Lymphedema After Cancer Surgery

Lymphedema is swelling caused by a buildup of lymph fluid in the body between the skin and muscle. The lymph system carries that fluid through the body and plays a role in your body's ability to fight infection and disease. When the flow is interrupted, fluid collects in the tissue and the area swells.

The National Cancer Institute describes three ways cancer and its treatment disrupt lymph flow: cancer or a tumor blocks the flow of lymph fluid, surgery for cancer disrupts the flow of lymph fluid, or radiation therapy causes scar tissue that blocks the flow of lymph fluid.

That is why lymphedema so often follows an operation involving lymph nodes. Breast cancer treatment, for example, often involves surgery that removes one or more lymph nodes in the underarm area, increasing the risk of lymphedema.

Other things raise the risk: having an infection, healing slowly after surgery, having lymph nodes removed, past surgeries or radiation, having advanced cancer, and being overweight or having obesity.

This is the part people are rarely told clearly. 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. A normal arm at your six-week check does not mean the risk has passed.

Watch the side where you had surgery or radiation for:

• a heavy, full, or tight feeling in the area
• swelling, where pressing on the swollen area may leave a dent in the skin
• numbness or tingling in the affected area
• swelling in an arm or leg that makes it appear larger than the other arm or leg
• difficulty moving your arm or leg, or weakness in it

In long-term, untreated lymphedema, the skin can become discolored and hardened. Rings, sleeves, or shoes that suddenly feel tight are worth mentioning too.

Contact your doctor as soon as you notice heaviness, swelling, or other signs of lymphedema. Small changes are easier to control than large ones.

A doctor examines the area and compares the size of your swollen arm or leg with that of the other limb. Tests may include ultrasound, MRI, CT, lymphoscintigraphy, perometry, or bioimpedance spectroscopy.

Lymphedema is described in stages. In stage 0 the flow is disrupted and symptoms may be absent. In stage I the limb feels swollen and heavy, and pressing on the swollen area leaves a pit, or dent, in the skin. In stage II it is more swollen and firmer, and pressing does not leave a pit. In stage III it is extremely swollen and the skin feels hard and thick, and movement may be reduced.

Compression does most of the work. Short stretch bandaging, compression wraps, leggings, or stockings help move fluid around in your arms and legs to prevent it from building up. Manual lymphatic drainage, also called lymphatic drainage massage, is gentle massage that helps move lymph fluid through the body, and it is used as part of complete decongestive therapy. The American Cancer Society describes that therapy as combining manual drainage, compression, skin care, exercises, and elevation. A compression pump applies pressure intermittently to the arm or leg. For some people, surgery is an option, including lymphovenous bypass, lymphovenous transplant, liposuction, and laser therapy.

Day to day, exercise works as a natural pump for the lymph system. Elevating the limb, keeping a healthy weight, protecting the skin, wearing compression garments as directed, drinking fluids, and cutting back on salt all help. Garments should be fitted properly rather than bought by guess, and the American Cancer Society also advises avoiding tight clothing and extreme heat.

Cellulitis is a potentially life-threatening bacterial infection of the skin and a common complication of lymphedema. Its signs are pain, tenderness, redness, and swelling in the affected area, skin that feels warm to the touch, and fever.

If you have a fever or other signs of cellulitis, call your doctor right away. If left untreated, cellulitis can become life-threatening. Always call your doctor if you notice redness or other signs of infection, and always check with your doctor about any skin changes or other symptoms.

• National Cancer Institute, Lymphedema (PDQ) - Patient Version: https://www.cancer.gov/about-cancer/treatment/side-effects/lymphedema/lymphedema-pdq
• American Cancer Society, Lymphedema: https://www.cancer.org/cancer/side-effects/swelling/lymphedema.html

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