Symptom Specific Services

Lymphedema
• What is lymphedema and what causes it?
• How can I tell if I have lymphedema?
• Is there anything I can do to prevent or control lymphedema?

What is lymphedema and what causes it?
Lymphedema is an accumulation of lymphatic fluid tissue which causes swelling, most often in the arms or legs, and occasionally in other parts of the body.

Lymphedema can develop when lymph nodes are removed from under the arm, a procedure often performed during surgery for breast cancer. Damage to lymphatic vessels caused by radiation oncology can also lead to a buildup of lymph fluids in tissue, which can cause swelling to occur.

Arm lymphedema usually develops slowly over time. The swelling can range from mild to severe, and it can develop soon after surgery or radiation treatment. Swelling can also develop months or years after treatment.

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How can I tell if I have lymphedema?
Lymphedema can develop in any part of the body or limbs. Signs or symptoms of lymphedema include:

• Feeling of fullness in the limb(s)

• Aching buttocks (legs) or back of the shoulder (arms)

• Skin tightness

• Decreased flexibility in the hand, wrist or ankle

• Difficulty fitting into clothing in one specific area

• Ring/wristwatch/bracelet tightness

• “Pins and needles” sensation in the limb

• “Pin” feeling in joints (e.g., elbows, knees or ankles)

• Shooting pains up the limb

Signs of lymphedema development include slow progression of swelling, with the greatest swelling occurring at the most peripheral (distant) parts of the limb(s). This means that swelling usually begins at the far end of your limb (fingers and toes) and then moves up the arm or leg. Skin may be dimpled (i.e., when a finger is pressed into the area the indentation remains).

In Stage I, this swelling may be eliminated with simple elevation. With further progression to Stages II and III, there will be progressive hardening of the affected area, seen as hardening or scarring of the skin, hyperkeratosis (overabundant skin thickening), and papillomas (cone-shaped wart-like projections of outer layer of the skin). With increased protein-rich swelling, there is a risk for bacteria growth and infection.

If you notice persistent swelling or any of these other symptoms, it is very important to inform your doctor or nurse. It may also be helpful to get a second opinion from a lymphedema specialist. Early diagnosis and treatment of lymphedema improves both the prognosis and the condition.

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Is there anything I can do to prevent or control lymphedema?
If you have been diagnosed with breast cancer or any other cancer requiring a lymph node dissection, talk to your doctor about your risk of developing lymphedema. After surgery try to avoid:

• Trauma to the affected arm (Some trauma may be unavoidable. Be sure to speak with your doctor or nurse before having blood drawn, your blood pressure taken, or having injections or an IV inserted.)

• Infection

• Burns

• Constriction

• Muscle strain

Planning a treatment program depends on the cause of the lymphedema. For example, if the initial signs and symptoms of swelling are caused by infection (redness, rash, heat, blister, or pain may indicate an infection), antibiotics will first need to be prescribed. Treating an infection often reduces some of the swelling and discoloration.

At Continuum Cancer Centers of New York, we use a comprehensive interdisciplinary treatment approach. Treatments by health care professionals may include the following approaches:

• Skin care and hygiene

• Manual lymph drainage (MLD)

• Compression bandaging

• Therapeutic exercises

• Activities of daily living/self-care training

• Compression garments

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