Lymphedema: Swelling After Cancer Treatment

Lymphedema is swelling caused by a buildup of lymph fluid under the skin. Lymph fluid is part of your lymph system, which helps your body fight infection and disease. If you have cancer, the cancer itself or its treatment can block the flow of lymph fluid. That causes lymphedema, sometimes called secondary lymphedema.

Lymphedema can start soon after cancer treatment, or years later. Most often, it develops slowly over months or years.

Once lymphedema develops, it becomes a long-term condition. It cannot be cured, but it can be treated to reduce swelling and help you function day to day. Lymphedema is easier to control when treatment starts early. Contact your doctor as soon as you notice heaviness, swelling, or other signs.

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

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

You may notice symptoms in an arm or leg, or near where you had surgery or radiation therapy. Signs can 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, if lymphedema is untreated for a long time.

In an arm or leg, lymphedema can make the limb look larger than the other side, or feel 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.

Watch for cellulitis. This is a bacterial skin infection that can be life-threatening. It 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.

If you tell your doctor about swelling or other changes, they will examine the area. For an arm or leg, they will 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 tests 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.

Treatments help manage symptoms. You can do some at home; others need a trained professional, such as a nurse or certified lymphedema therapist (CLT).

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

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. Call your doctor if you notice redness or other signs of infection.
• Wear compression garments daily and at night, as advised.
• Exercise. It 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 checks and blood draws done on the unaffected arm.
• Stay at a healthy weight, stay hydrated, reduce salt, and avoid extreme heat and sun.

The physical changes from lymphedema can affect how you feel day to day. Working with a certified lymphedema therapist is often the best way to manage and cope with it. Ask your healthcare team for support. They can help you prepare for, and get through, difficult times.

• Call 911 or go to an emergency department if swelling in the head or neck starts to make breathing or swallowing difficult. That is the one form of lymphedema that can close off an airway, and it should not wait for a clinic appointment.
• Call 911 or go to an emergency department if a skin infection on the swollen side brings shaking chills, confusion or unusual sleepiness, a very fast heartbeat or breathing, cold clammy skin, or hardly any urine, or if the redness is visibly spreading. Cellulitis can tip into sepsis, and sepsis is treated in hours.
• Call your care team the same day if the swollen area turns red, warm, tender, or painful, or if you have a fever. Those are the signs of cellulitis, a skin infection that can become life-threatening and that people with lymphedema get more easily.
• Call at once rather than the same day if chemotherapy is under way. A fever then is a medical emergency in CDC's terms, because the white cells that would fight the cellulitis may not be there. Use the 24-hour number, and go to an emergency department if it is not answered quickly.
• Call your care team the same day if the limb swells noticeably more over a short period, or if painful urination or pain on movement appears with swelling in the genital or abdominal area.
• Call your care team within a day or two if the area first begins to feel heavy, full, or tight, if a ring or shoe suddenly stops fitting, or if the limb feels weaker or harder to move. Catching it at this stage is what keeps it manageable.