Understanding Lymphedema and Decreasing Your Risk

Lymphedema is the swelling that can happen after some cancer treatments. It happens when extra fluid (called lymph) builds up because of damage or a blockage in your lymphatic system. The lymphatic system normally drains and filters fluid in your body. When this lymphatic system becomes blocked or damaged, swelling can occur. Lymphedema can be uncomfortable and painful. Over time it can cause infection.

Lymphedema can happen in areas of the body that have been treated for cancer. Lymphedema can be caused by damaged lymph nodes or lymph nodes that are removed during surgery. It can also be caused by the cancer itself or by radiation therapy.

What are the symptoms of lymphedema?

Lymphedema usually develops over time. You may first feel tingling or numbness in the area. Other common symptoms are:

• Feeling achy.
• Feelings of fullness or heaviness.
• Puffiness or swelling.
• Less flexibility.
• Numbness or tingling.
• Tightness.
• Stiffness.
• Jewelry feels tight.

Early treatment of lymphedema is important. Tell your provider if you have any of these symptoms.

What parts of the body are most at risk?

Different cancers have different risk areas:

• Breast cancer: The breast, underarm, arm, and hand on the side of surgery and/or radiation.
• Head and neck cancer: Face, chin, and neck.
• Gynecologic, prostate or other cancers in the abdomen/pelvis: The abdomen (belly), buttocks, genitals, legs, and feet.
• Melanoma (after groin lymph node dissection): The abdomen, buttocks, genitals, leg, and foot on the side of surgery.
• If lymph nodes were removed from the underarm (axillary) area, the risk is to the chest wall, arm, and hand on the side of surgery.

What increases your risk of lymphedema?

There is no research showing that lymphedema can be prevented. However, you can lower your risk of lymphedema by reducing the demand you place on the lymphatic system in the affected area.

There are both modifiable and non-modifiable risk factors for lymphedema. Non-modifiable risk factors are risk factors that you cannot control. Modifiable risk factors are ones that you can control.

Non-modifiable:

• The type of surgery or lymph node dissection you’ve had.
• How much radiation your lymph nodes received.
• Advanced stage cancer.
• Type of chemotherapy you have had.

Modifiable:

• Being overweight or obese.
• Weight gain.
• Infections, injury, or trauma to the affected limb.

What are the symptoms of infection?

If lymphedema goes untreated, there is a chance of infection. It is important to pay attention to any sudden changes in the affected area and to tell your care team right away. Symptoms of infection are:

• Sudden increase in swelling.
• Intense pain or a different pain than you are used to.
• Redness or any change of color to your skin.
• Feeling warm or hot in the area.
• Flu-like symptoms such as fever, chills, and achiness.

If you are having any signs of infection, call your care team or go to your closest Emergency Department right away. DO NOT WAIT!

How can I lower my risk of infection?

Skin Care

Take good care of your skin to lower your risk of infection and injury by following these tips:

• Keep your skin clean and moisturized.
• Wash your hands regularly/use hand sanitizer.
• For arms and hands at risk: wear gloves when you wash dishes, while gardening, or when you use harsh chemicals for cleaning.
• For legs and feet at risk, wear shoes and socks at all times to prevent injury.
• If you have peripheral neuropathy (decreased sensation in your hands or feet) from chemotherapy, look at your skin regularly since you may not be able to feel things like cuts, scrapes or burns.
• Use an electric razor for hair removal.
• Have injections or blood draws in areas that haven’t been treated (example: if you have had a left lumpectomy, have your blood and blood pressure taken on the right side).
• Ask your provider when it is safe to get manicures/pedicures (based on your at-risk area). If you decide to get a manicure or pedicure, bring your own sanitized tools.
• Clean cuts well with soap and water and use an antibiotic cream. Watch for signs of infection and tell your provider right away if you have any of these signs.
• Avoid overheating the at-risk area in a hot tub or sauna.
• Ask your provider about public swimming pools.
• Make sure to clean all equipment at the gym before and after use to avoid spreading germs.
• Use a high SPF sunscreen and insect repellent when needed.
  • Make sure to check with your provider about what kind of moisturizers to use.
  • If your leg and foot are at risk, you may want to have your toenails cut by a podiatrist (foot doctor).

Avoid Constricting Your Blood Flow

Constricting an area on your body can cause a 'backup' of fluid in the at-risk area. Ways to avoid constriction are to:

• Avoid blood pressure readings on the at-risk arm when possible. If not possible, a blood pressure can be taken on the affected arm using a stethoscope and manual blood pressure cuff (not the automatic blood pressure machines).
• Avoid tight jewelry or clothing on the at-risk limb.
• After treatments affecting the underarm (axillary) lymph nodes, wear a well-fitted bra without an underwire. If you wear a prosthesis, make sure it is lightweight (a heavy prosthesis can put too much pressure on the lymph nodes above the collarbone).
• Avoid carrying a heavy shoulder bag or suitcase for long periods with an at-risk arm. Rolling suitcases or luggage racks are good options.

Maintain a Healthy Weight

Obesity is a known risk factor for lymphedema. A balanced, healthy diet with a focus on portion control is recommended. Exercise is another great way to help maintain your weight. Before starting any exercise program, make sure to check with your care team.

Exercise with Care

Having cancer and receiving treatment will change your body. Exercise is one of the best ways that you can maintain strength, energy, mobility, and cope with cancer-related fatigue. Again, before starting any form of exercise, it is always recommended that you check with your provider.

Next Article: Treatment for Lymphedema: Complete Decongestive Therapy (CDT) »