Lymphedema and Cancer

What lymphedema isExplain▾

Lymphedema is swelling caused by a buildup of lymph fluid in the body between the skin and muscle. Lymph fluid is part of the lymph system, which plays a role in your body's ability to fight infection and disease. If you have cancer, the cancer or cancer treatment can disrupt the flow of lymph fluid and cause lymphedema (also called secondary lymphedema).

Lymphedema may arise soon after cancer treatment, or it may develop years after treatment has ended. Most often, it develops slowly over months or years.

Once lymphedema develops, it is a chronic condition that cannot be cured but can be treated to relieve swelling and improve your ability to function day to day. Lymphedema is easier to control when treatment starts early, so contact your doctor as soon as you notice heaviness, swelling, or other signs.

What causes itExplain▾

Anything that blocks or changes the flow of lymph fluid in the body can cause lymphedema. In cancer, this can happen when:

• cancer or a tumor blocks the flow of lymph fluid
• surgery for cancer disrupts the flow of lymph fluid
• radiation therapy causes scar tissue that blocks the flow of lymph fluid

Your risk depends on the type and location of your cancer and your treatments. Other risk factors include having an infection, healing slowly after surgery, having lymph nodes removed, past surgeries or radiation, advanced cancer, and being overweight or having obesity.

Lymphedema most commonly affects an arm or leg, but it can occur anywhere in the body. Breast cancer treatment often removes lymph nodes in the underarm area, which can raise the risk of lymphedema in the hand, arm, or chest. Cancers in the abdomen or genital area, and lymphoma, can also cause it, and it may develop after surgery for melanoma and sarcoma.

Signs and symptomsExplain▾

You may notice symptoms in an arm or leg, or near where you had surgery or radiation therapy. Signs may develop slowly, so pay attention to small changes. General signs include:

• a heavy, full, or tight feeling in the area where you had surgery or radiation therapy
• swelling that may leave a dent in the skin when pressed (as it worsens, pressing may no longer leave a dent)
• numbness or tingling in the affected area
• discoloration and hardening of the skin with long-term, untreated lymphedema

In an arm or leg, it may make the limb appear larger than the other, harder to move, or weak. In the head or neck it can cause swelling and trouble speaking, eating, swallowing, or breathing. In the genitals or abdomen it can cause swelling, painful urination, or pain during movement.

Cellulitis is a potentially life-threatening bacterial skin infection that is a common complication of lymphedema. Its signs include pain, tenderness, redness, swelling, warm skin, and fever. If you have a fever or other signs of cellulitis, call your doctor right away.

How it is diagnosedExplain▾

If you alert your doctor to swelling or other changes, they will examine the swollen area and, for an arm or leg, compare it with the other limb. You may also have tests such as ultrasound, MRI or magnetic resonance lymphangiography, a CT scan, lymphoscintigraphy, or noninvasive measures like perometry, water displacement, and bioimpedance spectroscopy. Doctors also use a staging system, from Stage 0 through Stage III, to describe how severe the lymphedema is.

How it is treatedExplain▾

Treatments help manage the symptoms and can be done at home or with a trained professional such as a nurse or a certified lymphedema therapist (CLT). Treatments include:

• Compression garments such as short stretch bandaging, wraps, leggings, or stockings that help move fluid and prevent buildup.
• Manual lymphatic drainage, a gentle massage that helps move lymph fluid and is part of complete decongestive therapy.
• A compression pump, a device that applies pressure to the arm or leg to help keep lymph fluid moving.
• Surgery and other treatments for advanced lymphedema, such as lymphovenous bypass, lymphovenous transplant, liposuction, and laser therapy.

Ways to lower your riskExplain▾

There is no way to prevent lymphedema, but you can lower your risk or keep it from getting worse. Your team may suggest:

• Protect your skin to prevent infection. Wear gloves when cooking and gardening, use lotion to prevent cracks, and call your doctor if you notice redness or other signs of infection.
• Wear compression garments daily and at night as advised.
• Exercise, which acts as a natural pump for the lymph system—ask your doctor for a program that is safe for you.
• Elevate the affected area when possible, and avoid putting pressure on it (for example, have blood pressure and blood draws done on the unaffected arm).
• Stay at a healthy weight, stay hydrated, reduce salt, and avoid extreme heat and sun.

Coping with lymphedemaExplain▾

The physical changes from lymphedema can affect your well-being. Working with a CLT is often the best way to manage and cope with it. It's important to ask for support from your healthcare team—they can help you prepare for and make it through difficult times.