Lymphedema After Head and Neck Cancer
What is the lymph system?
The lymph system is made up of lymph nodes and vessels. 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. The lymph system also recycles proteins throughout the body.
What is lymphedema?
Lymphedema is a chronic swelling that 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 a large number of 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 or externally:
- 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, ears, etc.
A patient can have either 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; this 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, treatment may be needed.
The most common symptoms first reported 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 symptoms?
Symptoms of lymphedema in the head and neck patient vary, depending on where the edema is and how severe it 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/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.
You may also feel embarrassment and frustration due to these changes.
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 strategies to lower the risk of developing lymphedema, including:
- How to prevent injury and infection to the head and neck.
- Regular exercise and maintaining 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 includes:
- Manual lymphatic drainage: Uses a series of gentle, circular massage strokes to promote lymphatic flow.
- Compression: Compression bands or garments are worn around the chin, face and head to provide gentle support to the soft tissues. The compression lessens swelling and helps the body reabsorb the extra fluid.
- Exercise: Strengthening of area muscles and increasing range of motion.
- Self-Care: Learning how to lower risks and continuing of 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 self-manage. These initial treatments are done in an outpatient therapy center. The therapist will spend time teaching the patient and caregiver how to continue these treatments at home.
- Phase two (the homecare phase) is when treatments are done at home.
In severe 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.
Deng J., Murphy B.A., et al. Impact of secondary lymphedema after head and neck cancer treatment on symptoms, functional status, and quality of life. Head Neck. 2013. 35(7): 1026-35.
Deng J Ridner SH et al. Factors associated with external and internal lymphedema in patients with head-and-neck cancer. International Journal of Radiation Oncology. 2012. 1 84(3).
Toronto Physiotherapy. Patient Guide: Head and Neck Lymphedema Following Cancer Treatment. Lindsay Davey. Jan 27, 2016. Found at: http://torontophysiotherapy.ca/head-and-neck-lymphedema-following-cancer-treatment/
Smith, BG and Lewin JS. The Role of Lymphedema Management in Head and Neck Cancer. Current Opinion in Otolaryngeal, Head and Neck Surgery. 2014. 18(3) 153-158.