Lymphedema – What you need to know

A chronic condition impacting 3 to 5 million Americans is called lymphedema.  This painful and uncomfortable swelling of the arms and fingers, which can also be present in the legs and feet, occurs after patients lymph nodes are removed as a necessary part of surgery.  It most commonly occurs in breast cancer patients but it can occur after other types of cancer and non-cancer surgeries.

What is the lymph system?

To understand lymphedema, it’s helpful to have an understanding of the body’s lymphatic system.  Fluid called lymphatic fluid circulates through the body to remove waste, bacteria and other unwanted substances.  This is our bodies’ network of lymph nodes and lymph vessels that collect and carry watery, clear lymph fluid, very similar to veins collecting blood from distant parts of the body to carry it back to the heart.

“Edema” is a term referring to the swelling or buildup of excessive fluids.  Lymphedema occurs after several lymph nodes are removed, or in the natural absence or impairment of them.  In some patients, their lymphatic system can no longer manage the fluid which builds up in the fatty tissues just under the skin collecting in the arms or other areas of the body, causing swelling and pain. Lymphedema can also affect the face, neck, abdomen, and genitals depending on the part of the body that was treated.

Why does cancer sometimes lead to lymphedema?

Anytime there is a change in the structure of the lymph system, this can put a person at risk for lymphedema.  That is why anyone being treated for cancer should talk to their cancer care team about their risk of lymphedema and how to lower it.  Once chronic lymphedema has started, it cannot be cured.  But early and careful management can reduce symptoms and help keep it from getting worse.

There are several reasons why lymphedema is more likely to develop due to cancer-related causes:

·      Surgery

If a doctor is performing surgery for cancer and has to take out lymph nodes near the tumor, this removal can trigger lymphedema.  The reason is because by removing the lymph nodes, the lymph vessels which carry fluid from that area to the rest of the body are taken out too. 

But by removing lymph nodes and vessels it makes it harder for the lymph fluid in the arms, legs, or other body parts to flow to the chest where it can get back into the bloodstream.  If the remaining lymph vessels cannot remove enough fluid in the area, the fluid builds up and can cause swelling or lymphedema.

·      Radiation

Radiation can cause lymphedema since it can affect the flow of lymph fluid by scarring and damaging the lymph nodes and vessels.

·      Cancer

Sometimes just the cancerous tumor itself can block part of the lymph system resulting in lymphedema.

·      Infection

Infections can restrict lymph flow which can cause lymphedema.

Signs of lymphedema

It is important to recognize the early signs of lymphedema so treatment can start right away.  Common signs and symptoms to watch for include:

·      Swelling

·      Part of your body - such as your arm, leg, abdomen, or genitals – feeling heavy or full

·      Skin changing texture, feeling tight or hard, or looking red

·      New aching, tingling, numbness, or other discomfort in the area

·      Less movement or flexibility in nearby joints – like your hand, wrist, or ankle

·      Trouble fitting into clothes in one area, such as a sleeve, pant leg, or shoe being too tight

·      Shirt collars, rings, watches, and/or bracelets feeling tight even though you haven’t gained weight

·      Any swollen area that looks red and feels hot to the touch or the skin feels hard and stiff.

At the first sign of any of the above, make an appointment with your doctor to get a diagnosis. 

Treatment for lymphedema

Unfortunately, there is no cure for this condition.  The primary treatment focuses on reducing the swelling and controlling the pain.  The following treatments could include the following:

·      Exercises – Light exercises in moving the affected limb may encourage lymph fluid drainage.  The exercises should not be strenuous or tire you out – work with your physician or a physical therapist for advice.

·      Wrapping your arm or leg – Bandaging your entire limb encourages lymph fluid to flow back toward the trunk of your body.  A lymphedema therapist can show how to wrap your limb.

·      Massage – Massage may not be for everyone but there is a technique called manual lymph drainage that may encourage the flow lymph fluid out of your affected limb.  Avoid massage if you have a skin infection, blood clots or active disease in the involved lymph drainage areas.

·      Pneumatic compression – This is where you would wear a sleeve over the affected limb that connects to a pump that intermittently inflates the sleeve, putting pressure on your limb helping move lymph fluid away from your fingers or toes.

·      Compression garments – Wearing long sleeves or stocking made to compress your arm or leg can also encourage the flow of the lymph fluid out of the affected limb.  It is advised to wear a compression garment when exercising the limb that is affected.