What is lymphedema?
Lymphedema is swelling, most often of the arm or leg. It occurs when fluid normally drained by the lymph vessels does not flow out of an arm or leg properly. It can occur following cancer treatment. Lymphedema can cause discomfort. It may cause clothes and jewelry to not fit well. It may also increase your risk for skin infections. If not treated, the arm or leg can become permanently swollen, hard, and heavy.
Lymphedema risk factors
You may be at risk of lymphedema if you have had surgery to remove some or all of the lymph nodes, or treated with radiation. You are at highest risk within three years of your surgery; however, the risk of getting lymphedema lasts a lifetime. You are at higher risk if you are overweight or gain weight during cancer treatment. An infection in the arm or leg can lead to lymphedema.
Lymphedema signs and symptoms
Some signs and symptoms may occur before swelling is noticed. These include a feeling of heaviness, tightness, or fullness. Rings, watches, or jewelry may feel tight.
There are several steps you can take to help prevent lymphedema.
- Avoid injury to the arm or leg, since even a small infection can trigger lymphedema.
- Treat any cuts, burns, bites or scrapes immediately.
- Wear long oven mitts when cooking and gloves when gardening or doing yard work.
- Wear high-factor sun block or long-sleeved clothing to avoid sunburn.
- Use insect repellant when outside.
- Use an electric shaver or cream for hair removal; do not use a razor.
- Whenever possible use the arm without lymphedema when checking blood pressure or for blood tests.
- Maintain an active lifestyle and healthy weight.
- Begin a weight-loss program if you are overweight.
- Call your doctor right away if you have fever, redness, tenderness, or warmth of the arm or leg. These can be the first signs of lymphedema.
- Do not move or carry very heavy objects.
- Do not use saunas.
- Check your hand and arm daily for signs of lymphedema or small injuries that could lead to the condition.
- When cleared by your doctor, do the recommended exercises to regain a full range of motion of the arm or leg.
Lymphedema Treatment and Surgery
If you think that you have lymphedema, ask your doctor to refer you to Rehabilitation Services at MD Anderson, where a lymphedema therapist will evaluate you, give you information, and create a treatment plan. This plan may include one or more of the following:
- Skin care: Good hygiene and proper moisturization can help prevent injury and infection.
- Massage: Two basic types of massage are used to treat lymphedema.
- Manual lymphatic drainage is a precise and gentle form of massage that helps mobilize the fluid and direct it to other pathways.
- Soft tissue mobilization is a type of massage used to release scar tissue and other tightness that might be contributing to the swelling. Sometimes massage is taught to patients or family members to carry out at home.
- Exercise: You may be instructed in stretching exercises to loosen the tissues in the region or specialized exercises to help move the fluid out. You will be given written instructions for these exercises.
- Bandaging: This is a precise technique using cotton low-stretch bandages to apply constant pressure on the limb. Bandaging is usually done in combination with other methods.
- Compression garments: These are elastic fabric garments similar to a girdle or support stocking. They apply pressure to the arm or leg to help move fluid out and keep new fluid from collecting.
- Medicine: Sometimes antibiotics or other medications are prescribed as part of your lymphedema treatment plan.
If these therapies aren’t effective, surgery may help reduce the symptoms and swelling of lymphedema. Surgeons at MD Anderson's Center for Reconstructive Surgery specialize in lymphedema surgery and perform pioneering procedures to treat the condition. These procedures improve drainage of the lymph fluid, lessening the effects of lymphedema and keeping it from getting worse.
Patients who have less severe lymphedema for a shorter time tend to have better results from surgery. In some cases, patients may be able to stop using compression garments completely. All lymphedema surgeries are effective in reducing the number of infections you may have.
While these surgeries may result in significant improvement of lymphedema, you should continue all therapies and treatments unless your doctor or rehabilitation specialist tells you otherwise. This includes compression, massage, skin care and exercise.
Your surgeon will review your medical history, physical examination findings, and test results to determine the best procedure for you. Lymphedema surgical procedures include:
Lymphovenous bypass: This is a minimally invasive procedure using a high-powered microscope, specialized instruments and sutures. Blocked lymphatic vessels less than half a millimeter in size are redirected to small veins. This improves the flow of lymphatic fluid out of the arm or leg and reduces the discomfort and swelling.
Vascularized lymph node transfer: The doctor removes lymph nodes from your trunk, neck, groin area, or from within the abdomen, preserving their delicate blood supply. These are reattached to blood vessels in the affected arm or leg using microsurgery. The lymph nodes continue to function normally and drain fluid from the arm or leg. If you have undergone a mastectomy, it may be possible to combine this procedure with breast reconstruction to treat your lymphedema. Tests are performed to reduce the risk of lymphedema if the lymph nodes are taken from near an extremity.
Liposuction debulking procedure: In chronic lymphedema, surgery to improve the fluid drainage may not be possible. Excess tissue that has grown due to the fluid can be removed with surgery. This is done using liposuction with minimal scarring. The appearance and function of the arm or leg are improved. The risk of future infections is reduced. The swelling will not return if compression garments are worn lifelong.
Lymphedema screening for breast cancer survivors
“Unfortunately, if lymphedema is not diagnosed early, it’s nearly impossible to completely reverse the condition,” says Simona Shaitelman, M.D.
Surgical relief from lymphedema
Paula Bell is one of many MD Anderson patients who’s experiencing big relief from lymphedema, thanks to some tiny reconnections.
Advances in surgical management of lymphedema
MD Anderson surgeons are refining treatment for severe lymphedema to reduce limb swelling and improve patients’ quality of life by combining procedures or using liposuction debulking.