Life After Cancer: Lymphedema 

Lymphedema is swelling in part of the body that may occur after cancer surgery or radiation. The swelling is caused by a buildup of lymph fluid that can’t drain away like it did before treatment. Lymphedema can happen months or even years after cancer treatment. It’s an ongoing (chronic) condition that has no cure. But you can do things to help reduce your risk for lymphedema. And there are ways to reduce or relieve symptoms if it happens. If left untreated, lymphedema can get worse and lead to other problems, such a infections. 

Talk with your healthcare provider about your risk for lymphedema and what you can do to help keep it from developing or getting worse.

What is the lymphatic system? 

The lymphatic system is a network of tiny vessels and small organs called lymph nodes. The system carries lymph around the body. Lymph is a clear fluid that contains a few blood cells.

The lymphatic system is part of your immune system. It helps protect and maintain the health of your body by filtering and draining lymph and cell waste products away from each body region. The lymphatic system also helps the body fight infection. 

How lymphedema happens 

During treatment for cancer, lymph nodes and the vessels around them that are near the cancer are often removed by surgery. Or they may be treated with radiation. This scars and damages them.  Radiation is done because it’s common for cancer to spread to nearby lymph nodes. When lymph nodes are gone or don’t work, it disrupts the flow of lymph fluid, which can lead to swelling. This swelling is lymphedema. 

Lymphedema can affect one or both arms or legs, the groin, the head and neck, or the belly (abdomen), depending on which part of the body was treated for cancer. Swelling can get worse over time and cause problems. You can develop sores or other skin problems. Affected areas are also more likely to become infected. 

After cancer treatment that removes or damages lymph nodes, you are at risk for lymphedema for the rest of your life. 

Breast cancer and lymphedema 

Lymphedema is especially a risk after breast cancer treatment. During treatment, some or all of the lymph nodes under the arm may be removed or treated with radiation. These lymph nodes are called the axillary lymph nodes. They drain the lymphatic vessels from the arms, hands, and the most of the breast, chest, neck, and underarm area. 

A mild type of lymphedema can occur within a few days after breast surgery and usually lasts a short time. A more serious type of lymphedema can occur about 4 to 6 weeks after surgery. The most common type of lymphedema is painless and may slowly develop 18 to 24 months or more after surgery. Once lymphedema develops there is no way to cure it. 

Symptoms of lymphedema 

Lymphedema can occur in an arm, leg, groin, chest, head, neck, or armpit area. Symptoms can include:

  • Swelling

  • A feeling of fullness or heaviness in the area

  • A stiff or tight feeling

  • Weakness

  • Aching or pain

  • Skin that looks red

  • Trouble bending or moving a joint in your fingers, wrist, elbow, shoulder, or ankle

  • Shoes, clothing, bra, or jewelry feels tight 

If you have any of these symptoms, contact your healthcare provider right away. Something else may be causing these changes and you may need treatment. If the cause is lymphedema, treatment needs to be started right away to keep it from getting worse.

How lymphedema can be treated

No medicines are available to treat lymphedema. Instead, the most common treatment is complete decongestive therapy (CDT). This is a set of methods used together to help reduce your symptoms. CDT is done by certified, trained therapists. Your arms or legs may be measured before and after CDT in order to see how well the treatment is working. 

Lymphedema treatment most often involves one or more of the following:

  • Manual lymphatic drainage. This is a kind of massage that uses gentle pressure to help move lymph out of areas where it is collecting.

  • Intermittent pneumatic compression. This uses a device to apply and relieve pressure to the arms or legs. Sleeves are put over the arms or legs. A pump fills the sleeves with air in a messaging motion. Then the air is let out. This happens over and over again for a set amount of time.

  • Compression bandages. Stretchy, padded fabric wrapping may be put on the part of the body with lymphedema. This wrap may include bandages, tape, or other types of compression garments. They help prevent fluid lymph from building up and squeeze fluid out of the area.

  • Compression garments. These are worn as often as needed, for life. These include sleeves, gloves, stockings, undershirt, or other types of special clothes. They compress or gently squeeze parts of the body to help prevent lymph buildup. You may wear these during daily life, or at night when you are asleep.

  • Therapeutic exercises. Some kinds of exercise may help your symptoms. These may include aerobic exercise, such as brisk walking. And may also include gradual weightlifting exercises that build muscle.

  • Skin and nail care. Proper care of your skin and nails will help prevent infection (see below). 

Preventing or managing lymphedema 

If you are at risk for lymphedema but have not developed it, the tips below can help prevent it. You are at risk for lymphedema for the rest of your life, so make these tips part of your regular habits. 

If you have lymphedema, you will need to make sure the swollen area stays healthy. These tips can help you do that.

To help prevent or manage lymphedema:

  • Protect your skin. Small injuries such as a cut, burn, or insect bite in the area with lymphedema are more likely to cause swelling and skin infection. Take special care to avoid injury. Prevent burns by wearing sunscreen and using gloves when cooking or doing housework. Use an insect repellent to avoid bug bites when outdoors. Moisturize dry skin. Wear protective gloves when doing outdoor chores such as gardening or lawn work. Check your skin regularly for cuts, sores, bug bites, or other problems. Take care of any wounds right away. Clean them, put on antibiotic cream, and keep the area covered as it heals. If you have any signs of infection, like redness or drainage, call your healthcare provider.

  • Avoid excess heat or cold. Hot and cold temperatures can cause the skin to swell and dry out. It can also cause fluid to build up. Be careful around hot objects to avoid burns. Don’t use hot tubs, saunas, or a heating pad. Cold can also damage skin. Don’t use ice packs, and protect your skin with warm clothing in the winter.

  • Try not to gain weight. This can make symptoms worse.

  • Tell your healthcare providers. Tell your healthcare providers about your lymphedema risk before getting shots, having blood drawn, having an IV put in, or having your blood pressure taken. If at all possible, these should not be done in an affected arm. 

If you have or are at risk for arm lymphedema:

  • Don’t wear tight sleeves, cuffs, wristwatches, or jewelry.

  • Don't pick at or cut the skin around your fingernails.

  • Trim your fingernails straight across to prevent ingrown nails.

  • Don’t carry heavy bags with the affected arm.

If you have or are at risk for leg lymphedema:

  • Don’t wear tight socks, underwear, or pants.

  • Don’t cross your legs when you sit. This can block lymph drainage.

  • Don’t walk around without shoes. This is to help keep you from injuring your feet.

  • Wear shoes that fit well and don’t cause blisters.

  • Trim your toenails straight across to prevent ingrown nails. 

When to call your healthcare provider 

Call your healthcare provider if you have any of these:

  • Swelling that gets worse

  • Rash, blisters, or other skin changes in the affected area

  • Skin that becomes red, painful, or warm to the touch

  • A wound in the area that increases in pain, is warm, drains fluid, or has red streaks

  • Fever of 100.4°F (38°C) or higher, or as directed by your healthcare provider