• Can be developed by anyone who undergoes surgery and/or radiotherapy to the breast, armpit or groin, or experiences any other episode that damages or destroys lymphatic vessels or nodes.

• But not everyone will do so and the risk generally depends on age, the side on which the surgery took place, the number of vessels and/or nodes removed, whether or not the patient undergoes radiotherapy, and their body mass.

• Post-operative infection can also increase the risk. The chance of developing lymphoedema is reduced to about 5% when a small number of lymph nodes are removed and no radiotherapy treatment is applied to the area. The risk increases to about 30% when a large number of lymph nodes are removed and radiotherapy is applied to the lymph nodes that remain.

• If you had surgery as part of your cancer treatment, some of these lymphatic vessels and their associated nodes where removed by the surgeon. This is because biopsy had shown them to contain cancer cells, or perhaps because they were near an area of cancer cells. This removal is necessary to try to ensure that the cancer does not re occur locally and does not get a chance to spread.
  
• If you had surgery associated with vein removal then also some nearby lymph vessels may have been damaged.
  
• The removal of lymph nodes and associated vessels (or even just the vessels themselves) means that they may not be enough lymphatic vessels remaining to drain the limb of excess fluids which have leaked out from the blood vessels.
  
• When the lymph load is greater than the transport capacity, fluid and other materials then accumulate in the tissues. This is the beginning of lymphoedema. Early intervention at this stage is important and can have significant impact.
  
• In some patients, there are enough remaining vessels so they may never get a swollen limb, in others there may be a period of no swelling (latent or hidden phase) but this may be followed by the rapid appearance of a swollen limb.
  
• Even though during this time you and your doctor may not be able to detect lymphoedema (measured by an increase in the circumference or volume of your leg) there may be a number of subtle but potentially damaging changes occurring within the tissues of the limb.

• The surgery may have removed or destroyed some of your nodes and vessels. The remaining ones would normally have tried to grow to replace the damaged ones but may have difficulty in doing so because of the scarring. The remaining vessels may be able to take care of the fluid and protein that has to be removed from the limb, but if they cannot do this then you will see some swelling. In some instances you might also be able to feel this swelling. You might notice an increased heaviness in the limb, or perhaps increased tension or just that your leg gets more tired than the other one. If you measure your limb with a tape measure, it may be bigger. Initially this swelling may come and go but it may become permanent. Treatment should be initiated as soon as any changes in how the leg feels or in its size are detected.

• You may be able to feel some of these changes. They might be pains, pins and needles, feelings of heaviness, tension or cramps. Some of these for instance numb areas and problems with your range of movement are associated with surgery, but if there are any doubts then you should seek a check up with a health professional.
  
• There are techniques and equipment which can detect even small changes. This enables us to initiate early treatment even before the swelling is detectable. Early presentation to your health professional is crucial.

• As part of the package you receive for the treatment of the cancer, you may also have had radiation therapy (generally about 6 weeks) or perhaps some other treatment such as hormone administration or chemotherapy medications.
  
• Generally, apart from the surgery, it is only the radiation treatment which might create further problems for the lymphatic system. Radiation can cause some scarring (build up of fibers) in the tissues. The small lymphatic capillaries have difficulty growing through this rather dense scar tissue and the bigger ones will have trouble pumping freely. However we can encourage growth and function by trying to break up this tissue. We also may be able to help bypass the scarred area thus helping the lymph fluids to move from the limb.

• Mainly linked to the location and type of surgery and other treatments to remove and destroy cancer. These treatments determine the number of functional lymphatic vessels remaining.
  
• Statistics from National Breast Cancer Center in Australia showed that Lymphoedema does not always develop immediately, on average it takes about 3.5 years
  
• Lymphoedemas and other swellings are really common. A recent survey showed that about 6% of people suffer from some form of significant swelling each year. But not all swellings are associated with a failure of the lymphatic system. In some instances, a healthy lymphatic system is overloaded by the large volume of fluid leaking from the blood vessels.

• A swelling that comes and goes with exercise, activity or other events
  
• Feelings of heaviness, pain, tension, bursting pains, pins and needles
  
• Numbness, a sensation of heat, redness, warmth, prickling, itchiness and the like
  
• If you experience any of these you should, see a doctor or any professional who is knowledgeable in this area of work
  
• One of the most important signs that you must take notice of however, is if the limb begins to feel warm and if it begins to develop a redness. This may mean you have an infection in your leg called “cellulitis” or erysipelas or sometimes lymphangitis. Early and rapid treatment of this is essential see your doctor immediately.

Reference Source: Recognition, Treatment and Management of Lymphoedema series by Prof Neil Piller, Lymphoedema Assessment Clinic, Flinders Medical Centre, South Australia. Information is Copyright ©