The American Cancer Society reports that surgery to remove a cancerous tumor is prescribed in 95 percent of early stage breast cancers and more than 70 percent of advanced stage breast cancers. This surgery is performed as a lumpectomy (in which the tumor and a narrow perimeter of healthy cells are removed while the rest of the breast is conserved) or a mastectomy (in which the entire breast is removed). These surgeries are typically accompanied by the removal of some or all of the lymph nodes from the underarm or axilla region in either a sentinel node biopsy or an axillary lymph node dissection. By removing these lymph nodes, the pathologist can determine whether cancer has spread to nearby lymph nodes, which can help determine the stage and best treatment approaches to deal with the cancer.
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Some patients who undergo these procedures will develop side effects upon the removal of the lymph nodes. Lymphedema, or a swelling of the arm and hand on the same side of the body where the lymph nodes were removed, is a relatively common side effect. According to the Memorial Sloan Kettering Cancer Center, 15 to 25 percent of patients who undergo an axillary lymph node dissection to treat breast cancer will develop lymphedema after surgery. Patients who’ve undergone a sentinel node biopsy develop lymphedema about 7 percent of the time, the MSKCC reports, although other studies have put the rate for developing lymphedema with either surgery at between 2 and 65 percent depending on the surgical technique and whether radiation and chemotherapy was also used.
But there are other side effects of surgery for breast cancer, and one of them is a little understood condition called axillary web syndrome, or cording. Cording shows up as “a web of thick, ropelike structures under the skin of your inner arm,” Breastcancer.org reports. These structures typically form in the axilla, or armpit area, and sometimes extend down most of the upper arm and even into the hand in some cases. Some patients may also notice cords in the chest.
Some patients may not notice the cord structures themselves, but may be bothered by other symptoms including pain and tightness in the area or a reduction in the range of motion of the arm. This limitation in movement can be problematic for patients set to undergo radiation treatments, as this procedure typically requires you to raise your arm above your head. Breastcancer.org reports that symptoms of cording usually surface within several days or weeks after surgery. A few cases have been reported months after surgery, but AWS appears to be a side effect that will occur sooner rather than later in most patients who experience it.
The National Lymphedema Network reports that AWS has been “found in up to 72 percent of women undergoing axillary node dissection and 20 percent of women undergoing sentinel node dissection in addition to lumpectomy or mastectomy. Even with conservative calculations, tens of thousands of women in the United States develop AWS every year without warning from their medical providers.” NLN argues that although awareness of lymphedema has improved greatly over the past decade, many patients are still unaware of the potential for developing AWS after surgery for breast cancer.
[See: Breast Pain? Stop Worrying About Cancer.]
Despite the potentially large number of patients who may experience cording, science still isn’t exactly sure what causes it or how best to avoid the condition. “Some experts believe that the surgery to the underarm and chest area traumatizes the connective tissue that encases nearby bundles of blood vessels, lymph vessels and nerves. This trauma leads to inflammation, scarring and eventually hardening of the tissue. This hardening can spread down the fibers of the connective tissue, which causes the cords to form,” Breastcancer.org reports.
If you notice cords developing or you’re experiencing tightness in the underarm area after surgery for breast cancer, don’t hesitate to see your doctor. Because of the tightness and pain that can accompany the syndrome, patients with cording often avoid moving the arm. This can actually compound the problem because movement seems to help reduce the accumulation of scar tissue.
Cording can be managed and resolved with the assistance of a physical therapist or lymphedema therapist. A case study published in the Canadian Journal of Surgery in 2009 noted that for the 37-year-old patient being studied, the application of “moist heat to the axilla and inner arm for 10 minutes per session,” followed by work with a physiotherapist to stretch the arm and palpate [gently massage] the cord along its length helped loosen the limb and reduce the other symptoms. Palpating the cord “prompted a painless audible snapping sound followed by subjective relief of tension and a 10-degree increase in range of motion,” the authors write.
Breastcancer.org reports that your management plan for AWS may include stretching and flexibility exercises to increase range of motion. You may be directed to apply moist heat to soften the cord, but this should be done with care, as too much heat can trigger lymphedema. Manual therapy or massage is also often used to help break up the scar tissue that seems to constitute the cords. (The NLN also suggests that coagulated lymphatic fluid may also contribute to the development of cords.) Anti-inflammatory medications such as ibuprofen may reduce inflammation and pain. Some therapists may also use a small, hand-held laser device to break down the hardened scar tissue. No one is really sure where the cords go once they disappear, but they’re likely broken down and reabsorbed by the body.
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In most patients, cording appears to resolve within two to three months, so unlike lymphedema, it’s not likely to be a problem for the rest of your life. However, NLN notes that 15 percent of patients who do not seek medical attention for the problem may experience symptoms for longer than six months. Still, cording is usually “a one-time event that doesn’t become a persistent problem,” Breastcancer.org reports.
Although some experts think the development of cording indicates that damage has been done to the lymphatic system and could increase a patient’s risk of developing lymphedema later, there isn’t enough evidence to say whether this is definitely true. Breastcancer.org reports “a 2006 International Consensus Statement on managing lymphedema does list AWS as a risk factor for lymphedema,” but a strong link between the two conditions has not been established yet.
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What Is Axillary Web Syndrome? originally appeared on usnews.com
