LymphActivist's Site

Dedicated to Lymphedema Patients and the Therapists Who Treat Them

What are the long-term effects of radiotherapy?

It baffles me how some physicians do not seem to understand the physiology of the lymphatic system, how removal of the breast mass often involves removal of the lymphatics that drain the breast and chest, and that you can get lymphedema without removal of any nodes. And oncologists often do not understand the long-term damages to the breast lymphatics that are caused by radiotherapy even when limited to the breast and not intentionally the axilla.

To comment on the above, whether your doctor thinks you have clinical lymphedema (10-20% excess limb fluid) you should demand a referral to a qualified lymphedema therapist (with CLT or CLT LANA after their name) for an evaluation for lymphedema of the upper quadrants (arm, hand, shoulder, breast, chest, trunk) that have had surgery and/or radiotherapy. It is never too soon. A recent study (Zimmerman 2012) showed that manual lymph drainage on breast cancer patients starting as early as 2 days after surgery and performed for 6 months was able to prevent lymphedema while the matched control arm that received "usual" care (therapy only after clinical swelling noted) grew to 10% swelling after 6 months. And make no mistake about it -- any swelling indicates that undesirable processes have started in the affected tissue involving inflammation, fibrotic and fat growth and functional impairment. The longer this process is allowed to progress, the harder it is to reverse.

Another "radiation injury" affecting breast cancer survivors is BREAST LYMPHEDEMA, sometimes called "delayed breast cellulitis". That is swelling and infection of the breast and trunk resulting from radiation fibrosis of the lymphatics in the breast (lymph vessels as well as lymph nodes). There is an excellent discussion of this issue from the point of view of patient informed consent on my web site under the RESEARCH --> Breast Lymphedema tab.