Lymphedema

Abnormal swelling of an arm or leg caused by excess of fluid in body tissues is known as lymphedema.  The type of cancer and treatment can affect which body part is affected by swelling.  Lymphedema interferes with motion and function of the affected area.  Swelling can range from mild to extreme.  However, improvements in surgical and radiation therapy have allowed cancer patients to decrease frequency of lymphedema.

 

Who is affected by lymphedema?

Surgical removal of lymph nodes is the most common cause of lymphedema. The more lymph nodes removed, the higher risk of lymphedema.  The most common nodes removed are from the underarm, groin, pelvis and neck.  Swelling occurs in the areas that are connected to the lymph nodes that are removed:

• Arm - axillary (underarm) lymph nodes removed during surgery for breast cancer
• Leg - pelvic or groin lymph nodes removed during surgery for uterine, ovarian, or prostate cancer
• Chin and face - neck lymph nodes removed during surgery for head and neck cancer

Risk of lymphedema is less for radiation therapy, than those treated with surgery.  Women who have surgery combined with radiation therapy for breast cancer have an increased risk of lymphedema.

 

What causes lymphedema?

Lymph is clear fluid that the body uses to carry cells to fight infection.  Lymphedema occurs when the fluid cannot normally flow through lymph vessels.  This can be a result of removal of nodes through surgery or damage to lymph nodes and vessels through radiation therapy.

 

When does lymphedema occur?

Swelling may occur from weeks to many years after treatment has been completed.  Although there is usually swelling in the first few days after surgery this is not considered lymphedema.  This initial swelling will usually last 6-12 weeks.

 

Management of Lymphedema

In order to manage lymphedema minimization of swelling is critical.  It is also important to prevent infection because infection could cause production of more lymph, which creates excess fluid.  This may cause lymphedema to worsen.  It is important to keep blood from pooling in the affected limb.  Keeping the affected limb higher than the heart will help alleviate some symptoms of lymphedema. A mild diuretic may be used to lower fluids pooling in affected limbs.

Patients can minimize swelling by wearing proper clothing.  Those suffering from lymphedema should avoid wearing clothing that could cause friction on the affected areas.  Wearing loose clothing and keeping legs uncrossed while seated can be beneficial.

Physical therapy may also be helpful for treating lymphedema.  Gentle exercises, such as manual lymph drainage, help rid lymph fluid from affected limbs.  Other techniques can also increase flow of lymph fluid.  Wrapping of the arm and leg in bandages, wearing a compression garment, and using pneumatic compression.  Bandages can push put pressure on affected limb and push bodily fluid away from the area.  A compression garments are pieces of clothing that provide support and pressure on affected area.  These garments can come in varying sizes, shapes, and level of pressure.  Pneumatic compression utilizes a compression sleeve with an attached pump.

 

When should a doctor be consulted?

It is important to consult a doctor during the early onset of lymphedema.  One should contact a physician if signs of lymphedema persist for 1 to 2 weeks. These signs may include:

 

• Swelling in the breast, chest, shoulder, arm, hand, leg, or foot
• Heavy feeling of limb or extremity
• Aches and discomfort in an area
• Changes in area looks red and feels tight and hard
• Lack of mobility and flexibility in joints
• Tightness of clothing and jewelry
• Fever not related to cold or flu