Early Detection and Treatment of Lymphedema After Breast Cancer

Lymphedema can be difficult to detect in the early stages. Some patients may not experience any symptoms at all, while others may notice that their arm or hand feels different or heavy, according to Steven Chen, MD, MBA.

Chen, breast surgeon chief medical officer at Impedimed, spoke with CancerNetwork regarding how to detect lymphedema early on. He noted that the earlier lymphedema is detected, the easier it is to treat.

Transcript:

The most common way it is presented is incredibly subtle. Patients will say their arm or hand feels a little different. Maybe if they’re being aware of it, they say it feels heavy. A good clinician who spent the time taking the history can detect that and start treatment. The other way that we detect it is by doing measurements. Historically, what we used to do was take a tape measure, and we would just measure the circumference of your arm in various positions. Then compare that against [various other measurements in] the future.

I work with a company called Impedimed, and they make a product called SOZO, which measures [lymphedema] using an electrical current. It’s looking to measure the amount of fluid in each arm and compare it against each other and compare it against what you measured the last few times and see if your arm is increasing in size. That allows us to detect lymphedema, even before patients have symptoms, which allows you to get into treatment sooner.

How do we treat the early stages of lymphedema? That would be before you have symptoms until you have slightly early symptoms, and that might be swelling that goes away when you raise your arm, and you keep it up for a while and the swelling starts to dissipate. During treatment at that point, you can just put [patients] into a compression sleeve and a glove. If you wear it for about a month or so, the vast majority of [patients] start to reverse the lymphedema and do not need to wear it forever. As lymphedema gets worse, though, it gets more chronic, you start to get more fibrosis, you start to get more chronic fluid accumulation. That’s where you start seeing people [wearing] these arm pumps where they wear them at night or go and get a lymphatic massage. Even as this gets worse and worse, we start to talk about doing surgery to try to reverse it by doing something like a lymph node transfer or a lymphatic bypass or even just removing the fibrotic tissue, which doesn’t cure the lymphedema, but helps to reduce the symptoms of having a big, giant arm, which thankfully we see less and less of them.