By Carrie Carone, LMT, CMT, LLCC
Cancer treatment has changed the rules of engagement for massage therapists, and for cancer survivors who receive massage.
30%-40% of breast cancer patients, who have had lymph nodes removed or radiated, will develop Lymphedema. The statistics are staggering and somewhat difficult to anticipate. The risk is the same, whether 2 or 20 nodes are affected and the potential for developing lymphedema exists for the duration of that person’s life.
Recently, in a phone conversation with a surgical nurse here in Chicago, the subject of Lymphedema came up and she asked, “Well, if someone has gone for one year after surgery and treatment and haven’t developed lymphedema, then they won’t, right?” Unfortunately, that isn’t true. This is an example of how little information, or how much misinformation there is about lymphedema.
Lymph nodes do not regenerate after being removed or damaged, nor does the fluid volume or rate of fluid exchange in a given quadrant change. This leaves the remaining lymphatic network of the affected quadrant working overtime to process the original volume.
The body is incredibly adaptive and may either reroute excess fluid from the affected quadrant to another, healthier group of lymph nodes, or the remaining lymphatic network will continue working overtime to maintain the limb’s fragile fluid balance. This adaptation may be successful for the rest of that person’s life and they may never develop lymphedema, but the lymphatic system of that compromised quadrant can potentially be overloaded at any time, even years after surgery.
Most women entering into surgery are given an informative flyer about lymphedema beforehand, or their discharge nurse may offer a word of advice when they leave the hospital. With so little emphasis placed on this important subject, most women never give the issue a second thought. They are happy to have their lives back and few remember hearing any warnings about lymphedema or take any preventative measures against it.
What does this mean in terms of massage therapy? It means that any massage technique that turns the skin red is contraindicated on the affected quadrant. Deep tissue work can trigger an inflammatory response and may bruise, or damage tissue. This may not necessarily cause lymphedema, but any additional load on the weakened lymphatic system, may create an invitation.
Again, this Quadrant Principle holds true only for the affected quadrant. Light effleurage, stroking away from axilla, (or groin if inguinal nodes are affected) can be done.
Familiarize yourself with the basic lymphatic pathways. If you see several clients who have had surgery involving lymph nodes, you may want to take a class in Manual Lymphatic Drainage, or Lymph Drainage Therapy. Nearly every therapist will have an opportunity to use the information.
Finally, remember that information is power, but so is touch.
The power of touch, from gentle massage to handholding, are profoundly beneficial to the receiver. Massage improves immune function, helps to elevate treatment side effects like nausea or pain, helps to replace feelings of isolation, loneliness, and anxiety with a sense of wellbeing and reduces levels stress. Conscious touch is a gift.
References:
- Medicine Hands: Massage Therapy for People with Cancer by Gayle MacDonald
- Massage Therapy Journal: Fall 2006- Massage and Cancer, Part II, by Tracy Walton
- Oncology Massage Matters.com: Isabel Adkins
- National Lymphedema Network- www.lymphnet.org
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