What is Lymphedema?

Sometimes cancer and/or cancer treatment can damage the lymph nodes or vessels that produce and carry lymph fluid, which helps fight infection and filters toxins and waste throughout the body. When this happens, lymph fluid can build up in the fatty tissues under the skin at the site of the tumor or treatment and cause swelling. This buildup is called lymphedema.

Lymphedema can happen after surgery or radiation treatment for any cancer, but is more likely to happen when treated for:

• Breast cancer
• Prostate cancer
• Pelvic cancer
• Lymphoma
• Melanoma
• Head and neck cancers

Baptist Health is known for advanced, superior care for patients with cancer and the diagnosis, treatment and management of lymphedema. You will appreciate timely appointments and a professional, friendly atmosphere where we take time to listen to your concerns. At Baptist Health, you have access to the region’s most comprehensive, multidisciplinary team of specialists and innovative therapies, including many available only through specialized clinical trials. In every way, we work to demonstrate the utmost in excellent care to those who trust us with their health.

Signs and Symptoms

Lymphedema can be a chronic disease that requires ongoing medical treatment or care. Chronic lymphedema symptoms might include progressive escalation of swelling, hardening of the skin, and difficulty moving affected legs or arms.

Lymphedema symptoms, which can occur in your arms or legs, can include:

• A swollen area that looks red or feels hot
• Aching, tingling, numbness or other discomfort 
• Less flexibility in a joint
• Skin that feels tight or hard
• Swelling, heaviness or fullness of a part of the body
• Trouble fitting into a sleeve, pant leg, shoe or ring

Diagnosis

Doctors use various imaging tests to determine lymphedema. These tests help doctors identify and treat specific types of lymphedema.

Imaging tests can include:

• MRI Scan. MRI stands for magnetic resonance imaging. An MRI uses a magnetic field and radio waves to take 3D images of the inside of your body.
• CT Scan. CT stands for computed tomography. A CT scan is a specialized X-ray exam that can locate potential obstructions in your lymphatic system.
• Doppler Ultrasound. This ultrasound bounces sound waves off red blood cells to spot blockages.
• Radionuclide imaging of your lymphatic system. This is also called lymphoscintigraphy. Your doctor will inject you with a radioactive dye that highlights blockages when scanned by an imaging machine.

Causes

Lymphedema can happen when any cancer or cancer treatment affects the flow of lymph through the body. The condition can occur months or years after treatment and can be temporary or chronic. Lymphedema associated with cancer can be caused by:

Radiation: Radiation can cause scarring and inflammation of lymph nodes and vessels.

Surgery: If cancer surgery requires removal of lymph nodes and vessels, flow of lymph may be interrupted, which will cause lymphedema. Risk increases with the number of lymph nodes removed.

Tumors: Certain tumors near lymph nodes or vessels can block the flow of lymph.

Infection: Skin infections can damage tissue and lead to lymphedema.

There are two different lymphedema causes. The causes can be primary or secondary. 

Primary Lymphedema

Primary lymphedema is a hereditary condition that develops spontaneously on its own. Abnormalities in lymph vessel development often lead to lymphedema. 

The following types of conditions can lead to primary lymphedema:

• Late-onset lymphedema (lymphedema tarda). This is a rare condition that typically occurs at age 35 or older.
• Milroy’s disease (congenital lymphedema). This condition starts at birth.
• Meige’s disease (lymphedema). This condition generally begins at puberty or during pregnancy. However, it can occur anytime from puberty to the age of 35.

Secondary Lymphedema

Secondary lymphedema develops because of other diseases, conditions, or procedures that injure the lymph nodes or lymph vessels. This type of lymphedema is more common than primary lymphedema.

Risk Factors

Risk factors that can contribute to lymphedema include:

Extensive surgery: The greater the surgical field and the larger the number of nodes removed, the higher the risk of developing lymphedema. 

Extensive radiation: The larger the size of the radiation field and the larger the radiation dose, the higher the risk of developing lymphedema

Age: Older age can increase the risk of developing lymphedema.

Obesity: People who are overweight or obese are more likely to develop lymphedema. This is true for those obese at the time of initial treatment as well as those who experience weight gain after treatment. 

Seromas after breast surgery: After breast cancer surgery, pockets of fluid, known as seromas, may develop. These can lead to development of lymphedema.

Infection: Skin infections can damage tissue and lead to lymphedema.

Early swelling: People prone to inflammation can be at higher risk for lymphedema.

Complications

Complications of lymphedema can include:

Cellulitis: This complication is a serious bacterial infection under the skin.

Lymphangitis: Lymphedema can cause infection of the lymph vessels.

Lymphangiosarcoma: This rare form of soft tissue cancer can be a complication of lymphedema.

Prevention

There are things you can do to help prevent lymphedema caused by cancer treatments:

Exercise: Supervised regular exercise improves lymph drainage and can help prevent lymphedema, but avoid heavy lifting, pulling or overusing any body part that is affected.

Maintain a healthy weight: Achieving and maintaining a healthy weight can help prevent lymphedema.

Reduce the risk of injury or infection: Protect any area of the body that has had radiation therapy or surgery to remove cancer or lymph nodes from injury or infection, which can trigger lymphedema.

Prognosis

While lymphedema cannot be cured, preventive measures and treatments can relieve symptoms and minimize swelling. Your lymphedema prognosis depends on the severity of your condition and consistency of treatment. Lymphedema is a life-long condition; however, individuals with mild cases often cope well. Untreated, it can be life-threatening.

Treatment and Recovery

Lymphedema treatment focuses on reducing swelling on the legs and arms, preventing it from getting worse and preventing infection. At Baptist Health Lexington we have physical therapists specially trained in the care of patients with lymphedema. Treatment may include: 

Manual Lymphatic Drainage (MLD)

Specially trained therapists can administer this massage technique that can help move lymph out of a swollen area to an area with working lymph vessels.

Pressure Garments

Special garments that put a controlled amount of pressure on an affected arm or leg can help move lymph and keep it from building up. Sometimes these garments can include a compression device that inflates and deflates on a timed cycle.

Exercise

People with lymphedema or at risk for lymphedema should talk with a lymphedema therapist about the best type of exercise to help encourage lymph fluid drainage.

Laser Therapy

Laser therapy can be used to help decrease lymphedema after a mastectomy.

Weight Loss

Weight loss can help reduce lymphedema in those who are overweight.

Skin Care

Keeping the skin of the affected area clean and moisturized can help prevent infection. Avoid cuts, burns or having a shot or IV in the affected area. Treat small cuts or burns with antibacterial ointment.

Protection from Extreme Heat or Cold

Protect any area affected by lymphedema from extreme heat or cold.