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Lymphedema: A Common Complication of Cancer Treatment

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Lymphedema is the buildup of fluid in the fatty tissue just under your skin. The fluid is made up of lymph, which is part of your immune system and helps fight infection and disease. It's common for doctors to remove some lymph nodes during many different types off cancer surgery to determine whether the cancer has spread. This removal, while necessary, can sometimes make it more difficult for fluid to move throughout the body. The fluid can build up, causing painful swelling, usually in the arm or leg.

Lymphedema can be an inherited condition, called primary lymphedema. In these cases, the lymph nodes and lymph vessels are abnormal or absent. But in this article, we're talking about secondary lymphoma, which is a result of damage to the lymph node.

Surgeries that require removal of a lymph node create the risk of lymphedema. These can include surgeries for breast, prostate, gynecological, head and neck, testicular, bladder and colon cancer and melanoma. Radiation, which can damage lymph nodes, can cause lymphedema as well.

Lymphedema sometimes occurs in the very early days after surgery. This is usually a milder version, and typically lasts a short time. The affected area may become warm and red, but generally improves within about a week if you keep the area elevated and if you contract the appropriate muscles. For example, if you develop lymphedema in your arm just after surgery, your doctor may recommend that you keep your arm raised and that you periodically make and release a fist.

Lymphedema also sometimes occurs six to eight weeks after surgery or during radiation treatment. In a case like this, you need to keep the area elevated and take anti-inflammatory medication.

The most common type of lymphedema that cancer patients experience develops slowly. You may not notice it until 18 or 24 months after surgery or radiation, or even after that time frame. Symptoms include skin discomfort and aching in the neck, shoulders, spine or hips. The pain is caused by the stretching of the soft tissue due to swelling. Additionally, the weight of the swollen limb can change your posture, which can also cause pain.

Lymphedema can be temporary or chronic

When lymphedema is temporary, it lasts less than six months. Your skin may remain pressed in when you push on it, but it doesn't become hard. You'll need to keep your arm or leg elevated, do gentle exercises and perhaps wear elastic garments that keep the area compressed.

Chronic lymphedema is more complicated, more painful and harder to treat. As the body tissues continue to swell with lymph fluid, the lymphatic system, which has been damaged, is unable to keep up with the need to drain that fluid. Pain, heat, redness and swelling increase. The skin becomes hard and stiff. Elevation, gentle exercise and elastic compression typically no longer improve the condition. Chronic lymphedema increases the risk of infection.

Know the early signs of lymphedema

Your recovery from lymphedema is likely to be more successful and faster if you recognize and address the early symptoms. These include:

" A tight feeling in the arm or leg
" Rings or shoes becoming tight
" Weakness in the arm or leg
" Pain, aching or a heavy feeling in the arm or leg
" Redness or swelling

Prevention is extremely important

In addition to having surgery to remove lymph nodes and having radiation treatment, there are other factors that increase your risk of lymphedema. These include being overweight, eating an unhealthy diet and not getting enough exercise. You're most likely to prevent lymphedema if, after surgery and radiation, you follow instructions for your care. Be sure to follow through on all prescribed exercises your doctor or physical therapist recommend.

You can also help avoid lymphedema by keeping all of your regularly scheduled medical appointments and by checking your arms and legs every day for early symptoms

Be sure to read our August 2003 Cancer E-Magazine article, which talks about ways that dance and movement therapy can be beneficial for lymphedema.



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