The lymphatic system is a bit like the plumbing for your body – your blood vessels leak fluid and protein and immune cells, and your lymph vessels pick up those things and pump the fluid through your body and help return it to the blood.
But what happens if you get a block in that plumbing? For some cancer patients who have had a surgery that involves lymph node dissection, lymphedema may happen.
“With respect to cancer, lymphedema can happen after all cancer surgeries that involve injury in some way to the lymphatic system,” says Brett Michelotti, MD, a plastic surgeon with UW Health who treats the condition. “It doesn’t happen in everyone, but in some patients, the lymph vessels can’t find a new pathway around the area that’s been injured and so they start to develop swelling in the limb.”
While lymphedema can be a debilitating side effect of cancer treatment, Michelotti says the good news is that there are treatments available – and, he stresses, the sooner patients begin treatment, the better the outcomes. He offers more information about the causes, symptoms and treatments for lymphedema, below.
Who is at risk for developing lymphedema?
Again, anyone who has had a surgery that involves injury to the lymphatic system is at risk of developing lymphedema in an affected arm or leg. Breast cancer patients are the most common patients we treat, but that is likely because there is a higher incidence of breast cancer in the population. But we see it in patients with, say, melanoma on their leg whose surgery requires a groin lymph node dissection, or with gynecologic cancer patients who require pelvic lymph node dissections. Patients are more at risk, too, if they additionally require radiation to the area as part of their treatment. In general, patients who have not developed lymphedema within three years of their cancer surgery are at very low risk of developing it later.
What are the signs and symptoms of lymphedema?
The initial symptoms are not clinically apparent. They include: heaviness, fullness, changes in sensation, clumsiness, numbness or tingling. Those are things that should prompt an immediate evaluation by a lymphedema therapist, so patients should not hesitate to bring up their symptoms with the oncologist or other physicians. Later, patients may develop pitting edema, where we see visible swelling.
What treatments are available?
There are two types of treatments available for lymphedema: conservative measures and surgery. Conservative measures can delay or prevent disease progression, and include things like gentle massage to reroute and move fluid, compression bandages or garments and exercise. Maintaining a healthy weight is really important, too.
Surgical measures that remove the blockage that results from lymphatic injury can reverse lymphedema. These surgeries include lymphovenous bypass and lymph node transfer procedures, and which one we choose depends on the extent of the patient’s lymphedema. In lymphovenous bypass surgery, we perform “supermicrosurgery” with really tiny needles, and we reroute direct connections between lymph vessels and the veins.
In lymph node transfer surgery, we release scar tissue from the area of damage and bring in healthy tissue from another location of the patient’s body that is rich in lymph nodes, vessels and growth factors that help promote regeneration of the lymphatics. We can also do excisional procedures, where we remove that fatty content of the limb and redrape the skin to help shrink the volume of the limb.
Excisional procedures do not cure lymphedema, however they are usually very satisfying for the patient initially because they immediately reduce the volume in the limb.
If you are experiencing lymphedema symptoms, please contact your oncologist or primary care doctor and ask them to refer you to a therapist who specializes in lymphedema.