What is lymphedema?
Lymphedema is the collection of lymph fluid in the tissues. This build up causes edema, or swelling, usually in the arms or legs.
What causes lymphedema?
Our bodies have a network of lymph vessels and nodes that drain and carry lymph fluid through the body. Lymph nodes filter the lymph fluid and produce white blood cells (infection fighting cells). The lymph vessels carry the fluid towards the lymph nodes and eventually carry the lymph fluid back to our blood vessels. Lymphedema can occur when there is a disruption of normal lymphatic flow. This disruption may be caused by surgery, radiation, infection or trauma.
When does lymphedema start?
Lymphedema can occur within weeks, months or years after the initial surgery, injury or infection. In each case, normal drainage of lymphatic fluid is interrupted.
Who gets lymphedema?
Lymphedema can become a problem after surgery or radiation treatment for any type of cancer, but it is most often associated with breast cancer, prostate cancer, pelvic cancer (uterine, cervical), lymphoma and melanoma.
Risk factors for lymphedema include:
- Cancer surgery where there has been surgical removal of lymph nodes in the armpit, groin or pelvic region.
- Radiation therapy to the underarm, groin, pelvic or neck regions.
- Scar tissue in the neck, underarm or groin region caused by surgery or radiation therapy.
- Cancer that has spread to the lymph nodes in the neck, chest, underarm, groin or pelvis.
- Tumors in the pelvis or abdomen that involve or put pressure on lymph nodes or vessels.
- Infections in the arm or leg where lymph nodes were removed in the armpit or groin.
What are the symptoms of lymphedema?
The most common symptom of lymphedema is the appearance of swelling in the arm or leg that has been affected by lymph node removal and/or radiation therapy.
Other symptoms include:
- A full or tight feeling in the at-risk arm or leg.
- Less movement or flexibility in your hand, wrist or ankle.
- A heavy feeling or aching in the at-risk, arm or leg.
- Rings, bracelets, watches or shoes that become tight, but you have not gained weight.
- Clothing feels tighter or more restrictive in the at-risk arm or leg.
How can I prevent lymphedema?
Although there are no scientific studies to show that you can prevent lymphedema, most experts agree that following these basic guidelines may lower your risk for lymphedema.
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Skin Care:
- Avoid cuts, scratches or burns to the area where your cancer was treated and at-risk arm or leg.
- Keep your skin clean, dry and well moisturized.
- Protect exposed skin with sunscreen and insect repellent.
- Avoid blood draws or injections in the at-risk arm or leg.
- Use gloves for activities such as gardening, cleaning with chemicals, working with tools and an oven mitt with baking/cooking.
- If a rash, redness, warmth, pain or swelling occur, contact your physician immediately for early treatment of possible infection.
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Activity / Lifestyle Modification:
- Use your at-risk arm or leg as normally as possible.
- If normal use involves strenuous activity, slowly and gradually build up the intensity and duration of the activity or exercise.
- Take frequent rest breaks during activity.
- Closely monitor the at-risk arm or leg for changes in size, shape, firmness or soreness with activity.
- Maintain optimal weight.
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Limb Constriction:
- If possible, avoid blood pressure checks with the at-risk arm.
- Wear loose fitting jewelry, sleeves, socks and gloves.
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Temperature Extremes:
- Avoid exposure to extreme cold
- Avoid prolonged exposure to heat, especially hot tubs and saunas.
Will lymphedema go away by itself?
A temporary lymphedema occasionally occurs immediately after surgery or radiation therapy. It is usually mild, improves with elevation and goes away within 1-2 weeks. For most people, lymphedema is a chronic problem that requires on-going effort to control.
How is lymphedema treated:
If you are diagnosed with lymphedema, there are treatments to reduce the edema, prevent it from getting worse, and reduce the risk of infection.
These treatments may include:
- manual lymph drainage (a specialized massage to help improve lymph flow from the affected arm or leg) use of a compression pump to reduce the edema
- special compression bandaging to reduce the edema
- use of a compression pump to reduce the edema
- special compression bandaging to reduce the edema
- fitting of compression garments
- skin care
- exercise to improve cardiovascular health and decrease edema
Most often the treatment is provided by a specially trained therapist. Seeking and getting treatment early usually leads to a shorter course of treatment and easier self-management of the lymphedema.
MeritCare Lymphedema Program
MeritCare's Lymphedema Program is offered through the physical therapy department. We have physical therapists who have specialty training in the management of lymphedema.
- How to get an appointment:
Survivors can self refer but it best to get a referral from a physician. Other processes like blood clots, infections and sometimes even cancer recurrences can cause swelling therefore you should be evaluated for these first. Many insurance companies require physician referral.
Physicians offices can call 701-234-6735 or 1-800-821-2232 to refer a patient. A signed PT (physical therapy) order will need to be faxed to 701-234-7452.
- When should you be referred to a Lymphedema Specialist?
It is best to see a specialist if you have any swelling if it is fluctuating in nature. It is also good to meet with a specialist if you have questions regarding lymphedema prevention and self care.
Additional Resources:
- American Cancer Society
(800) ACS-2345
- Lymphedema: Understanding and Managing Lymphedema After Cancer Treatment, is available for purchase from the American Cancer Society.
Call: (800) ACS-2345 for cost and ordering information.
- National Cancer Institute