Cancer and secondary lymphedema
The most common causes of secondary lymphedema in the US are cancer-related. Cancer itself can cause lymphedema when a tumor blocks lymph vessels or nodes. Lymphedema can also develop as a side effect of treatment, if lymph nodes or vessels are damaged or removed during radiation therapy
. Often lymph nodes need to be removed entirely to check for cancer or reduce its spread, especially in breast cancer patients.
All of these situations reduce the pathways available for lymph fluid to move through the body. This makes the buildup of lymph fluid in the tissues more likely, similar to how a dam causes free-flowing water to form a pool.
Other health conditions that can cause secondary lymphedema include rheumatoid arthritis, eczema and other inflammatory diseases, cardiovascular diseases like deep vein thrombosis or varicose veins, and certain kinds of infections and parasites.
People who are overweight or obese are more likely to develop lymphedema. So are cancer patients who have had several lymph nodes removed or who have had more extensive or multiple surgeries to the chest (making damage to lymph nodes and vessels more likely). Radiation therapy for breast cancer directly to the underarm area can also increase the risk of lymphedema, since many lymph nodes are affected.
Injury or infection on the side of the body where you had cancer surgery also increases lymphedema risk, since the lymphatic system may be weaker and more easily overwhelmed in that area. Older age is another risk factor for lymphedema.
Reducing your risk
There are many risk factors for lymphedema that you can’t control, such as your age and the number of lymph nodes affected by your cancer treatment. However, there are some steps you can take to minimize your risk as much as possible.
Maintain a healthy weight
During and after cancer treatment, work with your care team to keep an eye on your weight. Chemotherapy and steroid drugs can lead to weight gain. So can feeling unwell and fatigued, since you’re more likely to be sedentary. Ask your doctor for advice about maintaining a healthy weight during treatment, and enlist friends and family to help with healthy eating habits and to join you in regular light exercise
like walking. After treatment, consult with your doctor about developing an exercise plan tailored to your body’s needs during recovery.
Protect your skin from scratches and cuts
It’s important to protect yourself from skin breaks and injuries
, even minor ones, in areas where lymph nodes were damaged. Infection and inflammation can increase your chances of developing lymphedema.
Use lotion to keep your skin from becoming dry and cracking. Wear gloves when gardening or doing housework or other hobbies that could cause skin breaks. If you have pets, keep their nails trimmed. Wear long sleeves and insect repellent when needed. Avoid damaging your cuticles or cutting your nails too short.
Request that medical treatments be moved to other areas of the body
During your cancer treatment, tell your medical team about all your health conditions, including any additional risk factors for lymphedema. If possible, have any blood draws, intravenous therapies, or injections be done in a different area of your body than where you had surgery. (You may need to remind your team every time you receive treatment.) You can continue to make this request during any future medical treatment as well.
If you develop lymphedema, work with a specialist to develop a treatment plan. This can help you manage symptoms effectively and keep your quality of life high.
There are several methods for managing lymphedema, usually used in combination. The most important ones are:
Compression garments apply light pressure to the body. They are typically designed to apply greater pressure in the area where lymph fluid has gathered to help move fluid away from that area. Compression sleeves are used on the arms and other compression garments are used for the torso and hands. Compression garments need to fit properly in order to work. A garment that’s poorly fitted or used incorrectly can make lymphedema worse, so it’s important to work with a lymphedema therapist to get this right!
Compression garments are usually used for more mild lymphedema symptoms, to keep lymphedema from getting worse, or to maintain results following more aggressive treatment to reduce swelling.
Bandaging is another method for reducing swelling and is typically used when lymphedema symptoms are more severe. A trained lymphedema therapist will apply bandages for you when you begin treatment and will then teach you to apply them yourself. You may need to wear bandages all the time (except when bathing or during therapy sessions) until your symptoms are better controlled. This process may require daily bandage changes and wearing the bandages for a month or so until swelling is reduced.
Bandages apply greater pressure than compression garments and help move lymph fluid out of areas with significant swelling. If there are smaller areas of your body with more severe swelling or where the skin has hardened or scarred (called fibrosis), foam pads or “chip bags” may be applied under the bandages to help alleviate symptoms in those areas. “Chip bags” contain pieces of foam that massage your body as you move to soften hardened tissue and break up areas of fibrosis. Foam pads (sometimes called Schneider pads) add an extra layer of consistent pressure to spots with greater swelling.
When bandaging is done correctly it can help to significantly reduce the symptoms of lymphedema. But just like compression garments, improperly used bandages can make your symptoms worse. It’s important to see a trained lymphedema therapist to begin treatment. The therapist will teach you how to apply bandages correctly and will monitor your condition.
Often bandaging can be done for a month or so until swelling has been reduced, after which compression garments can be used to keep your lymphedema under control. Sometimes another period of bandaging might be needed if your symptoms flare up again.
Manual lymphatic drainage
Manual lymphatic drainage is a specialized form of manual (hands-on) therapy somewhat like massage that can help to move lymph fluid out of your tissues and into the lymph vessels, reducing swelling. The touch a therapist applies in manual lymphatic drainage is much gentler than a typical massage. A therapist may teach you the technique so you can do it yourself.
Carrying excess weight can make lymphedema more likely and exacerbate symptoms, so maintaining a healthy weight is an important part of managing lymphedema. If you’re struggling with your weight, ask your care team to connect you with a dietitian, or ask for guidance on developing a healthy eating plan. Exercise can be challenging during and after cancer treatment, so it’s important to respect your body’s limitations and need for rest. Go slowly, start with gentle exercise and get your doctor’s advice as you develop an exercise routine that supports a healthy weight and your recovery.
If you see a lymphedema therapist (you can find one here
), they may have you perform specific gentle exercises to encourage the movement of lymph fluid in affected parts of your body, as well.
Protecting against injury and infection
Infection can trigger lymphedema, and people who already have lymphedema face higher infection risks. This is because lymph nodes help launch the body’s immune response and fight infection. In addition, lymph fluid that isn’t flowing efficiently can become a fertile ground for infections, since it collects bacteria and other foreign substances.
People with lymphedema or who are at heightened risk for lymphedema should be aware of any signs of infection and get treated right away. In particular, if you develop a rash, swelling or bubbling on the skin that’s warm and tender, this could be a sign of cellulitis - an infection that can quickly become serious and even life-threatening. You should get treatment right away if you notice possible signs of cellulitis.
Again, it’s best to protect yourself from infection by avoiding any type of skin break. Prevent cuts, scratches, and scrapes by wearing gloves and long sleeved clothing, especially when doing activities where these minor injuries are common, like cleaning or gardening. Use lotion to keep skin from cracking, including around your cuticles. Protect parts of your body with lymphedema symptoms from heat or cold, since you can have reduced sensitivity to temperature and inadvertently cause injury from the exposure. Take special precautions when shaving. If you do get a cut, clean the area with soap and water and use antibiotic ointment to protect against infection.
Other treatments and self-care for lymphedema
The above strategies aren’t the only treatments for lymphedema, but they are the most commonly used and time-tested ones. Often several of these techniques are used together during the same period or at different times in the course of treatment for lymphedema.
Other treatment options include laser therapy, which is a relatively new approach, pneumatic pumps, which are an older method for moving lymph fluid and reducing swelling, and in severe cases and as a last resort, surgery. Your team will also show you self-care methods such as elevating the affected body part, cleaning and moisturizing the area, checking for signs of infection, and avoiding tight-fitting clothing or elastic bands around affected areas.
If your lymphedema is advanced, you might undergo an intense period of treatment called Complete Decongestive Therapy, which combines bandaging, exercise, and manual lymphatic drainage for an initial period of several weeks to two months to reduce swelling and minimize symptoms as much as possible. After that, a maintenance period will help you manage your weight, practice self-care techniques (which may include bandaging or switching to compression garments), and recognize signs of worsening symptoms so you can get treatment quickly in case of a flare-up.