For People at Risk of Lymphedema

Lymphedema that is related to cancer is most commonly caused by lymph node removal during surgery for cancer, radiation treatment to the lymph node area, and/or by the tumor itself, which might block part of the lymph system. Increased white blood cells due to leukemia or infection can also limit lymph flow and cause lymphedema.

People who have many lymph nodes removed and/or radiation therapy have a higher risk of long-term lymphedema. But at this time there’s no way to predict who will develop it.

Lymphedema can become a problem after surgery or radiation treatment for nearly any type of cancer, but it’s most common in:

• Breast cancer
• Prostate cancer
• Pelvic area cancers (such as bladder, penile, testicular, endometrial, vulvar, or cervical cancer)
• Lymphoma
• Melanoma
• Head and neck cancers

Depending on where the lymphedema is, it can cause different signs or symptoms.

Can lymphedema be prevented?

There is no sure way to prevent lymphedema related to cancer. However, doctors can sometimes use a surgical technique to remove fewer lymph nodes, which can help  lower the risk of lymphedema.

Sentinel lymph node biopsy (SLNB) is a procedure used to find lymph nodes the tumor drains into so they can be removed and checked for cancer. SLNB checks only the lymph nodes the cancer would most likely go to first. If cancer is not found in these nodes, this procedure helps to limit the number of lymph nodes removed, so the risk of lymphedema might be lower.

How can I help reduce my risk for lymphedema?

There is no sure way to prevent lymphedema related to cancer, but there are ways to help lower your risk for it, and to reduce the chance of it worsening.

Get regular medical check-ups

If you’ve had cancer surgery or other treatments that put you at increased risk for lymphedema, regular check-ups should include screening for lymphedema. Screening is for people who have not noticed or reported symptoms.

Your doctor or a certified lymphedema specialist might get baseline measurements of your arm or leg or the affected part of your body after you finish your cancer treatment. They will continue to measure the affected area at your follow-up visits to see if they are getting bigger (which might be a sign of lymphedema). Talk to your cancer care team about how often you should be checked.

Report any changes to your doctor

Healing and recovery from surgery or other treatments for cancer take time. As you heal, you will learn how the affected part of your body looks and feels. Be sure to let your cancer care team know if you notice any changes that are concerning, such as  any changes in size, color, temperature, feeling, or skin condition.

Get to and/or stay at a healthy weight

Being obese (very overweight) puts people at higher risk for lymphedema, and obesity can make it harder to treat lymphedema. Talk to your cancer care team about what a healthy weight is for you. Get their advice on how to get to and/or stay at that weight.

Exercise

It’s important to use the part of your body that’s affected by cancer for normal, everyday activities. This will help you heal properly and regain strength. Using your muscles also helps the lymph fluid circulate and drain like it should. It also helps keep your muscles flexible and helps reduce scarring.

Work with a trained fitness or certified lymphedema specialist  to design an exercise plan that’s right for you and starts at a low level of intensity and progresses slowly to avoid overuse. Contact the American Physical Therapy Association (APTA) at www.apta.org or 1-800-999-2782 to find a physical therapist near you who works with people who have been treated for cancer.

Avoid skin infections, burns, and injuries

Your body responds to infection, burn, or injury to the skin by sending extra fluid and white blood cells to the area. If lymph nodes and vessels are missing or damaged, it’s harder for your body to move this extra fluid, which can trigger or worsen lymphedema.

Be careful with injections or blood draws

If the lymph nodes under your arm were treated as part of the treatment for cancer, some doctors recommend having blood drawn, IVs, and shots done in the unaffected arm if possible. Some also recommend getting flu shots and other vaccinations in the unaffected arm or somewhere else, like the hip. But not all experts agree with this restriction. And if the lymph nodes under both arms were treated, it's not possible to have an unaffected arm. For this reason, it's important to ask your doctor about whether this restriction is right for your situation.

Watch for signs of cellulitis

Cellulitis is an infection in the tissues just under your skin. It can lead to lymphedema. Cellulitis is an urgent medical problem that you need to tell your doctor about right away.

Signs and symptoms of this problem include redness, warmth, pain, and possibly cracking or peeling on the skin in the area that's infected. Fever and flu-like symptoms may also be present. If it becomes a repeated problem, antibiotics may be needed to keep it under control.

Lymphedema can also put you at risk of getting cellulitis.

Avoid tight or restrictive clothing or jewelry

Wearing tight or restrictive clothing or jewelry can squeeze the arm or leg unevenly or too much, which might increase the pressure in nearby blood and lymph vessels. This can lead to increased fluid and swelling (much like water building up behind a dam). Some people have linked this with the start of lymphedema.

Ask about compression garments

Compression garments are fitted sleeves or stockings that apply a specific amount of even pressure that can help prevent swelling by moving lymph fluid from the arm or leg back into the body. A lymphedema specialist or doctor will know how much pressure is right for your situation. Careful fitting is needed for a compression garment, and it's very important to follow your health care team’s advice on getting fitted, using, and caring for the garment.

Compression garments are most often used by people who already have lymphedema. But if you’re at risk for lymphedema, you might want to ask about using one to help lower your risk in certain situations. For example, the risk for lymphedema might increase with long air travel, possibly because of air pressure changes. But there are risks and benefits to using a compression garment on long or frequent flights. Ask your doctor or lymphedema specialist if you should be fitted for a garment to wear during air travel. You might also want to discuss ways to safely move and exercise your affected body part during long flights.

Be sure compression garments fit well and are worn properly

Even if you don't have lymphedema, do not use a poorly fitting compression garment under any circumstance. This may increase your risk for lymphedema.

You usually don’t need a compression garment to prevent lymphedema during exercise, but it is best to talk to your doctor or lymphedema specialist before starting an exercise program.