Symptoms in the arms

Going through ongoing treatment for secondary breast cancer can lead to pain and swelling in the arms due to a variety of causes.

In this section

Phlebitis

Phlebitis is a condition in which the veins become inflamed, causing pain and swelling.

Causes of phlebitis

In secondary breast cancer, this usually happens as a result of treatments delivered via a vein in the arm, which can damage the vein in a number of ways:

  • The vein may be damaged or irritated by the needle or cannula itself.
  • The treatment (e.g. chemotherapy, targeted therapy) may cause damage to the vein. This is more likely to happen where high doses or multiple different treatments are given.
  • The needle may introduce bacteria from the surface of the skin into the vein, causing an infection which results in inflammation.

Signs & symptoms

Inflammation of the veins in the arms can cause a range of signs and symptoms including pain, throbbing and burning along the vein and swelling and itching of the surrounding skin. The vein itself may feel hard and the area where the cannula was inserted may be red, warm, swollen and sore. If there is an infection, you may also experience a high temperature (fever) and the skin may breakdown.

If you think you might have symptoms of infection it is important for you to contact your hospital immediately and ask to speak to the Oncology Patient Enquiries Bleepholder.

Please also see our guidance on managing and reporting a raised temperature.

There are several things you can try to help relieve other symptoms of phlebitis.

Tips for coping with phlebitis

  • Painkillers such as paracetamol and ibuprofen can help to ease pain and swelling.
  • Anti-inflammatory creams/gels and heparinoid creams/gels (e.g. Hirudoid cream) rubbed into the affected area can also ease symptoms.
  • A warm flannel placed over the vein can soothe pain and burning.  

Please speak to your doctor or nurse about these symptoms before using any creams, gels or medications.  

Lymphoedema

Lymphoedema is a long term condition causing swelling of the body’s tissues due to poor functioning of the lymphatic system; a network of channels running through the body which are involved in draining excess fluid and fighting infection.

Causes of lymphoedema in secondary breast cancer

In cancer, this network may be damaged by treatment such as radiotherapy, surgery (involving removal of lymph nodes, which form part of this network) or chemotherapy. The cancer itself may cause damage by blocking or pressing on the channels. For women with secondary breast cancer, this may have occurred during previous treatment or surgery for primary breast cancer (for those who had an initial primary breast cancer, which is not always the case) or as a result of metastases or more recent, ongoing treatments.

Signs & symptoms

Lymphoedema can develop in any part of the body but usually affects the arms, which become swollen and sore. Women treated for breast cancer may also experience swelling in the breast and chest area, in their shoulders or behind their armpit.

Symptoms of lymphoedema can include:

  • General discomfort or aching in the affected area.
  • Tightness caused by the extra fluid building up.
  • Dry flaky skin where it has been stretched by swelling.
  • Stiffness which may restrict movement of the arms and legs.

Rarely, fluid may leak from the skin of the swollen area of lymphoedema. This is known as ‘lymphorroea’.

It is important to speak to your doctor or breast cancer nurse if you begin to notice any symptoms of lymphoedema. They will be able to assess you and decide how best to manage your condition.

Because it is a long-term (chronic) condition, lymphoedema is unlikely to ever go away completely. However, there are lots of different treatments and things that can be done to manage the effects of lymphoedema.

Tips for coping with lymphoedema

Look after your skin

Keeping your skin clean, healthy and free from injury helps to reduce the risk of infection. This is important if you have lymphoedema, or you are at risk of developing lymphoedema, because this also puts you at risk of developing a skin infection known as cellulitis.  When you are living with cancer, any infection is a concern since cancer treatment impairs the body’s ability to fight infection.

If you notice any of the following symptoms, please contact your hospital immediately as you may need antibiotics to treat an infection:

  • Redness of the skin or a rash
  • Warmth
  • Swelling
  • Pain or tenderness
  • Flu-like symptoms

Wash your skin with warm water every day before carefully drying. If your skin is particularly dry, it is best to go for a soap-free cleanser. Dryness and cracking can lead to infection of the skin (cellulitis) so it is important to moisturise your skin after washing.

If lymphoedema affects your feet, clean between your toes daily using alcohol wipes to prevent the development of any fungal infection (otherwise known as athlete’s foot). If you notice itching or peeling skin between your toes, this could be a sign of athlete’s foot and should be treated using over the counter treatment. Ask your pharmacist for advice if you are unsure.

If you are out in the sun, be sure to wear a high factor (at least factor 30) sun block and use insect repellents to prevent bites and stings. If you notice any cuts or grazes, keep these clean using antiseptic wipes or cream.

Take care when cutting your nails and using razors. Electric razors or hair removal creams can be gentler options. Wear protective gloves for household tasks such as washing up, cooking, gardening and DIY.

Maintain a healthy weight

Carrying excess weight can worsen the swelling caused by lymphedema and affect how well a person responds to treatment. To maintain a healthy weight, it is important to eat a balanced diet and to exercise as regularly as you are able to.

If you are struggling to maintain a healthy weight, your GP or breast cancer nurse will be able to offer some expert advice or may refer you to a dietician.

Keep physically active

Regular physical activity not only helps to improve the flow of fluid and reduce swelling, but also to improve mobility by strengthening muscles and keeping joints flexible.

Swimming, yoga and walking are all good options, though it is a good idea to start off slowly and build up gradually if you haven’t exercised for a while. Stop exercising if you notice any discomfort or increased swelling.  

Speak to your doctor or breast cancer nurse before starting any new exercise regime whilst managing lymphedema. They may advise you to wear a compression garment during physical activity or may advise against any sports which might be a particular risk for damaging your skin.

Your breast cancer nurse may also be able to advise you on some specific stretches designed to reduce swelling caused by lymphoedema.

Breast Cancer Now have further information and helpful visual guide on how to perform arm and shoulder exercises designed to improve mobility and encourage the drainage of fluid.

Macmillan also have a wide range of information on exercising with lymphoedema and guidance on performing arm and leg exercises to reduce swelling.

Careful positioning of the arms & legs

Positioning your arms/legs carefully when resting or sitting down can help to reduce swelling.

If you have arm swelling, try using a cushion to raise and support your affected arm and try not to leave in the same position for too long. It is also a good idea to avoid raising your arms above shoulder height for a prolonged period of time.

If you have leg swelling, don’t sit with your legs crossed and try not to sit in the same position for too long. If possible, support and raise your legs when sitting e.g. by using a footstool or leg rest.

It is also a good idea to stand up and move about regularly. Avoid standing still for long periods of time though, if you must, try moving backwards and forwards from your heels to your toes and shifting your weight from one leg to the other. Rising up on your tip toes and back down again can also help.

Avoid pressure to the affected area

Avoid bras and items of clothing which are tight fitting. Making sure you have a supportive and correctly fitting bra is very important, especially if you are wearing a breast prosthesis since these can be very heavy and cause pressure around the chest area. Wide and flexible shoulder straps can help to provide better support.

It is also a good idea to avoid wearing tight fitting jewellery or having your blood pressure taken on your affected side.

Treatment

After reviewing your symptoms, your doctor or breast cancer nurse may decide that a specific form of treatment would be beneficial for you. Some hospitals have health professionals specialising in lymphoedema, who you may be referred towards. Alternatively, your GP may be able to refer you to a lymphoedema specialist who works in your community. These specialists will be able to guide you on the best ways to manage and treat your symptoms.

Treatments for lymphoedema include;

  • Compression (applying pressure to the affected area to encourage fluid drainage).
  • A form of massage therapy known as lymphatic drainage.

Less common treatments, used when lymphoedema is more difficult to treat, include;

  • Applying tape to the skin (lymphoedema taping)
  • Surgery
  • Laser therapy

Macmillan and Breast Cancer Now have a wide range of further information on these sorts of treatments.

Disclaimer: on this website you will find self-management advice to help you to manage a range of mild symptoms and side effects of secondary breast cancer and its treatment. Please ONLY use this advice if you are currently participating in the LIBERATE study. Otherwise, please follow the advice of your own healthcare team.

Sources

  Page last updated: April 2020