Lymphedema is the buildup of lymph fluid in the tissues just under the skin, resulting in swelling, tightness and discomfort in the affected limb. Damage to or blockage of the lymph system is the cause of lymphedema, and in cancer patients, this damage is usually due to surgery or radiation therapy. While there is no single treatment for lymphedema, steps can be taken to manage the symptoms, including compression of the area, a specific type of massage to increase lymph flow and specialized exercises.

What is lymphedema?

Lymphedema is the buildup of lymph fluid in the tissues just under the skin. As the blood travels into smaller and smaller vessels, excess fluid, protein and other substances are pushed out into the surrounding tissue. This substance is called lymph fluid. Under normal circumstances, lymph fluid is removed from the tissues by the lymph system, which is a series of vessels and organs that move the fluid back toward the heart and filter it through lymph nodes. Lymph nodes are specialized structures that are composed of white blood cells and serve to “clean” the lymph fluid of bacteria or other contaminants. If there is damage to or blockage in the lymph system, the lymph fluid cannot be removed and builds up in the tissues.

What causes lymphedema?

Lymphedema is caused by blockage or damage to the lymph system. It may be caused by cancer treatment or the cancer itself. Damage to the lymph system by surgery or radiation is the primary cause of lymphedema in cancer patients, especially when treatment is conducted in the underarm, groin, pelvic, or neck regions. Swelling may occur immediately after treatment, or it may arise weeks, months or even years later. Lymphedema commonly occurs in patients with breast cancer who had lymph nodes removed in the underarm and/or received radiation to that area.

Lymphedema that is caused by the cancer itself is usually related to:

  • Spread (metastasis) to the lymph nodes in the neck, chest, underarm, pelvis or abdomen
  • Growth of tumors (cancer) in the pelvis or abdomen that block lymph drainage by involving or putting pressure on the lymphatic vessels and/or the large lymphatic duct in the chest

What are the symptoms of lymphedema?

Notify your doctor if you have any of the following symptoms:

  • Feelings of tightness in the arm or leg
  • Decreased flexibility in a hand, elbow, wrist, fingers or leg
  • Difficulty fitting into clothing
  • Ring, wristwatch, bracelet, shoe that fits tighter than usual
  • Pain, aching, heaviness, or weakness in the arm or leg
  • Redness, swelling, or signs of infection
  • Skin that feels stiff or taut
  • Pitting (small indentations left on the skin after pressing on the swollen area)

How is lymphedema managed?

While there is no single treatment for lymphedema, steps can be taken to manage the symptoms.

Compression garments: Your doctor may recommend that a specially made “elastic sleeve” be worn on the affected limb. This sleeve provides compression and has been shown to significantly reduce swelling. Talk with your doctor about when and how to use compression garments. Some people need to use compression garments both day and night.

Manual lymphatic drainage: This is a specialized form of very light massage that helps to move fluid from the end of the limb toward the trunk of the body. Manual lymphatic drainage is different from standard massage and should be performed by a trained professional. This individual may be able to teach you ways that you can massage yourself to increase lymph flow.

Exercise: Lymphatic drainage is improved during exercise. Your doctor or physical therapist will recommend specific exercises.

How can lymphedema be prevented?

Lymphedema occurs less frequently now than in the past because of improved surgical techniques. Historically, when breast cancer was thought to spread to the lymph nodes, the surgeon would remove as many lymph nodes as possible. This approach would sometimes cause severe lymphedema. Recently, a technique has been developed that makes it possible to remove only one lymph node, called the sentinel node. The sentinel node is the first node that drains a particular area, such as the breast. In a sentinel node biopsy, the surgeon injects a dye into the affected area to identify which node is the first to be marked by the dye. If the sentinel lymph node is free of cancer, then it is unlikely any of the other lymph nodes located “downstream” have cancer and they are not removed.

What else can I do?

Try these tips for managing or reducing lymphedema:

  • Keep the arm or leg raised above the level of the heart, when possible.
  • Clean the skin of the arm or leg daily and moisten with lotion.
  • Avoid injury and infection of the arm or leg.
  • Avoid tight clothing.
  • Do prescribed exercises regularly as instructed by your doctor or therapist.
  • Avoid pressure on the arm or leg:
    • Do not cross legs while sitting.
    • Do not carry a handbag on the arm that is swollen
    • Wear loose jewelry; wear clothes without tight bands.
    • Do not use blood pressure cuffs on the affected arm.
    • Do not sit in one position for more than 30 minutes.