Lymphedema

Preventing Lymphedema

Lymphedema (poor lymph flow) is the buildup of lymph fluid in the tissue just under the skin caused by a blockage or damage to the lymph system. It creates swelling or a tight feeling, usually in the arms and legs, and may be caused by cancer treatment or by the cancer itself.

Surgery and radiation therapy often lead to this condition, particularly when those treatments are applied to the underarm, groin, pelvis, or neck. Lymphedema commonly occurs in patients with breast cancer who had lymph nodes removed in the underarm and/or received radiation to that area. Swelling may occur immediately after treatment, or it may arise weeks, months, or even years later.

Improved treatment methods have lessened the risk that you’ll develop lymphedema. By staying alert to certain symptoms, you’ll help your health care team know if there’s a problem, so quick action can be taken.

How Lymphedema Develops

As the blood travels into smaller and smaller vessels, excess fluid, protein, and other substances are pushed out into the surrounding tissue. The combination of these substances is called lymph fluid. Under normal circumstances, lymph fluid is removed from the tissue by the lymph system, which is a series of vessels and organs that move the fluid back toward the heart and filter it through lymph nodes. Lymph nodes are specialized structures made up of white blood cells that “clean” the lymph fluid of bacteria and other contaminants. If there is damage to or blockage in the lymph system, the lymph fluid cannot be removed and builds up in the tissue.

Lymphedema that is caused by the cancer itself is usually related to:

• Spread (metastasis) to the lymph nodes in the neck, chest, underarm, pelvis, or abdomen
• Growth of cancer in the pelvis or abdomen that blocks lymph drainage by invading or putting pressure on the lymphatic vessels and/or the large lymphatic duct in the chest

Preventing Lymphedema Can Start with Selecting Cancer Treatment

Lymphedema occurs less frequently now than in the past because of improved surgical techniques. Historically, when breast cancer was thought to spread to the lymph nodes, the surgeon would remove as many lymph nodes as possible. This approach would sometimes cause severe lymphedema. Recently, a technique has been developed that makes it possible to remove only one lymph node, called the sentinel node. The sentinel node is the first node that drains a particular area, such as the breast. In a sentinel node biopsy, the surgeon injects a dye into the affected area to identify which node is the first to be marked by the dye. If the sentinel lymph node is free of cancer, then it is unlikely any of the other lymph nodes located “downstream” have cancer, and they are not removed.

Research now indicates that sentinel node biopsy appears to be just as effective in determining cancer spread to axillary lymph nodes as an axillary lymph node dissection, and results in fewer side effects in patients with early-stage breast cancer. 

Effective Management of Lymphedema Starts With Being Aware of Symptoms

Understanding and recognizing symptoms of lymphedema at its first onset is important for successful management of this condition. Even a slight increase in swelling in the extremities should not be ignored. Patients should notify their health care provider immediately if they notice any of the following:

• Feelings of tightness in the arm or leg
• Decreased flexibility in a hand, elbow, wrist, fingers, or leg
• Difficulty fitting into clothing
• A ring, wristwatch, bracelet, or shoe that fits more tightly than usual
• Pain, aching, heaviness, or weakness in the arm or leg
• Redness, swelling, or signs of infection
• Skin that feels stiff or taut
• Pitting (small indentations left on the skin after pressing on the swollen area)

Staying Vigilant: Lifestyle Choices Can Help Prevent Lymphedema

While newer treatment techniques reduce the number of lymph nodes removed, some patients still develop symptoms. A few lifestyle changes can help prevent lymphedema. The basic principles are to minimize any increases in lymph production and minimize any impediments to lymph flow.

Circumstances that should be avoided because they tend to increase lymph production include:

• Extreme heat from saunas, hot tubs, and heating pads
• Strenuous, fatiguing exercises
• Airplane travel and high altitudes (increased pressure)
• Excessive sun exposure

Circumstances that should be avoided because they tend to impede lymph flow include:

• Blood pressure monitoring on the affected arm
• Restrictive clothing or jewelry
• Extreme cold (such as an ice pack)
• Carrying a handbag or luggage with the affected arm

In addition, attention to health and hygiene improves overall health and can also help prevent lymphedema.

• Hygiene - Clean the skin of the arm or leg daily, but avoid rigorous scrubbing. Keeping the affected arm clean can reduce the risk of infection, which is higher among patients experiencing lymphedema because of the decreased capacity of their lymphatic system to carry bacteria away from the tissue. There is also a higher presence of protein and oxygen in the spaces between the cells, providing an environment where bacteria can flourish.
• Exercise - The muscle contraction of moderate exercise promotes lymph flow and an increased absorption of protein. However, fatiguing exercise can actually increase the production of additional fluid. Patients should consult with a doctor to determine the most beneficial type of exercise and do the prescribed exercises regularly.
• Diet - Maintaining an ideal weight and following a healthy, low-fat, low-sodium diet are associated with improved overall health that may hinder the development of lymphedema.