Lymphedema

WEB EXCLUSIVE / NOVEMBER 2005
POSTGRADUATE MEDICINE
Update of a handout originally published in May 1999

Download this Patient Note in PDF format

Lymph nodes are part of the body's special circulatory system for moving and processing an important fluid called lymph. This clear fluid, which carries disease-fighting white blood cells throughout the body, is filtered by the lymph nodes and then drained into the bloodstream. Lymph also contains proteins and salts removed from the tissues. When lymph nodes are removed as part of cancer treatment or are injured or blocked, fluid can build up in the tissues--usually in an arm or leg. This buildup, and the swelling that results, is called lymphedema. This condition is physically and emotionally distressing.

What causes lymphedema?
Lymphedema can be hereditary or caused by infection or injury, but most often it occurs as a result of tumor growth or after surgery or radiation therapy for cancer--sometimes years later. About 20% of women who have had lymph nodes in the underarm region removed because of breast cancer have symptoms of lymphedema. More than 400,000 women in the United States have this condition. Mild cases usually get better after a few days; more severe cases may last months or years.

Radiation therapy can cause scarring of lymph nodes and vessels, which interrupts the normal flow of lymph. It can also cause burns similar to sunburn. After radiation therapy, skin should be examined carefully for changes in temperature or color or blistering that could lead to infection and lymphedema.

Hereditary lymphedema can affect one or all limbs and sometimes other parts of the body. It may be present at birth, or it may appear later in life. The cause is often unknown, but abnormalities of the lymph system seem to be responsible for some cases.

What are the symptoms of lymphedema?
Symptoms of lymphedema include pain from swelling, a heavy sensation, skin tightness, and decreased flexibility in the hand, wrist, or ankle. You may feel that your clothing is suddenly too tight or that a watch or ring is uncomfortable. If you notice any of these changes, call your doctor right away.

How is lymphedema treated?
People with lymphedema are often referred to a clinic or healthcare practitioner specializing in treatment of this condition. Treatment depends on the cause and is aimed at relieving discomfort, improving range of motion, and decreasing emotional distress. It typically consists of nonsurgical and nondrug measures, with the exception of antibiotic therapy if infection caused the lymphedema.

Often-recommended treatments include elevation of the affected arm or leg, bandaging, use of compression sleeves or stockings (particularly when flying), certain exercises, a type of physical therapy called manual lymphatic drainage (a special kind of massage), and various techniques that fall into the category of complex physical therapy. Exercise, such as yoga, swimming, light aerobics, and biking, is encouraged.

When lymphedema is not treated, fluid rich in protein accumulates and causes swelling and hardening of the tissues. The swollen limb then becomes a perfect place for bacteria to grow. In severe lymphedema, the arm or leg can become seriously enlarged and the tissues may become hard--problems that are difficult to treat.

Because lymphedema can be disabling, painful, and disfiguring, some people with the condition seek counseling or join a support group. Social support is very important.

Whichever treatment you and your doctor decide is best, the most important step is to address the problem early. Be alert to changes that might be clues to lymphedema.

Tips for preventing lymphedema after breast cancer surgery Avoid infection Keep your arms clean. Wash often if your arms perspire or get dirty. Always dry your skin well so moisture doesn't remain in skinfolds or between fingers. Protect your fingers, hands, and arms from punctures. Use the unaffected arm or hand whenever you have blood drawn, need injections, or have your blood pressure taken. Use insect repellant outdoors to prevent bites and stings. Trim your fingernails carefully. Do not cut or tear the cuticles. Wear gloves when you're working outside to help avoid punctures from thorns and injuries from tools. Wear loose-fitting rubber gloves when you're using household cleaners or have your hands in hot water. Use an electric shaver for shaving under your arms. It is less likely to injure the skin than a traditional razor. Use your affected arm normally Avoid vigorous exercise immediately after lymph node removal to prevent swelling. After recovery from surgery, move your arms and legs as you usually would. Physical activity is encouraged because it promotes drainage from lymph glands. Ask your doctor, nurse, or physical therapist about the best program for you. Avoid burns Protect your arms and chest from the sun. Always wear protective clothing and sunscreen with an SPF rating of 15 or higher. If possible, stay out of the sun altogether from 10 AM to 3 PM. Avoid hot baths, saunas, and hot dishwater. Use oven mitts when cooking or baking. Avoid tight squeezing of the hands and arms Wear loose-fitting gloves and avoid anything that puts pressure on your hands or arms, such as tight sleeves or cuffs, watchbands, jewelry, or rings. Make sure your bra fits properly so the straps do not dig into your shoulders. Do not carry your purse or briefcase over either shoulder. Keep your doctor informed Call your doctor right away if you notice even slight swelling in your chest or in an arm, hand, or finger. Be informed. For more information on lymphedema, contact: National Cancer Institute Suite 3036A 6116 Executive Blvd, MSC8322 Bethesda, MD 20892 800-422-6237 800-332-8615 (TTY) http://www.cancer.gov National Lymphedema Network Latham Square 1611 Telegraph Ave, Suite 1111 Oakland, CA 94612 800-541-3259 http://www.lymphnet.org

This information is not a substitute for medical treatment.

Please send technical questions related to the Web site to Ann Harste