling

Swelling caused by lymphoedema may: 

• come and go to begin with
• be worse towards the end of the day
• be worse after strenuous activities or in hot weather

Clothing (particularly your bra) and jewellery (especially rings and bracelets) may feel much tighter than usual.

Swelling in the arm or chest area often develops immediately after breast surgery as part of the healing process, and usually settles without any treatment. However, it’s important to get any swelling assessed by your treatment team as soon as possible.

Discomfort 

Discomfort can be an early sign of lymphoedema. It can be: 

• a dull ache 
• heaviness in the arm, breast or chest area 
• tingling
• numbness

Tightness

The arm or breast can feel tight when there’s extra fluid in the tissues. Some people feel tightness in the arm without the arm appearing swollen. 

Dry skin 

Where there’s swelling the skin is stretched and can become dry and flaky and sometimes feel itchy.  

Dry, cracked skin increases the risk of cellulitis (a sudden infection of the skin and the tissue underneath it). 

Arm stiffness 

If your arm is swollen, it may limit movement in the joints.

3. What causes lymphoedema?

Lymphoedema can be caused by damage to the lymphatic system.

The lymphatic system

The lymphatic system helps the body get rid of waste products and also fights infection. It’s made up of lymph nodes, also called lymph glands, and tiny tubes called lymph vessels. 

The vessels transport a fluid called lymph to the lymph nodes. The lymph nodes filter out waste products and bacteria. They can also filter out cancer cells that have spread from a breast cancer.

Breast cancer treatment

Some people develop lymphoedema after surgery or radiotherapy to the lymph nodes under the arm and surrounding area. 

One, some or all of the lymph nodes under the arm can be removed during breast surgery to check whether any cancer cells are present.  

Lymph nodes and vessels that are damaged or removed cannot be replaced. This can affect the lymphatic system’s ability to drain fluid in this area, and lymph fluid can build up in the surrounding tissues. 

Lymphoedema may develop soon after surgery, radiotherapy or chemotherapy, but it can also occur many years later and may be triggered by a skin infection (cellulitis) or possibly injury.

Sometimes lymphoedema can be due to cancer cells blocking the lymphatic system.

4. Treatment for lymphoedema 

There are various treatments and techniques to manage lymphoedema. These include skincare, exercise, compression garments and a type of massage called manual lymphatic drainage.

Find out more about how lymphoedema is treated and managed. 

5. Reducing your risk 

There are a number of things you can do to reduce your risk of developing lymphoedema.

Maintaining a healthy weight 

Being overweight can increase your risk of developing lymphoedema because of added strain on an already weakened lymphatic system.

Eating healthily and doing some regular physical activity can help you maintain a healthy body weight.

If you’re unsure about the level of exercise you’re able to do, or would like guidance on a diet appropriate for you, your GP, practice nurse or pharmacist may be able to help you.

Using your ‘at risk’ arm and regular exercise

Try to use your arm normally. You’re more likely to increase your risk of lymphoedema by overly protecting your arm and not using it enough.

If you’ve recently had breast surgery, do the arm and shoulder exercises provided by your treatment team to help your recovery, and gradually return to normal activity.

Exercising the arm regularly can help, and you should be able to return to any sporting activities you did before your surgery. However, if you haven’t been doing these activities regularly you’ll need to gradually build up your arm strength. You may need to ask for guidance from your treatment team first.

Unless you’re used to regularly lifting heavy loads, ask for help carrying luggage or heavy shopping, or when moving furniture.  

Reducing your risk of infection 

Infection in your ‘at risk’ arm, hand, breast or chest area can cause swelling and may damage your lymphatic system, leading to lymphoedema. 

Contact your GP or breast care nurse as soon as possible if you notice any signs of infection, such as:

• redness or a rash 
• heat
• swelling 
• tenderness or pain
• flu-like symptoms

You may need antibiotic treatment.

Skincare

To help reduce your risk of developing an infection: 

• keep the area clean by washing your skin with warm water every day and drying it thoroughly
• moisturise the skin daily to prevent dry and cracked skin (use a moisturising cream that suits your skin type)
• use a high factor sunscreen to avoid sunburn
• apply insect repellent to avoid bites and stings
• wear protective gloves in the garden (particularly when near rose bushes or brambles) or when taking hot dishes out of the oven
• take care when cutting your nails 
• take care if using wax or a razor to remove hair from under your arm. Electric razors are gentler on the skin. You can use depilatory (hair removal) cream, but check first you’re not sensitive or allergic to it 
• keep any cut or grazes clean and use antiseptic cream 

Procedures on your ‘at risk’ arm 

There is not any strong evidence that having injections, taking blood, taking a blood pressure reading or having intravenous fluids in your ‘at risk’ arm will cause lymphoedema. However, you may prefer to use your other arm.

Speak to your healthcare professional if you’re worried about having any of these procedures on your affected side. 

Deep tissue massage will encourage more fluid to the treated area so you may want to avoid this on your ‘at risk’ side. However, many therapists are now trained to work with people who have, or are at risk of, lymphoedema, so check with your therapist.  

Travelling 

During flights or long train and car journeys, do gentle exercises such as clenching and unclenching your fist and shrugging your shoulders to reduce the risk of swelling.   

There’s no evidence that air travel or cabin pressure triggers lymphoedema, or that wearing a compression sleeve (usually used by people with lymphoedema) will help prevent swelling. In fact, an ill-fitting sleeve may cause problems. 

If you’re travelling to a country where quick access to good-quality medical care is difficult, ask your GP for a course of antibiotics to take with you in case of infection. If you develop signs of infection in your ‘at risk’ arm or hand, treat the infection as early as possible, even if there’s no swelling. 

Protect against insect bites by using insect repellent (at least 50% DEET), and carry antiseptic cream for cuts and grazes. 

Other precautions

While there’s no strong evidence to support them, wearing comfortable clothing and avoiding tight-fitting jewellery may affect lymph drainage.

There’s no evidence that having manicures or using hot tubs increases your risk of lymphoedema.  

Swollen Lymph Nodes and the COVID-19 Vaccine: What to Know

A vaccine reaction of enlarged lymph nodes is normal but can look suspicious on mammograms and other cancer screenings.

An expert explains how to avoid unnecessary worry.

If you have received a COVID-19 vaccine, you may have experienced a reaction such as a sore arm, a headache or fatigue — normal signs that the body is mounting an immune response. But one immune reaction can end up causing unnecessary confusion and worry. After the COVID-19 vaccine rollout, radiologists began to note swollen lymph nodes in the armpit, or axilla, on the mammograms of some recently vaccinated women. Enlarged nodes also have been evident on chest CT scans to detect lung cancer and on other imaging tests.

Ordinarily, this finding can lead to the need for additional tests or even biopsies to make sure it’s not a sign of cancer. Swollen armpit nodes could mean that the body is reacting to cancer in the breast or that there are cancer cells from the breast that have spread to the lymph nodes, says Dr. Elise Desperito, chief of the Division of Breast Imaging at NewYork-Presbyterian/Columbia University Irving Medical Center.

Nevertheless, “Enlarged lymph nodes after the COVID vaccine are a normal response of the body,” says Dr. Desperito, who is also an assistant professor of radiology at Columbia University Vagelos College of Physicians and Surgeons. “They will enlarge temporarily and return to their normal size after several weeks.”

Lymph nodes, small beanlike structures throughout the body, are an essential part of the immune system. “They contain lymphocytes, or white blood cells, which help fight infection and disease,” says Dr. Desperito.

The nodes tend to swell when they are reacting to a bacterial or viral infection. Because COVID-19 vaccines prompt an immune response, they can cause a similar reaction. The swollen glands typically appear on the side of the body where the vaccine was administered, such as the left armpit nodes in patients who have gotten the shot in their left arm.

It’s not uncommon for vaccines to cause swollen lymph nodes after vaccinations. This has occurred after other immunizations, such as the h2N1 influenza vaccine. “But with COVID, it’s happening on such a large scale that more people have experienced the reaction and a public conversation is needed,” says Dr. Desperito.

How can you make sure your cancer screenings don’t lead to an unnecessary cancer scare or tests? “Talking to your healthcare provider is the first, most important step,” says Dr. Desperito. She suggests the following measures:

Right now, many people are trying to schedule both their COVID-19 vaccine and cancer screenings, particularly those wanting to catch up on routine tests they put off due to the pandemic. “We don’t want vaccination to be delayed, and we don’t want people’s cancer screenings to be delayed,” says Dr. Desperito.

If you have the choice in scheduling appointments, schedule your imaging tests before you receive a COVID-19 vaccine, she advises. Then you can avoid having swollen lymph nodes muddy your test results.

“Enlarged lymph nodes are visible as early as one day after vaccination, and they can remain enlarged for a month or more,” says Dr. Desperito. (Keep in mind that while you may stop feeling a swollen lymph node, which can feel like a lump in your armpit, it may still be visible on a scan.) Call your doctor if you still feel a swollen lymph node after six weeks following your vaccine.

If you do get your COVID-19 shot before you get a cancer screening, make your providers aware of your vaccine status so they can manage your care appropriately.

When you have your cancer screening exam, tell the radiologist or technician when you had the first vaccine shot (and the second, if you received one) and in which arm. These factors should be in the report that your doctor receives.

If your test shows swollen lymph nodes, your doctor may decide to order another imaging test a few weeks later and/or watch you closely before ordering a more invasive test. For instance, if a woman had her vaccine in her left arm and enlarged lymph nodes are identified in the left axilla on her mammogram or ultrasound, a clinical exam by the patient’s healthcare provider in 4 to 6 weeks, if needed, is the recommended follow-up.

But “if swelling persists, your doctor may say, ‘I want you to go get an ultrasound and get it checked out,’” Dr. Desperito says.

If you are currently being treated for cancer or have recovered from it, you may be getting advanced imaging, such as CT scans and PET scans, periodically to see if it has spread to other organs or how you are responding to treatment, or to check for recurrences. Ask your oncologist if it is possible to coordinate them with your vaccine appointment, Dr. Desperito says.

If you’re offered the vaccine and you have tests coming up soon, you can request to have the shot administered in a different body part. For example, if your breast cancer is or was in the left breast, ask to get the vaccine in your right arm or even your thigh muscle, Dr. Desperito advises.

Talk to your doctor if swollen nodes appear on an imaging test after you got the vaccine. “If you had a CT scan and it shows enlarged lymph nodes, a targeted ultrasound can be done of the axilla to see if they’ve gone back to normal,” Dr. Desperito says. “You may not have to get a repeat CT scan. There are other ways to check on it.”

Scheduling your cancer screenings or follow-up imaging tests is very important. “We know that many people have had to delay these screenings because of the COVID pandemic,” Dr. Desperito says. “Generally, the earlier we find a cancer, the more treatable it is. Very simply, finding cancer early saves lives.”

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Mastitis | Morozovskaya Children’s Clinical Hospital DZM

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Physiological breast engorgement in newborns occurs on the 3rd-4th day of life, reaching a maximum by the 7th-8th day of life. Associated with the ingress of maternal hormones into the placental circulation. It occurs in both girls and boys.

Manifested as an increase in the mammary glands, often symmetrical. The skin over the enlarged mammary gland is not changed. A milky-white fluid may come out of the nipple. This condition does not require special treatment. As the level of maternal hormones in the blood decreases in a newborn child, physiological breast engorgement disappears.

Mastitis is a purulent-inflammatory disease of the breast. It occurs in both girls and boys in the first 2 weeks of life.

Mastitis is caused by bacteria entering the breast ducts during the period of physiological engorgement. It starts suddenly and progresses rapidly. It manifests itself in the form of an increase and redness of one breast. The gland becomes dense, sharply painful, pus may stand out from the nipple. The general condition of the child is deteriorating. The baby becomes lethargic, refuses to breastfeed, body temperature rises. In the future, the skin over the mammary gland acquires a purple-cyanotic hue, due to the underdevelopment of the capsule, inflammatory changes quickly spread beyond the mammary gland. In the absence of the necessary treatment, the process can spread in breadth and depth, causing necrotic changes in the breast itself and surrounding tissues.

Treatment of mastitis depends on the timeliness of seeking medical attention. In the early stages, at the very beginning of the disease, conservative treatment is possible. Apply warming ointment compresses, antibiotic therapy. In cases where an abscess has already formed in the region of the mammary gland, a surgical intervention is performed to open and drain the abscess cavity. From the first day, broad-spectrum antibiotics are prescribed until the postoperative wound heals and the seal resolves, which is an indication for the patient to be discharged.

The prognosis for mastitis in uncomplicated cases is favorable. In the case of late treatment and the severity of the inflammatory process, the death of the glandular tissue in girls is possible, which in the future may manifest itself in the form of a cosmetic defect and a decrease in lactation on the side of the lesion.

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Breast awareness and how to perform breast self-examination

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This information will help you learn about breast awareness and how to perform a breast self-examination.

Breast awareness means understanding how normal breasts should look and feel. Each person should be aware of the state of their mammary glands. This will make it possible to notice any changes in the mammary glands. If you notice any changes, such as a lump or discharge (fluid) from your nipple, call your doctor. It is important not to panic though. In most cases, these changes are not caused by cancer.

One way to find out what your breasts look like and how they feel is to do a breast self-examination. MSK does not recommend breast self-examination as part of a routine breast cancer screening. This is due to the claim that such screenings do not help detect breast cancer and do not lead to a longer life.

However, you can still do a breast self-examination to find out about their condition. You can do a self-examination once a month, occasionally, or not at all. If you decide not to do the self-examination, that’s fine. But you still need to know what your breasts usually look like and how they feel to the touch.

People of any gender can get breast cancer, so regardless of your gender, you should have a breast self-examination.

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When to do breast self-examination

Breast exams are best when they are not painful or swollen. If you have a period (menstruation), it is advisable to do a self-examination a few days after it ends.

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How to perform breast self-examination

In front of a mirror

1. Stand in front of a mirror, undress from the waist up. Press your hands firmly against your thighs (see Figure 1).

   Figure 1 Examination standing in front of a mirror

2. Look in the mirror and check if you have these changes in your breasts (see Figure 2):

   Figure 2. Redness and indrawing on the breast

   • change in size, shape or contour;
   • indrawing (orange peel texture) on breast skin;
   • redness or peeling (or crusting) of the nipple or breast skin;
   • any discharge (liquid) from the nipple.
3. Raise one arm slightly and examine the armpit area. Feel the armpit for changes or lumps. Do the same in the other armpit. Don’t raise your hand straight up. Because of this, the tissues in this area will stretch, and it will be more difficult to examine them.

Examination in lying position

1. Lie on your back with a small pillow or folded towel under your right shoulder. Put your right hand behind your head. When you lie down, the breast tissue spreads out as thinly as possible, making it easier to fully feel it.
2. Use the pads of the three middle fingers of your left hand to feel the right breast for lumps (see Figures 3 and 4). Do this in circular motions, describing circles the size of a coin, and moving up and down the breast with a little pressure. You can move your fingers clockwise (right) or counterclockwise (left).

Figure 3. The pads of the three middle fingers

Figure 4. Breast Self-Exam in Lying Position

You will need to vary the amount of pressure within 3 levels. When probing breast tissue, apply all 3 levels of pressure at each point before moving on to the next. If you are not sure how much pressure to apply, check with your doctor.

• Feel the subcutaneous tissue layer with light pressure.
• Feel the deeper layer with moderate pressure.
• Feel the tissues adjacent to the chest and ribs with strong pressure. If a harder tissue or a hard edge is felt along the lower curve of each breast, this is normal.

Figure 5. Use of the Vertical Scheme for Breast Examination

1. Then examine the entire mammary gland, moving up and down. This is sometimes referred to as a vertical layout (see Figure 5). Start at the armpit and slowly move your fingers down until you reach the bottom of the chest. Then move your fingers a little closer to the center and move up until you reach the collarbone. Continue moving your fingers up and down the breast. You can stop when you reach the middle of the chest (also called the sternum).
2. Repeat the examination on the left breast, performing it with the right hand.

Call your doctor if you notice any changes in your breasts.

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