After Cancer Treatment Surveillance: Lymphedema

Lymphedema is swelling that usually occurs in the arms and legs as the result of an impaired lymphatic system. The lymphatic system can be injured in a number of ways, including as a result of surgery, and radiation therapy (which may be used to treat cancer), or  by injury or infection.Since the lymphatic system is used to drain fluid from the tissue of the cells, if it becomes impaired, protein-rich fluid can become backed up, causing swelling. In some cases, swelling due to lymphedema can occur immediately following treatment but in others, lymphedema does not occur until years after treatment.

Signs of lymphedema can include a feeling of fullness or pressure, the sensation of swelling before visually noticeable swelling, pins-and-needles sensation in the limb, feeling of heat in your arm or on the affected side of your body, redness and inflammation, a bursting sensation in the limb, or aches in the limb.  Someone might notice that a watch or an article of clothing is tighter than it was previously on one side of the body.

There are three grades of lymphedema: 

• Grade one marked by when the skin is pressed and the pressure leaves a pit that takes some time to fill back in, referred to as pitting edema, it is usually reversible.
• Grade two is when the swelling area does not pit and is not reduced by elevation of the limb, if left untreated the limb can change in texture and density.
• Grade three, often called elephantiasis, usually occurs in the legs after lymphedema has been left untreated for a long time. There may be leakage of fluids through the tissue in the affected area.  

There are multiple treatments for lymphedema which may help to reverse the effects of swelling. It is helpful to seek treatment shortly after symptoms emerge.  Self-massage, called manual lymph drainage, involves massaging the affected area to reduce swelling. If you are going to use self-massage, it is important to first consult a therapist. This can be a physical therapist, occupational therapist or massage therapist with training in lymphedema management who can teach you the technique. Compression bandages can be used to compress the swollen tissue to assist in reducing swelling. It is important to use compression bandages rather than ace bandage wraps with this treatment as ace bandage wraps are not effective in treating lymphedema. Compression garments can also be worn to help with swelling as prescribed and fit by a trained lymphedema therapist.

As lymphedema can occur weeks, months or years after treatment, it is important to monitor for increased swelling especially if your cancer treatment included radiation therapy or surgery. Participating in heavy lifting or strenuous exercise during warm weather can put extra stress on your body and exacerbate lymphedema symptoms. If you notice symptoms of lymphedema, consult your doctor so they can put together a treatment plan for you that may include seeing a trained lymphedema therapist, along with some of the treatments listed above.

References: 

Burt, J., & White, G. (1999). Lymphedema: A Breast Cancer Patient’s Guide to Prevention and Healing. Alameda, CA: Hunter House Publishing