Lymphedema

Lymphedema is an excess of fluid in body tissues that causes abnormal swelling of an arm or leg. Swelling can also occur in other parts of the body, depending on the type of cancer and the treatment. The amount of swelling can range from mild increases to extreme swelling that interferes with motion or function of the affected area. The frequency of lymphedema has decreased over the past few years because of improvements in surgical and radiation therapy techniques.
 

Lymphedema is most likely to occur in people who have surgery that involves removal of lymph nodes from the underarm, groin, pelvis, or neck. The more lymph nodes removed, the greater the risk for lymphedema. The area affected depends on the lymph nodes removed:

• Arm—axillary (underarm) lymph nodes (during surgery for breast cancer)
• Leg—pelvic or groin lymph nodes (during surgery for uterine, ovarian, or prostate cancer)
• Chin and face—neck lymph nodes (during surgery for head and neck cancer)
  People who receive radiation therapy in an area near a collection of lymph nodes may also be affected by lymphedema, but it is less likely than among those treated with surgery. The risk of lymphedema is higher for women who have surgery and radiation therapy for breast cancer.
   

Lymphedema occurs when lymph, clear fluid that carries cells to fight infection, cannot flow normally through lymph vessels. Lymphedema is a possible side effect of surgery when lymph nodes are removed. Lymphedema is a possible side effect of radiation therapy if the flow of lymph is restricted because of damage to lymph nodes or lymph vessels.
 

Lymphedema can develop from weeks to many years after cancer treatment. Swelling in the area of surgery may occur in the first few days after surgery, but this swelling is different from lymphedema and will usually resolve over 6-12 weeks.

Prevention of infection is an important part of managing lymphedema because infection causes your body to respond by making more lymph, and if the lymph nodes and/or vessels are damaged, the excess fluid has nowhere to go.

Management of lymphedema focuses on ways to minimize swelling and control discomfort.
Avoid constriction of the area by wearing loose clothes or jewelry on the affected side, carrying a handbag or back pack on the unaffected side, keeping legs uncrossed while seated, and avoiding socks or stockings with tight bands. It is also important to keep blood from pooling in the affected limb. When possible, elevate the affected limb to a point higher than the heart; do not swing the limb quickly in circles or let the limb hang down, and do not apply heat to the limb.

Your doctor may recommend elastic compression stockings, especially for lymphedema of the legs. Occasionally, a mild diuretic may be ordered to lower the tissue fluids in your body.

Your doctor may also suggest that you be treated by a physical therapist or health care professional who has specialized training in the treatment of lymphedema. This specialist will help you with gentle exercises to help pump lymph fluid out of the affected limb. For some people, a special massage technique called manual lymph drainage may help lymph fluid flow out of the arm or leg. Other techniques to increase the flow of lymph fluid include wrapping the arm or leg in bandages; wearing a compression garment (a specially made tight sleeve or stocking); and using pneumatic compression, a compression sleeve with an attached pump that intermittently inflates the sleeve, putting pressure on the limb. If you have lymphedema of an arm, avoid having injections (blood draws or vaccines) and blood pressure measurements in that arm.
 

You should talk to your doctor about the possibility of lymphedema when discussing the risks and benefits of surgery or radiation therapy. Early treatment of lymphedema can help control swelling and discomfort, so it is important to call your doctor’s office if signs of lymphedema persist for 1 to 2 weeks. These signs include:

• Swelling in the breast, chest, shoulder, arm, hand, leg, or foot
• An extremity or affected area feels full or heavy
• Changes in how the skin in an area looks (red) or feels (tight and hard)
• New aching or discomfort in an area
• Less movement or flexibility in nearby joints (shoulder, hand, wrist, hip, or knee)
• Difficulty fitting your arm into a jacket or shirt
• Difference in how your bra fits
• Tightness of jewelry on your hand or wrist

Contact your doctor or nurse immediately if:

• The affected limb or body area feels hot, looks red, or swells suddenly
• You have a fever (oral temperature of 100.5°F or higher) that is not related to a cold or flu
   

• American Cancer Society: www.cancer.org, publishes a book: Lymphedema, Understanding and Managing Lymphedema After Cancer Treatment
• Lymphology Association of North America: www.clt-lana.org
• Lymphedema Research Foundation: www.lymphaticresearch.org
• National Cancer Institute: www.cancer.gov
• National Lymphedema Network: www.lymphnet.org
• Susan G. Komen for the Cure: www.komen.org

• Lymphedema and Breast Cancer