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Lymphedema

Lymphedema is swelling of a body part caused by a build up of lymph fluid. It usually occurs in an arm or leg.

Our bodies have a network of lymph vessels that carry lymph fluid to all parts of the body. These lymph vessels are connected to lymph nodes, which are small bean-sized collections of immune system cells. The lymph fluid and lymph nodes both contain white blood cells that help the body fight infections. If the lymph vessels are not working well, lymph fluid can build up in body tissues; this is called lymphedema.

Many people with cancer have treatments that involve lymph nodes and lymph vessels. Surgery that removes lymph nodes or radiation treatment to areas that contain lymph nodes can increase the chance of having lymphedema. Having both surgery and radiation increases the chance even more. Having a few lymph nodes removed is less likely to cause lymphedema than having many nodes removed. Sometimes, the cancer can cause a blockage of the lymph system and result in lymphedema.

Lymphedema is most often linked to treatments for breast, prostate, uterine, vulvar, or cervical cancers, sarcomas, and melanoma. If lymphedema occurs after breast cancer treatment, swelling can affect the arm on the side of the breast cancer. After treatment for cancer in the abdomen or pelvis, lymphedema may occur in the lower part of the body including the legs.

    WHAT ARE THE SIGNS AND SYMPTOMS OF LYMPHEDEMA?

The signs and symptoms of lymphedema may include:

• a full or heavy feeling in the arm, leg, or genitals,
  
• a tight feeling in the skin of the arm, leg, or genitals,
  
• less movement or flexibility in your hand, wrist, or ankle,
  
• trouble fitting into clothing or jewelry in one specific area, such as one sleeve of your jacket being tight.
  

Early on, lymphedema may be relieved by raising the affected limb.

    HOW CAN LYMPHEDEMA BE PREVENTED AND CONTROLLED?

There is no cure for lymphedema, so we try to prevent it from starting. If it has started, then we try to improve the symptoms and prevent them from getting worse. Most experts suggest basic steps (listed below) to lower your chance of developing lymphedema or to help delay its start.

    Protect the Arm or Leg From Injury
Protect the arm or leg nearest where the cancer was treated from any burns or injury. Your body responds to an injury by making extra fluid. When lymph nodes and vessels have been damaged or removed by cancer treatments, it is harder to get rid of this extra fluid. This can trigger lymphedema.

• Keep the arm or leg (on the side of the cancer treatment) clean.
  
• Keep your skin and cuticles soft and moist by regular use of a lotion or cream. Do not cut or clip cuticles.
  
• Use an electric shaver for removing underarm and leg hair instead of a blade razor or hair removal cream.
  
• Use an insect repellent and sunscreen to avoid bug bites and sunburn.
  
• Avoid extreme heat or cold.
  
• Use standard first aid measures to treat any cuts, scrapes, burns, insect bites, hangnails, or torn cuticles. Ask your doctor or nurse team if you are unsure about what to do. Watch for early signs of infection, such as pus, redness, swelling, increased heat, tenderness, chills, or fever. Call your doctor right away if you think you have an infection.
  
• If your arm is affected, try to avoid blood drawing, IVs, or shots on that side. Tell all health care workers that you are at risk for lymphedema. Wear protective gloves when doing household chores and yard work.
  
• If your legs are affected, always wear well-fitting, closed shoes instead of sandals or slippers. Wear soft protective socks. Do not go barefoot.
  

    Avoid Pressure or Squeezing the Leg or Arm
Wearing tight clothing or squeezing the arm or leg can cause increased fluid and swelling. Lymphedema may get worse during air travel because of the changes in cabin pressure.

• If your arm is affected, do not wear tight jewelry or tight clothing. Avoid using shoulder straps when carrying briefcases and purses. Women should not wear bras that fit tightly or have straps that dig into their shoulder. Do not have your blood pressure taken on the affected side.
  
• If your legs are affected, avoid socks, stockings, or undergarments with tight elastic bands. Do not cross your legs for long periods of time when sitting.
  
• Ask your doctor or physical therapist about wearing a compression sleeve or compression stocking on the affected arm or leg when you travel by air. Try to move and flex the affected arm or leg often during the trip.
  

    Avoid Muscle Strain
Being active helps lymph fluid to drain from the arms and legs, but overuse of the arm or leg may cause injury and lymphedema in some people.

• Exercise regularly but try not to overtire your arm or leg. Ask your doctor, nurse, or physical therapist about what level of activity is right for you and about wearing a compression sleeve or stocking during activities.
  
• If your arm or leg starts to ache, lie down and raise it above the level of your heart.
  

    Maintain Good General Health
Some studies have found that being obese or having high blood pressure increases the chance that arm lymphedema will occur after breast cancer treatment. If you have lymphedema or are at risk for it, you should keep your weight and blood pressure under control.

    HOW IS LYMPHEDEMA TREATED?

Lymphedema treatment helps reduce swelling, prevents it from getting worse, and decreases the chance of complications. The standard treatment is called Complete Decongestive Therapy (CDT). This includes skin care, a specific form of massage, special bandaging, exercises, and fitting for a compression sleeve or stocking. These treatments are prescribed by your doctor and are performed by an experienced therapist who has gone through special training. Most insurance companies will pay for this treatment, but some companies will not cover the cost of compression garments and bandages.

If treatment is not started early, it can take longer to get lymphedema under control, and the long-term results may not be as good. So, you should have regular exams by your doctor or nurse to find swelling while it is still mild and more easily treated.

If lymphedema does not respond to CDT, there are other treatment options, but we do not know how effective they may be for you. If you are thinking about these treatments, please see a lymphedema specialist who can help you decide what is best for you.

    OTHER SOURCES OF INFORMATION

Information about lymphedema is available from several nonprofit lymphedema organizations.

American Cancer Society. Available at: http://www.cancer.org

Circle of Hope Lymphedema Foundation, Inc. Available at: http://www.lymphedemacircleofhope.org

Lymphedema Research Foundation (LRF). Available at: http://www.lymphaticresearch.org

Lymphology Association of North America (LANA). Available at: http://www.clt-lana.org

National Cancer Institute (NCI). Available at: http://www.cancer.gov

National Lymphedema Network (NLN). Available at: http://www.lymphnet.org

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