Which Is More Effective In Reducing Arm Lymphoedema For Breast Cancer Patients

Breast cancer treatment involves different aspects like through surgery, radiation therapy, chemotherapy, endocrine therapy, bone marrow transplant, oophorectomy, and adrenalectomy. With this kind of treatments, the patient may develop arm lymphoedema due to the surgery to remove lymph nodes or radiotherapy to the lymph nodes in the armpit. If lymphoedema is not treated, it will get worse. It can be painful and make it difficult to move the arm. This complication can lead to systemic infections and localized swelling that will be very hard to bear. But today, lymphoedema is becoming less common. This is because specialists now try to avoid giving women both surgery and radiotherapy to the armpit. Having surgery and radiotherapy to the armpit greatly increases the risk of damaging the lymph nodes and causing lymphoedema. It is important that the patient know about his or her disease and the risk of developing lymphoedema. Poor drainage of the lymphatic system due to surgical removal of the lymph nodes or to radiation therapy may make the affected arm or leg more susceptible to serious infection. Even a small infection may lead to serious lymphoedema. Patients should be taught about arm care after surgery and/or radiation. It is important that patients take precautions to prevent injury and infection in the affected arm because lymphoedema can occur 30 or more years after surgery. Breast cancer patients who follow instructions about skin care and proper exercise after mastectomy are less likely to experience lymphoedema. As management of lymphoedema, compression bandages and manual lymphatic drainage are the mostly used care for such patients. Statement Of Fact After treatment, some things can increase fluid collection in your arm and increase your risk of lymphoedema. These include Infection in a cut or graze, insect bites, severe sunburn, putting too much strain on your arm too early. But this can be prevented by not using your arm for anything heavy until you are told you can, not letting anyone take blood, give injections or take your blood pressure from the treated arm, unless it is an emergency and there is no alternative, wearing gloves when gardening or doing housework, taking care when playing with pets, using insect repellent and high factor sunscreen, using nail clippers rather than scissors and not pushing your cuticles back, using an electric razor rather than a manual one if you shave under your arms, avoiding anything that will increase the temperature of your skin, like very hot baths or showers, sitting too close to a heater, saunas, steam rooms and sun beds, using a non scented moisturizer or oil on your skin each day to help it stay moist and supple, using a thimble when sewing, continuing to do the arm and shoulder exercises you were taught after your surgery. If you do get a cut or scratch on your arm, however small, wash it well and cover it un til healed. If you see any redness or swelling around the cut, see your GP straight away. You may need antibiotic. Lymphoedema can start at any time after there have been treated for breast cancer. It is important to take these precautions for the rest of life. If lymphoedema has occurred already, it can be managed by exercises that help the fluid to drain from your arm, compression bandages or by manual lymphatic drainage. Definition of Terms: 1. Lymph – a pale coagulable fluid that bathes the tissues, passes into the lymphatic channels and ducts, is discharged into the blood by way of the thoracic duct, and consists of a liquid portion resembling blood plasma and containing white blood cells but normally no red blood cells. 2. Lymphatic – a vessel that contains or conveys lymph, that originates as an interfibrillar or intracellular cleft or space in a tissue or organ. 3. Lymph node – any of the rounded masses of lymphoid tissue that are surrounded by a capsule of connective tissue , are distributed along the lymphatic vessels, and contain numerous lymphocytes which filter the flow of lymph passing through the node. 4. Arm Lymphoedema – swelling of the arm and armpit due to the treatment of breast cancer by surgery or radiation. 5. Lymphoedema – edema due to faulty lymphatic drainage. 6. Breast cancer – a carcinoma in the breast 7. Axillary lymph clearance – operative management for disease control in invasive breast cancer, obtaining prognostic information and influencing postoperative therapy including the choice of breast cancer trials. Main Body The management of lymphoedema consists of compression bandages, manual lymphatic drainage, or by exercises but shou ld be done by trained or specialist person. Mostly used now are the compression bandages and the manual lymphatic drainage. In using the management of lymphoedema, the patient should have passed the axillary lymph clearance. Axillary node clearance is the established operative management for disease control in invasive breast cancer, obtaining prognostic information and influencing postoperative therapy including the choice of breast cancer trials.Dying of Breast Cancer in the 1800s Axillary node clearance can be defined as clearing the axillary contents bounded by the axillary skin laterally, latissimus dorsi, teres major and subscapularis posteriorly, the lower border of the axillary vein superiorly, pectoralis muscles anteriorly, and the chest wall medially. The levels of axillary nodes are anatomically defined as level one (inferolateral to pectoralis minor), level two (posterior to pectoralis minor) and level three (superomedial to pectoralis minor). There are alternatives to level one, two and three axillary node clearance for breast cancer. Some surgeons simply excise the lower axillary nodes (level one), others believe, particularly for small or impalpable cancers, that an axillary node sample taking a minimum of 4 nodes is a satisfactory alternative. Most recently the concept of sentinel node biopsy (reviewed by McIntosh and Purushotham in 1998) has been exciting great interest. Current recommendations, by a range of surgical and oncological groups, are that some form of axillary surgery, and hence axillary staging, should be performed in all patients who undergo operative treatment for breast cancer. It is no longer acceptable to ignore the axilla if performing surgery for breast cancer. The axilla is one of the area with lymph nodes mostly affected by breast cancer and the patient who finished the axillary lymph clearance will then be undergoing the management of compression bandages or the manual lymphatic drainage. There is no cure for lymphoedema, which makes proper care and treatment of the affected arm even more important. Compression bandaging, also called wrapping, is the application of several layers of padding and short-stretch bandages to the involved areas. Short-stretch bandages are preferred over long-stretch bandages (such as those normally used to treat sprains), as the long-stretch bandages cannot produce the higher tension necessary to safely reduce Lymphoedema and may in fact end up producing a tourniquet effect. During activity, whether exercise or daily activities, the short-stretch bandages enhance the pumping action of the lymph vessels by providing increased resistance for them to push against. This encourages lymphatic flow and helps to soften fluid-swollen areas. Compression bandages gives comfort to the patient through giving pressure and compression in the affected area specifically in the arm and armpits. It serves as a support in the said area preventing further swelling and redness. Practitioners may want to encourage long-term and consistent use of compression bandages by women with lymphoedema. Its advantage is in terms of support and comfort to the patient and less invasive. Compression bandages may also protect the extremity from injuries such as burns, lacerations and insect bites. The compression bandage has its benefits such as it is less costly and patient does not need further effort to use it because it is for support and pressure in the specified area. In contrast to compression bandages, another management to lymphoedema is through manual lymphatic drainage. One of the main treatments for lymphoedema is a massage-like technique called manual lymphatic drainage that helps to stimulate the lymphatic vessels. However, massage, the way people generally think of massage, is a vigorous technique that can cause an increase in fluid production. The type of massage that is used to treat lymphoedema is a very gentle technique. Lymphatic massage is directed towards the heart from the fingertips, up the arm, towards the shoulder, and there are very specific directions and strokes that are used in this particular massage. A very specialized type of massage called manual lymphatic drainage (MLD) is an important part of the treatment of lymphoedema. To be effective in treating lymphoedema, it is important to use the correct technique. The aim of the massage is to stimulate or move the excess fluid away from the swollen area so that it can drain away normally. Massage also encourages and improves drainage in the healthy lymphatics (which helps keep fluid away from swollen areas). Manual lymphatic drainage differs from ordinary massage – it is very gentle and aims to encourage movement of lymph away from swollen areas. MLD is particularly useful if there is swelling in the face, breast, abdomen, genitals or elsewhere on the trunk. As this is a specialized form of massage, it should be given only by a trained therapist. There are some other different techniques including the Vodder, Foldi, Leduc or Casley-Smith methods. Therapists should be trained in at least one of these. The aim of this massage is to stimulate the lymph channels on the trunk to clear the way ahead so excess fluid can drain away. The skin is always moved away from the swollen side. You will find it easier to start with one hand, and then swap to the other as you move across the body. Before and after MLD, breathing exercises can help to stimulate lymphatic drainage. This can be done by letting the patient sit upright in a comfortable chair or lie on your bed with your knees slightly bent. Rest his hands on ribs and let patient take deep breaths to relax. This exercise should be done 5 times and there should be short rests before getting up to avoid dizziness. Manual lymphatic drainage is improved during exercise; therefore, exercise is important in preventing lymphoedema. Breast cancer patients should do hand and arm exercises as instructed after mastectomy. Patients who have surgery that affects pelvic lymph node drainage should do leg and foot exercises as instructed. The doctor decides how soon after surgery the patient should start exercising. Physiatrists (doctors who specialize in physical medicine and rehabilitation) or physical therapists should develop an individualized exercise program for the patient. The advantage of the manual lymphatic drainage as management of lymphoedema is that it gives opportunity for open wounds to drain with gentle massage and excess exudates to drain freely without pressure. In terms of the disadvantage side of the management of lymphoedema, it differs also. In compression bandages, there is an exemption in placing it especially if the affected area has an open wound or has an ample amount of drainage in the area or with pus. The pressure given by the compression bandage can even more contribute to the entry of microorganisms or infection to occur. This may cause another disease process to start and give greater complications to the patient. Compression bandages are probably the most difficult problem is in the maintenance and control of lymphoedema before, during and after treatment. Patients may be noncompliant with using compression garments because the garments are unsightly, uncomfortable, difficult to put on and expensive. Customized, lightweight and colourful garments may be an option for comfort and wear. As for the manual lymph drainage, its disadvantage is in terms of the inaccurate use of the MLD of the one giving care which can also rupture other lymph nodes in the area and also as well as the hygienic process in giving the manual lymphatic drainage. Some patients also experience some discomfort on such procedure as the drainage is in its process. The preference in such procedures is by the patient by giving proper education and explanation on each management. Conclusion Both compression bandages and manual lymphatic drainage as management of arm lymphoedema gives comfort and benefit to the patient giving different of care to the patient in relieving such discomfort. Both have advantages and disadvantages to consider but what matters most is the greater care and comfort the patient gets in being free of pain and swelling in such areas which would be very difficult for the patient to do the activities of daily living with an arm that cannot be moved and with great amount of pain being experienced. It also is extremely important to remember that a certified lymphoedema therapist needs to either perform the treatment or educate the patient and/or family members in self-care techniques, once the patient has gone through an intensive treatment program. The therapist will design the treatment plan based on the severity of the lymphoedema. It can also depend on the type of reimbursement patients can get from their health plans. In my practice, for example, we would treat a patient with a mild upper extremity lymphoedema for a five-day period, including of manual lymphatic drainage (MLD), bandaging, exercise, and also education in self-care. So by the end of the five days, usually the patient is able to manually drain the limb and follow a home program. There is no greater comparison on both management, the physician orders such management for the patient’s welfare and fast recovery yet this lymphoedema does not have the accurate cure but just the rehabilitation to the pain and swelling to the arms and its surrounding areas. It may be done by compression bandage or manual lymph drainage, it all points out to the care of the patient that lessens the access of infection, occurrence of pain and swelling.