Understanding and Decreasing Lymphedema Risk

Lymphedema is abnormal swelling that can develop. It occurs when extra fluid (lymph) collects in the body due to damage or blockage in the lymphatic system. The lymphatic system normally drains and filters fluid in your body. When this lymphatic system becomes blocked or damaged, swelling can occur. Lymphedema can be uncomfortable and even painful, and over time, it may result in infections. Lymphedema usually develops gradually, and you may feel an unusual sensation such as tingling or numbness. Other common symptoms include achiness, feelings of fullness or heaviness, puffiness or swelling, and decreased flexibility or tightness in the hand, arm, chest, breast, or underarm areas. Early treatment of lymphedema is important, so you should tell your doctor if you experience any of these symptoms. Lymphedema can happen in areas of the body that have been treated for cancer. Lymphedema can be caused when lymph nodes are removed or damaged by cancer surgery, caused by the disease itself, or due to the effects of radiation.

Following some cancer treatments, there is a risk of developing lymphedema. This is called the "at-risk area.” Difference cancers have different risk areas:

• Breast cancer risk areas: the breast, underarm, arm, and hand on the side of surgery and/or radiation.
• Head and neck cancer risk areas: face, chin, and neck.
• At-risk areas after treatment to the abdomen or pelvis (such as in gynecologic cancers): the abdomen, buttocks, genitals, legs, and feet.
• In melanoma, the at-risk areas after groin lymph node dissection are the abdomen, buttocks, genitals, 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.

What increases your risk of lymphedema?

Lymphedema happens when there is a buildup of lymph due to damage or blockage in the lymphatic system. Currently, no research demonstrates that lymphedema can be prevented, but the risk of lymphedema can be lowered by reducing the demand you place on the lymphatic system in the affected area. There are both modifiable and non-modifiable risk factors. Non-modifiable risk factors are risk factors that are beyond your control. However, modifiable risk factors are ones that you can control.

Non-modifiable:

• Amount or extent of surgery or lymph node dissection.
• Amount of radiation to the lymph nodes.
• Advanced stage cancer.
• Type of surgery/chemotherapy. 

Modifiable:

• Being overweight or obese.
• Weight gain after diagnosis.
• Infections, injury, or trauma to the affected limb.

What are the signs/symptoms of lymphedema?

• Aching pain or heaviness
• Swelling or puffiness
• Decreased flexibility
• Numbness or tingling
• Tightness
• Stiffness
• Tight jewelry

If lymphedema goes untreated, there is a chance of infection. It is important to pay attention to any sudden changes in the affected area and notify your doctor right away.

What are the signs/symptoms of infection?

• Sudden increase of swelling
• Change or increased intensity of pain
• Redness or any change of color to your skin
• Increased temperature of the affected area/ warm to touch
• Flu-like symptoms such as fever, chills, and achiness

Note: If you are experiencing signs of infection, contact your care team or report to your closest Emergency Department right away. DO NOT WAIT!

Ways to Reduce Your Risk of Infection

Skin Care

Take good care of your skin to reduce the risk of infection and injury by following these tips:

• Keep your skin clean and moisturized.
• Wash your hands regularly/ use hand sanitizer.
• For arms and hands at risk: wear gloves when you wash dishes, gardening, or when you use harsh chemicals for cleaning.
• For legs and feet at risk, wear shoes and socks at all times to prevent injury.
• If you are experiencing decreased sensation in your hands or feet due to chemotherapy-induced peripheral neuropathy, make sure to visibly check your skin since you may not be able to feel things appropriately.
• Use an electric razor for necessary hair removal to reduce cutting yourself
• Reduce injections or blood draws in the at-risk area.
• Ask your doctor when it is safe to get manicures/pedicures (based on your at-risk area). If you do decide to get a manicure or pedicure, bring your own tools so that they have not been used for another person.
• Clean cuts 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.
• Ask your doctor about safety when it comes to public swimming pools.
• Make sure to clean all equipment at the gym before and after use to avoid spreading germs.
• Use a high SPF sunscreen and insect repellant when appropriate.
  • Make sure to check with your doctor about what kind of moisturizers to use. 
  • If your leg and foot are at risk, you may want to consider having your toenails cut by a podiatrist.

Avoid Constricting Your Blood Flow

This can result in a 'backup' of fluid in the at-risk area. Ways to avoid constriction include:

• Avoid blood pressure readings in the at-risk arm when possible. If not possible, a blood pressure can be taken on the affected arm using a stethoscope and manual blood pressure cuff. 
• 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 an underwire 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 an emphasis on portion control is recommended. Exercise is another excellent way to help maintain your weight. Before starting any exercise program, make sure to check with your doctor. 

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. Again, before starting any form of exercise, it is always recommended that you check with your doctor. 

Next Article: Treatment for Lymphedema: Complete Decongestive Therapy (CDT) »