Preventing and Managing Lymphedema

One sentence from the National Cancer Institute shapes this page: "Although lymphedema cannot be prevented, there are things you can do to lower your risk." And if swelling does start, NCI adds that "once lymphedema develops, it is a chronic condition that cannot be cured but can be treated."

That is a narrower promise than most risk-reduction lists suggest, and worth saying plainly: people who did everything right and still swelled often assume they made a mistake. NCI's wording says otherwise.

NCI publishes its risk-lowering steps as a single list. It does not rank them or say how much any one lowers your risk. MedlinePlus publishes nearly the same list under the heading "Lymphedema - self-care," meaning it is written for people who already have swelling. So these habits sit somewhere between sensible protection and proven prevention, and the federal sources do not claim more than that. Follow them because the cost is low, not because the list is a guarantee.

Broken skin lets bacteria into a limb that drains poorly. NCI's instructions are specific: wear gloves when cooking and gardening to protect your hands from injury. Use lotion to prevent dry skin and cracks where bacteria can enter. If you get a burn or cut, ask your doctor about an antibacterial ointment to use.

MedlinePlus adds detail: use an electric razor rather than a blade, wear gloves for household work, use sunscreen with SPF 30 or higher and insect repellent outdoors, cut toenails straight across, and keep your feet covered rather than going barefoot. For a cut, wash gently with soap and water, apply antibiotic cream, and cover with gauze that is not tight. For a burn, apply a cold pack or cold water for 15 minutes, then wash gently and bandage.

NCI advises avoiding pressure on the affected area: wear loose jewelry and clothes without tight bands or elastic, avoid carrying handbags or other items with an affected arm, and have blood pressure and blood draws taken using the arm without lymphedema. MedlinePlus adds that blood draws, IV therapy, and shots should go in the non-affected arm or another part of your body. It also suggests not sitting in one position for more than 30 minutes, not crossing your legs, and avoiding tight rings, waistbands, cuffs, and bras.

NCI describes exercise as "a natural pump for the lymph system." It can improve the flow of lymph fluid, may help treat lymphedema, and "may also help lower your risk." NCI's instruction is to talk with your doctor to find a program that you enjoy and that is safe for you. The American Cancer Society, writing about arm exercises after lymph node surgery, is blunter: do not start any of these exercises without talking to your doctor first. ACS notes those exercises matter after radiation, which may affect your arm and shoulder long after treatment is finished.

NCI also advises staying at or getting to a healthy weight, which it says can keep lymphedema under control.

Avoid extreme heat and sun, since high temperatures can make lymphedema worse; use sunscreen, hats, and lightweight long-sleeved shirts. Skip ice packs, heating pads, hot tubs, and saunas on the affected limb. Drink plenty of water to keep lymph fluid moving. Reduce salt, which makes swelling worse by causing your body to retain fluid.

NCI advises wearing compression garments daily when you are up and moving around, and at night if your certified lymphedema therapist tells you to. Fit is not a do-it-yourself job: your nurse or therapist will help you find garments that fit properly. MedlinePlus describes a sleeve worn during the day, removed at night, and worn during air travel.

MedlinePlus suggests resting the arm above heart level two or three times a day for about 45 minutes while lying down, opening and closing your hand 15 to 25 times. Elevate a leg on a pillow or rolled-up blankets.

MedlinePlus lists these reasons to contact your provider: new rashes or skin breaks that do not heal; feelings of tightness in your arm or leg; rings or shoes that become tighter; weakness in your arm or leg; pain, aching, or heaviness in the arm or leg; swelling that lasts longer than 1 to 2 weeks; and signs of infection, such as redness, swelling, or fever of 100.4°F (38°C) or higher.

NCI is more urgent about infection specifically: "If you have a fever or other signs of cellulitis, call your doctor right away." And: "Always call your doctor if you notice redness or other signs of infection."

• National Cancer Institute, Lymphedema (PDQ) - Patient Version: https://www.cancer.gov/about-cancer/treatment/side-effects/lymphedema/lymphedema-pdq
• MedlinePlus (U.S. National Library of Medicine), Lymphedema - self-care: https://medlineplus.gov/ency/patientinstructions/000045.htm
• American Cancer Society, Exercises After Breast Cancer Surgery: https://www.cancer.org/cancer/types/breast-cancer/treatment/surgery-for-breast-cancer/exercises-after-breast-cancer-surgery.html

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