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Changes to This Summary (07 / 17 / 2015) The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above. Editorial changes were made to this summary. This summary is written and maintained by the PDQ Supportive and Palliative Care Editorial Board, which is editorially independent of NCI. The summary reflects an independent review of the literature and does not represent a policy statement of NCI or NIH.
More information about summary policies and the role of the PDQ Editorial Boards in maintaining the PDQ summaries can be found on the About This PDQ Summary and PDQ NCI's Comprehensive Cancer Database pages. About This PDQ Summary Purpose of This Summary This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the pathophysiology and treatment of lymphedema. It is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions. Reviewers and Updates This summary is reviewed regularly and updated as necessary by the PDQ Supportive and Palliative Care Editorial Board, which is editorially independent of the National Cancer Institute (NCI). The summary reflects an independent review of the literature and does not represent a policy statement of NCI or the National Institutes of Health (NIH). Board members review recently published articles each month to determine whether an article should: • be discussed at a meeting, • be cited with text, or • replace or update an existing article that is already cited.
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Lymphadema Procedures that affect or remove your lymph nodes can cause as a side effect. Lymphedema will only occur in the area of your body near the surgical site. For example, if you have lymph nodes removed as a part of cancer surgery to your left breast, only your left arm, not your right, might be affected with lymphedema. Lymphatic massage is a gentle pressure technique used to move the waste fluids from the damaged area. Raakhee Patel, PT, DPT, CLT is a physical therapist and certified lymphedema specialist who trains patients to perform their own lymphatic massage after surgery. Lymphatic massage is one technique used to reduce lymphedema. “We don’t talk enough about lymphedema,” says Patel.
Not only is fluid buildup uncomfortable, causing pain and heaviness in the affected area, but according to Patel, “Stage 3 lymphedema can be devastating,” causing significant depression and lack of mobility that could further complicate healing. Clearing and Reabsorption Patel teaches two stages of lymphatic massage: clearing and reabsorption. The purpose of clearing is to create a vacuum with gentle pressure so the area is prepared to bring in more fluid, creating a flushing effect. Clearing motions can be repeated as many as ten times a day. Patel advises, “Always massage both sides of your body, not just the side with the lymphedema.” A Guide to Clearing There are three stages to clearing. Be sure to clear the supraclavicular area, the axillary area, and the inner-elbow area, in order.
To clear the supraclavicular area: • Begin by lying on a comfortable, flat surface. • Cross your arms on your chest, with your hands resting just below the collarbones. • Then simply lift your elbows slowly. The muscle action is as much pressure as is required to prepare the area to flush lymphatic fluid. • Begin at the affected part of the body farthest from the core of the body.
Begin at the tips of the fingers if you have lymphedema in your hand, arm, and shoulder. • Using a gentle, sweeping motion with just enough pressure to shift the surface of the skin. Massage from fingertip to hand, from hand to elbow, and from elbow to shoulder. “Patient compliance is the hardest part of self-care, especially for women, who are so used to taking care of others,” says Patel.
She advises patients to set aside at least 20 minutes a day for lymphatic drainage massage. “If you only have a brief amount of time, perform the clearing stage of massage.” Measuring Effectiveness How do you know if lymphatic drainage massage is effective? “This is a maintenance technique,” says Patel. “Your lymphedema should not get worse if you regularly practice lymphatic massage.” Managing your lymphedema can also include using a compression sleeve to prevent fluid buildup. You can see a qualified therapist for in-office drainage massage.