Patient education: Peripheral lymphedema after cancer treatment (The Basics)

What is peripheral lymphedema? — Peripheral lymphedema is a buildup of fluid in the limb (arm or leg). It happens in some people who have had surgery or radiation treatment for cancer. Not all people treated for cancer get lymphedema.

The body has a network of vessels called the "lymphatic system" that carries a clear fluid called "lymph" (figure 1). The lymph nodes are part of this system. The lymphatic system is similar to the system of blood vessels. But instead of blood, the lymphatic system carries lymph, which contains infection-fighting cells.

Lymphedema happens when the flow of lymph through the lymphatic system gets backed up. Cancer treatments, such as surgery or radiation, can cause damage to the lymph nodes or lymphatic vessels in the armpit, groin, or other places. This can cause peripheral lymphedema.

What are the symptoms of peripheral lymphedema? — The most common symptoms are:

●Swelling in your limb

●Aching pain

●Tight or heavy feeling in the affected limb

●Trouble moving the affected limb

The symptoms can begin slowly. It might be weeks, months, or even years after your cancer treatment before you have symptoms of peripheral lymphedema.

Is there a test for peripheral lymphedema? — Yes, but this is usually not needed. Your doctor or nurse can figure out if you have peripheral lymphedema by talking to you about your symptoms and doing an exam. An important part of the exam will be to measure the length around the affected limb. This measurement is called your "limb circumference." Your doctor or nurse will do this in several places along your limb.

Is there anything I can do on my own to feel better? — Yes. It is very important to avoid injury or infections of your affected limb. There are also other things you can do that might help reduce the amount of swelling.

To avoid injury:

●Keep your skin clean. Wash with a mild soap every day.

●Be careful with your nails. Don't pick at the skin around your nails or cut your cuticles.

●Use lotion to keep your skin from getting dry and cracked

●Use an electric razor instead of a razor blade to shave

●Always use sunscreen when you go outside

●If an arm is affected, wear gloves when gardening, cooking, or doing other things that could hurt your skin

●If a leg is affected, wear hard-soled shoes when outside

●If you do get a small cut, scrape, or bite on your arm, hand, leg, or foot, clean it well with soap and water. Then use an antibiotic cream, such as bacitracin. Call your doctor or nurse if it does not heal quickly or if you have signs of an infection.

●When possible, avoid shots, blood draws, or IV lines in the limb with lymphedema. Avoid other procedures that puncture the skin, like acupuncture or tattooing.

●If you have lymphedema in an arm, avoid routinely having your blood pressure taken on that side

●Avoid saunas, steam baths, and hot tubs

To help reduce the amount of swelling:

●Wear loose-fitting clothes and jewelry, unless it is a special garment or bandage your doctor or nurse gives you

●Keep your weight under control

●Do not let your arm hang at your side for long periods of time without moving it. If your leg is affected, avoid standing for long periods of time.

●Keep your limb raised on pillows when you're sitting or lying down

Should I see a doctor or nurse? — You should call your doctor or nurse if:

●You have increased swelling

●You have redness (red patches or streaks) or a rash

●The affected limb feels warm to the touch

●You have a temperature higher than 100.4°F (38°C) that is not from a cold or other illness

How is peripheral lymphedema treated? — There is no cure for lymphedema. But there are treatments that can help reduce the swelling and make you more comfortable. These treatments work best if you start them before the swelling has gotten too bad, so see a doctor or nurse as soon as you notice any swelling. It is best to go to clinics that have people who have experience treating lymphedema.

Treatments can include:

●Exercise – Exercise can help keep lymphedema from getting worse. During exercise, people with lymphedema should always wear a compression bandage or sleeve (see below).

●Compression bandaging – Compression bandaging is a special kind of bandaging that puts gentle, steady pressure on the swollen area. This helps keep the swelling down.

●Compression "sleeves" or "hosiery" – These work a lot like compression bandaging. They put gentle, steady pressure on the affected limb to keep swelling down.

●Manual lymphatic drainage – For this treatment, a physical therapist massages your limb in a special way to help move the fluid that has built up.

●Surgery – If you have severe lymphedema, your doctor might suggest surgery. These procedures are called "lymph bypass" and "lymph node transfer."

Can peripheral lymphedema be prevented? — Sometimes. If you have breast cancer, a surgeon might need to remove lymph nodes from your armpit area to check if the cancer has spread. Removing all or most of the lymph nodes in this area increases the risk of getting arm lymphedema later. Similarly, if you have melanoma (a type of skin cancer), a surgeon might need to remove lymph nodes from your groin area. This can increase the risk of leg lymphedema. In some cases, doctors can lower the risk of lymphedema by only removing 1 or a few lymph nodes.

Lymphedema cannot always be prevented, but if you treat it early, you might be able to keep it from becoming too severe.

More on this topic

Patient education: Sentinel lymph node biopsy for breast cancer (The Basics)

Patient education: Lymphedema after cancer surgery (Beyond the Basics)