Many of the changes resulting from breast cancer are physical. Long term effects of surgery and radiation can include scars and lymphedema.

Lymphedema is a condition in which fluid collects in the arm, hand or fingers and causes swelling. It can be painful and limit movement.

Some people get lymphedema as a result of treatment to the lymph nodes in the underarm. When lymph nodes are removed by surgery or damaged by radiation therapy, some of the lymph vessels can be blocked and prevent lymphatic fluid from leaving the arm. Having both surgery and radiation to the lymph nodes, having more nodes removed and being overweight all increase the risk of lymphedema.

Lymphedema most often occurs within 3 years of surgery, although some women develop symptoms much later.

Fortunately, today, most people treated for breast cancer don’t get lymphedema since modern surgery removes fewer axillary lymph nodes than in the past.

Compared to the past, the cases that do occur are usually less severe in terms of the impact on movement and the way the arm looks.

Although there is no cure for lymphedema, there are treatments that can relieve pain and swelling.

Long term effects of chemotherapy can include early menopause, cognitive problems, and fatigue.

Early menopause may be temporary in women under 40, but after 40 it’s more often permanent. Because the onset is abrupt, hot flashes and vaginal dryness may be more intense than with natural menopause. Early menopause is also related to loss of bone density or osteoporosis.

Some people have cognitive problems after chemotherapy, including mental “fogginess” and trouble with concentration, memory and multi-tasking. This condition is often called

“cancer brain” or “chemo-brain.” Not all survivors get it and most who do experience it have relatively mild symptoms. Most people report that the symptoms go away over time.

In rare cases, some types of chemotherapy can cause heart disease and leukemia.

Heart disorders can sometimes be reversed if the drugs are stopped at the first sign of heart damage. The risk of heart disorders and leukemia are related to the dose of chemotherapy drugs. With the lower doses given today, the risk of either is very low.