Occurrence and Recommended Treatment of Lymphedema

Christina S. Chu, MD,
Last Modified: November 1, 2001

Dear OncoLink "Ask the Experts,"
I had a total abdominal hysterectomy, bilateral salpingioopherectomy, pelvic and peri-aotic lymph node dissection last year for left low malignant potential ovarian tumor. About 3 months after surgery I realized my left calf and ankle were enlarged. Ultrasound was negative for blood clot. My surgeon says it is lymphedema. I would appreciate any information you can provide about this occurrence and recommended treatment.

Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of Pennsylvania Health System, responds:

The lymphatic system is responsible for collecting fluid and proteins from body tissues. Small vessels carry this fluid to regional lymph nodes, and eventually drain the fluid back into the bloodstream. Lymphedema occurs when these vessels are blocked. Excess fluid and protein accumulates in the tissues and leads to swelling. Some patients develop lymphedema as a result of a developmental problem with the lymphatic vessels. Other patients develop lymphedema due to the spread of cancer to regional lymph nodes or, as in your case, by the surgical removal of the lymph nodes, particularly when radiation therapy is also administered.

Controlling lymphedema can be a difficult problem. I would recommend you seek out a specialist in the area. Often, treatment starts with simple measures such as leg elevation and sequential pneumatic compression boots that provide massage to the leg. Firm elastic stockings, or specially fitted elastic garments can also help the swelling. Lymphatic flow can be enhanced by physical exercise and by a technique of massage called effleurage. If you notice any discoloration of the skin or sores on your affected leg, you should see a physician for evaluation.