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Lymphedema

Topic Overview

What is lymphedema?

Lymphedema is a collection of fluid that causes swelling (edema) in the arms and legs.

What causes lymphedema?

One of the causes of lymphedema is surgery to remove lymph nodes, usually during cancer treatment. Normally, lymph nodes filter fluid as it flows through them, trapping bacteria, viruses, and other foreign substances, which are then destroyed by special white blood cells called lymphocytes. Without normal lymph drainage, fluid can build up in the affected arm or leg, and lymphedema can develop. Medicines such as tamoxifen (Nolvadex), radiation therapy, and injury to the lymph nodes can also cause lymphedema. This type is called secondary lymphedema.

Primary lymphedema can be present at birth or develop during puberty or adulthood. The cause of primary lymphedema is not known.

What are the symptoms?

Symptoms of lymphedema include feeling as though your clothes, rings, wristwatches, or bracelets are too tight; a feeling of fullness in your arms or legs; and less flexibility in your wrists, hands, and ankles.

How is it treated?

Treatment for lymphedema depends on its cause and includes wearing compression garments such as stockings or sleeves, proper diet and skin care, and fluid drainage.

Elevating an arm or leg that has swelling can help ease the drainage of lymph fluid from the affected limb. Whenever possible, rest a swollen arm or leg on a comfortable surface, above the level of your heart. Don't put pressure on your armpit or groin area, and don't hold a limb up without support for very long since this can increase swelling.

Gentle exercise can help reduce swelling. The use of muscles during exercise naturally helps lymph fluid to circulate, which can reduce swelling. But exercise also increases blood flow to the muscles being used, which can increase the amount of lymph fluid present. If you have swelling, it is important to properly bandage an affected limb before exercising. Ask your doctor how to use a bandage for this purpose and what exercises are appropriate for your condition.

After surgery or radiation treatment

If you have had surgery to remove some lymph nodes, use your affected arm or leg as normally as possible. Most people are healed about 4 to 6 weeks after surgery, and able to go back to their normal activities.

If you have had lymph nodes removed or have had radiation therapy as part of cancer treatment, you may be able to avoid lymphedema or keep it under control by following the tips below.

  • Contact your doctor promptly if symptoms of an infection—such as redness, pain, or increased swelling—develop in your arm, hand, leg, or foot.
  • Protect the area below the surgery from injury, even many years after surgery.
  • If you have had lymph nodes removed from under your arm:
    • Do not have blood drawn from the arm on the side of the lymph node surgery.
    • Do not allow a blood pressure cuff to be placed on that arm. If you are in the hospital, make sure you notify your nurse and other hospital staff of your condition.
    • Use an electric shaver for underarms.
    • Wear gloves when gardening or doing other activities that may lead to cuts on your fingers or hands.
  • If you have had lymph nodes removed from your groin:
    • Bathe your feet daily in lukewarm, not hot, water. Use a mild soap, preferably one that has moisturizers, or use a moisturizer separately.
    • Wear comfortable and supportive shoes that fit properly.
    • Wear the correct size panty hose and stockings. Avoid wearing constricting garters or knee-high or thigh-high stockings.
  • Ask your doctor how to handle any cuts, scratches, insect bites, or other injuries that may occur.
  • Use sunscreen and insect repellent when outdoors to protect your skin from sunburn and insect bites.
  • Do not ignore a feeling of tightness or swelling in or around your arm, hand, leg, or foot. Let your doctor know about it immediately.
  • Ask your doctor to refer you to a physical therapist who specializes in lymphedema. Many insurance companies will not pay for physical therapy evaluations and treatments without a doctor's referral.

If you have been diagnosed with lymphedema and plan to travel by air, you'll need to use a compression garment. Changes in cabin pressure during flight can cause swelling or make it worse. A compression garment that doesn't fit right can also make swelling worse, so be sure your garment fits correctly.

If you have lymphedema, you may want to wear a lymphedema alert bracelet. These bracelets, available through the National Lymphedema Network, are worn to protect people who have lymphedema from receiving treatment such as blood pressure readings, injections, or blood draws to their affected limbs. These treatments could make their conditions worse.

Related Information

References

Other Works Consulted

  • Lawenda BD, et al. (2009). Lymphedema: A primer on the identification and management of a chronic condition in oncologic treatment. CA: A Cancer Journal for Clinicians, 59: 8–24.
  • Stubblefield MD (2011). Rehabilitation of the cancer patient. In VT DeVita Jr et al., eds., DeVita, Hellman and Rosenberg's Cancer: Principles and Practice of Oncology, 9th ed., pp. 2500–2522. Philadephia: Lippincott Williams and Wilkins.

Credits

By Healthwise Staff
Sarah Marshall, MD - Family Medicine
Douglas A. Stewart, MD - Medical Oncology
Last Revised June 28, 2013

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