Lymphedema After Head and Neck Cancer

What is the lymph system?

The lymph system is made up of lymph nodes and vessels (tiny tubes that carry blood throughout your body). They run throughout the body to drain extra fluid and return it to the blood near the heart. Lymph nodes filter viruses, dying cells, foreign matter, and bacteria to fight infection and keep us safe. The lymph system also recycles proteins throughout the body.

What is lymphedema?

Lymphedema is swelling that happens over a long period of time (chronic swelling). Lymphedema happens when lymph fluid is not moving well through the lymph system. It starts to build up in the tissues and leads to swelling.

What causes lymphedema in head and neck cancer patients?

If you have head and neck cancer, lymphedema can happen in any part of the head, neck, and face. There are many lymph nodes in these areas. Lymphedema can happen after cancer treatment because parts of the lymph system have been removed or harmed by surgery or radiation. Also, scar tissue from these treatments can change how the lymph system works.

Lymphedema happens 2-6 months after treatment. Lymphedema can happen internally (inside the body) or externally (closer to the outer parts of the body):

• Internal lymphedema can happen anywhere inside the body, such as the oral cavity, tongue, larynx (voicebox), airway and throat.
• External lymphedema happens in the neck and face and can include lips, nose, eyelids, and ears.

You can have internal or external lymphedema, or both.

How is it diagnosed?

The more lymph nodes removed or harmed during treatment, the greater the chance of having lymphedema. It is normal to have swelling during and shortly after treatment that gets better on its own, which is not lymphedema. Your provider will know the difference between normal swelling and lymphedema. The normal swelling from surgery often goes away, but if it lasts more than 6 weeks, you may need treatment for it.

The most common first symptoms are swelling, skin tightness, or achiness. A provider will do a physical exam to check these symptoms and look for any signs of lymphedema. If swelling is found, the provider may measure the swelling or rate it using a standard scale for lymphedema.

What are the other symptoms?

Symptoms of lymphedema in the head and neck patient vary, depending on where and how bad the edema is. Symptoms can include:

• Swelling in any part of the head and neck that may feel hard to the touch.
• A feeling of tight skin or muscles.
• Decreased range of motion in the neck and shoulders (feeling like you can’t move these areas as freely or easily as you could before).
• Change in sight or hearing.
• A change in breathing, swallowing, eating, or speaking.
• Feeling congested (stuffy).
• Pain in the ear.

What is the treatment for head and neck lymphedema?

The earlier that lymphedema is treated, the better the outcomes. You may be referred to a therapist to learn ways to lower the risk of getting lymphedema, such as:

• How to prevent injury and infection to the head and neck.
• Regular exercise and keeping a healthy weight.
• Using proper body movement and sleeping positions.
• Protecting your skin and keeping it moisturized.
• Avoid tight clothing, scarves, and jewelry around the neck.

If you have been diagnosed with lymphedema, your treatment will most likely use complete decongestive therapy (CDT). CDT uses:

• Manual lymphatic drainage: A series of gentle, circular massage strokes to help with lymphatic flow.
• Compression: Compression bands or garments are worn around the chin, face, and head to give gentle support to the soft tissues. The compression lessens swelling and helps the body reabsorb (take in) the extra fluid.
• Exercise: Strengthening of area muscles and increasing range of motion.
• Self-Care: Learning how to lower risks and keep up with the above treatments.

It is important to find a therapist who has specialized training in lymphedema. Therapy is often done in two phases.

• The first phase (called the intensive phase) is over a period of 2-4 weeks, with focus on reducing the swelling and teaching you how to manage it yourself. These first treatments are done in an outpatient therapy center. The therapist will spend time teaching you and your caregiver how to do these treatments at home.
• Phase two (the homecare phase) is when treatments are done at home.

In serious cases, patients should be followed closely as the swelling could block the airway, making it hard to breathe. Lymphedema in the head and neck cancer patient is manageable when diagnosed and treated early. Report any symptoms to your provider. If you feel like the swelling is making it hard to breathe, call 911 right away. Learn more about lymphedema on OncoLink.