Lymphedema

Lymphedema is a buildup of “lymph,” a body fluid containing infection-fighting cells.

It occurs when the lymphatic system, consisting of thin vessels and lymph nodes, is damaged or blocked. It commonly affects the arm or leg but can also affect other parts of the body such as the neck.

Cancer itself may damage lymph nodes and lymphatic vessels. More commonly, surgery, including the removal of lymph nodes, and radiation therapy may cause scarring, which can result in lymphedema. For example, a surgeon may remove lymph nodes from the armpit of a patient with breast cancer.

Patients can experience the following symptoms in the affected areas:

• Swelling

• Heaviness, and tightness, including tighter fitting jewelry

• Dull aching

• Skin thickening or skin that resembles an orange peel

• Small blisters that leak clear fluid

These symptoms occur gradually over weeks to months, and can even occur years after cancer treatment. The discomfort associated with lymphedema may interfere with daily activities. Patients with lymphedema are at increased risk of infection in the area.

Your doctor can usually determine if you have lymphedema by talking to you and examining you. They may consider other causes of swelling, such as infections or blood clots. Formal testing for lymphedema is generally not required.

Let your doctor know if you notice these symptoms. Lymphedema cannot generally be cured. The goal of treatment is to control the swelling, improve functioning, and prevent complications, such as infection. Lifestyle changes may include the following:

• Avoid hanging your arm at your side for prolonged periods; elevate the arm or leg with pillows when sitting or lying down.

• Keep your skin clean by washing with mild soap daily.

• Use cream or lotion to prevent your skin from becoming cracked.

• Wear sunscreen to prevent sunburn when outdoors.

• Maintain a healthy weight; obesity increases the risk of lymphedema and makes it harder to treat.

• Be careful when trimming your nails and shaving; do not pick at the skin around your nails; use an electric razor instead of a blade.

• If your arm is affected, wear gloves while gardening and cooking; avoid blood draws and injections in the affected arm.

• If you cut or scrape the affected area, clean it with soap and water. Call your doctor if you notice redness or warmth or if you develop a fever higher than 100.4°F (38°C).

• Avoid saunas and hot tubs.

Apart from lifestyle changes, your doctor may recommend exercises to improve lymph flow, yourself or with trained physical therapists, and compression garments, which place gentle pressure on the affected area. Your doctor may also prescribe antibiotics to treat infection or suggest surgical treatments in refractory cases.

Published Online: March 1, 2018. doi:10.1001/jamaoncol.2017.5553

Conflict of Interest Disclosures: None reported.