Understanding and Decreasing Lymphedema Risk
Andrea Branas, MSE, MPT, CLT & Joy Cohn, PT, DPT, CLT
Good Shepherd Penn Partners
Last Modified: December 12, 2011
Following some treatments for cancer, there is a risk of developing lymphedema. Lymphedema is an uncomfortable swelling that occurs in the area where you had cancer treatment. This is called the "at risk area" and can include:
- Breast cancer at risk areas include the breast, underarm, arm and hand on the side of surgery and/or radiation.
- At risk areas for head and neck cancers are the face, chin and neck.
- At risk areas after treatment to the abdomen or pelvis (such as in gynecologic cancers) are the abdomen, buttocks, genitals, legs and feet.
- In melanoma, the at risk areas after groin lymph node dissection are the abdomen, buttocks, genitals, and leg and foot on the side of surgery. If lymph nodes were removed from the underarm (axillary) area, the risk is to the chest wall, arm and hand on the side of surgery.
Lymphedema occurs because of an impaired lymphatic system. There is no research that demonstrates that lymphedema can be prevented, but the risk of developing lymphedema can be reduced or moderated by understanding how to reduce the demand you place on the lymphatic system in your arm.
We do know from research that there are a number of factors that increase the risk that you MAY develop lymphedema. They include:
- Amount or extent of surgery or lymph node dissection
- Amount of Radiation to the lymph nodes
- Advanced Stage Cancer
- Infection or injury to the body part
- Being overweight or obese
What are the Signs/Symptoms of Lymphedema?
- Aching Pain or Heaviness
- Tight jewelry
What are the signs/ Symptoms of Infection?
- Sudden increase of swelling
- Change or increased intensity of pain
- Increased temperature of the affected area/ warm to touch
- Flu-like symptoms of fever and achiness
**If you are experiencing signs of infection, contact your physician or report to your closest Emergency Department within 12 hours of these symptoms. DO NOT WAIT!
Common Sense Rules to Reduce Your Risk
Take good care of your skin to reduce the risk of infection and injury by following these tips:
- Keep your skin clean and moisturized.
- For arms and hands at risk: wear gloves when you wash dishes or garden or when you use harsh chemicals for cleaning
- For legs and feet at risk, wear shoes and socks at all times to prevent injury
- Use an electric razor for your armpit, face or legs (if you need to!)
- Avoid injection or blood drawing in the at risk area
- Avoid manicures/pedicures (based on your at risk area) or at least avoid cutting your cuticles and bring your own tools so that they have not been used for another person
- If your leg and foot are at risk, you may want to consider having your toenails cut by a podiatrist.
- Clean cuts/bites well with soap and water and use an antibiotic cream to encourage early healing. Observe for signs of infection and report immediately if they occur.
- Avoid overheating the at risk area in a hot tub or sauna
- Use a high SPF sunscreen or Insect repellant when appropriate
Avoid constricting your blood flow, which can result in a 'backup' of fluid in the at risk area
- Avoid blood pressure readings in the at risk arm (if applicable)
- Avoid tight jewelry or clothing on the at risk limb
- After treatments affecting the underarm (axillary) lymph nodes, women should wear a well fitted bra without underwires and, if applicable, use a lightweight prosthesis (a heavy prosthesis can put too much pressure on the lymph nodes above the collarbone)
- Avoid carrying a heavy shoulder bag or suitcase for long periods with an at risk arm. Rolling suitcases or luggage racks help!
Maintain your Ideal Weight
Obesity is a known risk factor for lymphedema. A balanced healthy diet with emphasis on portion control is recommended. Exercise is another excellent way to help maintain your weight.
Exercise with Care
Having cancer and receiving treatment for it will change your body. Exercise is one of the best ways that you can maintain strength, energy, mobility and cope with cancer related fatigue. Refer to the About Exercise During and After Cancer Treatment article for more information on exercise.