Lymph fluid travels through the body as part of the circulatory system, using a network of thin tubes called vessels. Small glands called lymph nodes filter bacteria and other harmful substances out of this fluid. When the lymph system is working as it should, lymph flows through the body and is returned to the bloodstream. However, when part of the lymph system is damaged or blocked, fluid cannot drain from nearby body tissues. The result is a fluid buildup that collects in the surrounding tissues, causing them to swell. This is called lymphedema.
Lymphedema is a common problem that can be caused by cancer and cancer treatment. It may develop immediately after surgery or radiation therapy for some patients, while other patients might not experience it until months or even years after cancer treatment has ended.
Lymphedema is most common for women who have had breast cancer, resulting in swelling in the arm near where surgery was performed to remove lymph nodes. But it can occur in people with other types of cancers, including:
Uterine cancer
Prostate cancer
Vulvar cancer
Ovarian cancer
Head and neck cancer
Lymphoma
Melanoma
Signs and Symptoms of Lymphedema
Typically, lymphedema affects the arms and legs. But it can also happen in the neck, face, mouth, abdomen, groin, or other parts of the body, or any area near where lymph nodes were removed as part of a cancer surgery. Therefore, you should notify your oncologist or cancer care team immediately if any of the following problems occur:
Swelling of an arm or leg, which may include fingers and toes
A full or heavy feeling in an arm or leg
A tight feeling in the skin
Trouble moving a joint in the arm or leg
Thickening of the skin, with or without skin changes such as blisters or warts
Itching of the legs or toes
A burning feeling in the legs
Trouble sleeping
Loss of hair
A feeling of tightness when wearing clothing, shoes, bracelets, watches, or rings
Early treatment may prevent or reduce the severity of problems caused by lymphedema.
Diagnosing and Staging Lymphedema
Your oncologist may use the following tests or procedures in order to diagnose lymphedema:
Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
Lymphoscintigraphy: A procedure that involves injecting tiny amounts of radioactive particles (called radiotracers) into the body to check the lymph system for disease. A scanner or probe is used to follow the movement of the radiotracer. Lymphoscintigraphy is used to find the sentinel lymph node (the first node to receive lymph from a tumor) or to diagnose certain diseases or conditions, such as lymphedema.
MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body.
If your doctor determines lymphedema is present, he or she will then determine the stage, which refers to the severity of the condition. There are four stages of lymphedema:
Stage 0: No swelling, but subtle symptoms such as feeling the affected area is heavy or full, or that the skin is tight.
Stage I: The limb is swollen and feels heavy. Pressing on the swollen area leaves a pit (dent). This stage of lymphedema may go away without treatment.
Stage II: The limb is swollen and feels spongy. A condition called tissue fibrosis may develop and cause the limb to feel hard. Pressing on the swollen area does not leave a pit.
Stage III: This is the most advanced stage. The swollen limb may be very large. Stage III lymphedema rarely occurs in breast cancer patients. Stage III is also called lymphostatic elephantiasis.
The later the stage, the harder it is to treat. This is why it’s very important to talk with your Affiliated Oncologists team as soon as you notice any concerning symptoms.
Treating Lymphedema
At this time, there is no cure for lymphedema. However, there are steps that can be taken to reduce the swelling or keep it from getting worse, and to relieve symptoms. Your cancer care team at Affiliated Oncologists can help you figure out which treatment methods are best for you. Some suggestions might include:
Protect your skin. Use lotion to avoid dry skin. Use sunscreen. Wear plastic gloves with cotton lining when working in order to prevent scratches, cuts, or burns. Keep your feet clean and dry. Keep your nails clean and short to prevent ingrown nails and infection. Avoid tight shoes and tight jewelry.
Exercise. Work to keep body fluids moving, especially in places where lymphedema has developed. Start with gentle exercises that help you to move and contract your muscles. Ask your doctor or nurse what exercises are best for you.
Manual lymph drainage. See a trained specialist (a certified lymphedema therapist) to receive a type of therapeutic massage called manual lymph drainage. Therapeutic massage works best to lower lymphedema when given early, before symptoms progress.
Wear compression garments or bandages. Wear special garments, such as sleeves, stockings, bras, compression shorts, gloves, bandages, and face or neck compression wear. Some garments are meant to be worn during the day, while others are to be worn at night.
Other practices. Your health care team may advise you to use compression devices (special pumps that apply pressure periodically) or have laser therapy or other treatments.