Lymphedema

What is lymphedema?

Lymphedema is swelling due to a buildup of lymph fluid in the fatty tissues just under the skin. Lymph is fluid from the cells of your body. The lymphatic system collects excess fluid from the body tissues and carries it back to the bloodstream. It also is part of your body's system for fighting infection.

How does it occur?

Lymphedema can happen when the lymph system is blocked and cannot drain fluid from the tissues. It may happen when the lymphatic system becomes damaged. Damage can occur when lymph nodes are blocked by infection, radiation, physical injury, cancerous growths, or surgical removal of lymph nodes. Lymphedema is a common side effect after surgery to remove a breast and nearby lymph nodes.

In rare cases lymphedema occurs because the lymph system did not form normally before you were born. In this case it is called primary or congenital lymphedema.

What are the symptoms?

The symptoms of lymphedema may include:

• painless swelling of 1 or both arms or legs (the swelling usually gets worse during the day and better at night)
• a feeling of tightness, heaviness, or weakness in your arm or leg
• rings or shoes that become tight
• pain, aching, or warmth in your arm or leg
• redness of the skin of the arm or leg.

Sometimes lymphedema develops very slowly and becomes noticeable 18 to 24 months after surgery or not until many years after cancer treatment. You may experience discomfort of the skin or aching in the neck and shoulders or spine and hips. This discomfort may be caused by stretching of the soft tissues, by overuse of your muscles, or by changes in your posture caused by the increased weight of your swollen arm or leg.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history, including any medicines that you are taking. Your provider will examine you. You may have a special X-ray test that uses dye injected into the lymph system.

How is it treated?

The treatment will vary somewhat, depending on the cause. Treatment may include:

• keeping the swollen body part above the level of your heart, especially when you are sleeping
• using compression stockings, boots, gloves, or sleeves
• very light massaging that helps to move fluid from the end of the limb toward the trunk of your body
• carefully exercising your arm or leg according to your healthcare provider's instructions
• cleaning the skin carefully to prevent infection
• taking antibiotics to treat or prevent infection.

How long will the effects last?

How long lymphedema lasts depends on what is causing it and how much your lymphatic system is damaged. Mild lymphedema may get better with treatment in a week. Sometimes the lymph ducts have been damaged to the point that even with treatment the lymphedema never completely goes away.

How can I take care of myself?

• Follow your healthcare provider's instructions.
• Keep the swollen arm or leg elevated whenever possible.
• Watch for signs of infection, such as redness, pain, heat, swelling, and fever. Call your healthcare provider if any of these signs appear.

How can I help prevent and control lymphedema?

• Learn about arm, leg, and skin care after surgery or radiation treatment.
• Take precautions to prevent injury and infection in the affected arm or leg. For example:
  • Use an electric razor for shaving.
  • Wear gloves when gardening or cooking.
  • Keep your feet covered when outdoors.
  • Keep your feet clean and dry; wear cotton socks.
  • Clean cuts with soap and water, then use antibacterial ointment.
  • Talk to your healthcare provider about any rashes.
  • Avoid needlesticks, such as shots, in the affected arm or leg.
  • Avoid extreme hot or cold such as from ice packs or heating pads.
  • Do not overwork the affected arm or leg.
• Do the exercises recommended by your healthcare provider.
• Do not put too much pressure on the arm or leg:
  • Do not cross your legs while sitting.
  • Wear loose jewelry. Wear clothes without tight bands.
  • Use your unaffected arm to carry a handbag or wear a watch.
  • Do not use blood pressure cuffs on the affected arm.
  • Do not use elastic bandages or stockings with tight bands.
  • Do not sit in one position for more than 30 minutes.
• Watch for signs of infection.
• Do exercises regularly as instructed by your healthcare provider.
• Keep regular follow-up appointments with your healthcare provider.