I am 48 years female suffered from breast cancer in 2007 which is absolutely fine now. But due to the operation I now have a swollen hand from past 5-6 yrs. The swelling is as much as the size of an elephant's leg. What can I do to treat it or at least reduce the swelling to some extent?

Dr. Nikhilesh BorkarOncologist14yrs exp

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The lymph nodes in the armpit are the first point where any infection of the hand gets controlled. Hence all the research into screening to detect early cancers, which can be treated with sentinel node biopsy, which prevents Lymphedema in most of the patients. If axillary clearance is done for breast cancer, the chances of arm swelling increases. We ask patients to avoid any trauma to that arm as in can incite cellulitis and leave residual edema in the arm. Also if any minor injury, we prescribe prophylactic antibiotics for the same. Treatment of Lymphedema is according to the severity. Obesity interferes with the treatment of Lymphedema. Hence if overweight, weight loss is advised. Mild Lymphedema usually responds to limb elevation with compression stockings, exercises and skin care. Moderate Lymphedema usually requires in addition to above, Manual lymphatic drainage, which is a massage like therapy performed by specially trained physiotherapists. Severe Lymphedema needs Complete Decongestive Therapy (CDT), which includes lymph drainage, multilayer compression bandaging, elevation, remedial exercise, and skin care. Those who donot respond may be offered Lymphapress, which is an intermittent pneumatic compression device. Whichever therapy is used, compliance is required which is the most difficult part. Surgery is recommended only for the refractory edema. It may be in the form of 1) lymphatic bypass procedure (lymphoma venous bypass or lymph node transfer) for very select patients without fibrosis and venous hypertension or 2) tissue reduction (Liposuction or direct tissue excision) Please ask your breast surgeon to refer you to a good physiotherapist first and if need be to a plastic surgeon with experience in Lymphedema surgery.  

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