Monday, January 9, 2012

The Why, What, How & Treatment Options for Lymphedema in Cancer Survivors

How does lymphedema affect some survivors?

Lymphedema affects the lymphatic system. The lymphatic tissues and organs produce, store and carry the white blood cells that help fight infections and other diseases. There is an accumulation of protein-rich fluid in the interstitial spaces of an affected body part due to a blockage or malfunction in the lymphatic system. It is often associated with swelling that you can see and feel. This occurs most frequently in the arms and legs.

The swelling of arms, legs, trunk, or other body part occurs from the build-up of lymph fluid. Lymph fluid is the clear fluid that travels through the lymphatic system and carries cells that help fight infections and other diseases. There are two types of lymphedema: primary and secondary.

Sometimes radiation damages lymph nodes and these changes can contribute to lymphedema. In addition, surgeries that remove lymph nodes are sometimes a necessary part of treating cancer. The side effects from some treatments can cause lymphedema.

Lymphedema can occur during treatment, immediately following treatment, or years after cancer treatment ends. Because there is not an exact risk time period, it is important to go for regular check-ups and look for changes in your body that might be symptoms. Whether or not you will get lymphedema really depends on the type of treatment you had, other predisposing factors, and your body's response to treatment.

If you do experience lymphedema, it does not mean that your health care team did not do a good job. The primary goal of your health care team is to treat your cancer. They then work to manage any aftereffects you might experience. It is important to be aware of the risks of lymphedema and other aftereffects of treatment. Watch for symptoms to increase your chances of early detection. This will enable you to inform your doctor and get treated as early as possible.

What are some symptoms of lymphedema?

Symptoms and swelling may appear for a short time, disappear without treatment, and then return. If you notice any symptoms, write down when they happened, what you were doing and if anything made it better.

Sometimes, when the swelling comes and goes often, it might be the beginning of chronic lymphedema. Early detection and treatment are very important. Once swelling becomes chronic, it is only manageable and not reversible. You are likely to be the first to notice symptoms of lymphedema. Check your body regularly for changes.

Lymphedema can affect survivors physically and emotionally. You may have concerns about your appearance, increased risk of infections, functional limitations and pain. Talk with your doctor about any concerns you have.

Common symptoms of lymphedema include:
  • Swelling of the arms, legs or trunk on the affected side of the body
  • Feeling of heaviness or discomfort in an arm or leg
  • Loss of flexibility in the hand, wrist, or ankle
  • Difficulty fitting into your clothes
  • Tightness of rings, watch or bracelet
  • Infections that won't go away or keep coming back in the same area
  • Feeling of tightness in the skin (this may be felt even before there is noticeable swelling)
  • Pitting of the skin

Why does cancer and treatment sometimes cause lymphedema?

Even though other non-cancer conditions can cause lymphedema, it often happens after a treatment that changes your lymph nodes and lymphatic vessels. Lymphedema does not happen because treatment was not done correctly.

The lymphatic system can function at a higher level when your body needs it to do so--but only for a brief period of time. Once the lymphatic system fails to keep up with how much fluid your body needs it to pump, it may not be able to move the fluid where it needs to go in your body.

An infection can also cause damage to the lymphatic system. It is very important to protect the body from infection in order for the lymphatics to work as well as they can.

Certain types of treatment may bring a greater risk for lymphedema. Talk with your health care team about treatments whether there is a risk for you. Ask what can be done to try to prevent this from happening.

Cancer-related procedures that may bring increased risks of developing lymphedema include:
  • Biopsy: A biopsy is when your tumor and surrounding tissue is removed for testing. This may damage lymphatic pathways and may allow bacteria to enter the body through the break in the skin. Damage to the lymph pathway and infection both cause increased congestion. This can be a first step in the development of lymphedema.
  • Surgery: You may have lymph nodes removed during surgeries for melanoma or breast, gynecological, head and neck, prostate, testicular, bladder, colon or other type of cancer. Lymph vessels may also be cut during the course of surgery to remove tumors and surrounding tissue. This puts survivors at risk of developing lymphedema.
  • Radiation therapy: Radiation kills cancer cells that might be left behind after surgery. Radiation therapy often causes fibrosis or thickening of the tissues in the area of your body that received radiation. The thickening of the tissue may make it harder for lymph fluid to flow from your legs and arms into the middle of your body.

Lymphedema can be managed with effective treatment, but there is no cure. However, it is believed that an early diagnosis and treatment of any temporary swelling can help prevent chronic lymphedema from happening.

Who might be at most risk for lymphedema?

People who have had the following surgical procedures may be at greater risk for developing lymphedema:
  • Biopsy
  • Lumpectomy
  • Simple mastectomy
  • Modified radical mastectomy with node dissection in the armpit
  • Surgical removal of lymph nodes
  • Traumatic injury
  • Radiation
  • Infection
  • Impaired lymphatic structure and function
  • Surgery or biopsies that sample lymph nodes or disrupt lymph flow in the groin or axilla (armpit).
  • Individual predisposition and basic conditioning factors yet to be fully understood

Survivors of the following cancer types are at risk for developing lymphedema:
  • Breast cancer
  • Melanoma
  • Prostate cancer
  • Ovarian cancer and other gynecological cancers
  • Head and neck cancers
  • Colorectal cancer
  • Cancers involving lymph node sampling or dissection
  • Radiation to the lymph nodes

Other factors can also put a survivor at risk for lymphedema. These include being seriously overweight, having diabetes and taking certain medications. However, there has not yet been a great deal of research about how or whether these factors increase your risk for lymphedema. Discuss these factors with your health care team, if they apply to you.

What can be done to minimize risks for developing lymphedema?

To decrease your risk of developing lymphedema, talk with your health care team about treatment alternatives. Ask about strategies to minimize your risk and learn about lymphatic therapy. Contact Melissa Gallagher, Certified Lymphatic Therapist for more information.

Works Cited

Lymphedema Risk Reduction Practices – National Lymphedema Network

Ridner SH. "Breast cancer lymphedema: pathophysiology and risk reduction guidelines." Oncology Nursing Forum 29(9) (Oct. 2002): 1285-93.

National Lymphedema Network Position Papers online:

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