What is lymphedema? Understanding this common cancer treatment side effect

Lymphedema is a common cancer treatment side effect that can cause swelling in a patient’s arm or leg. It may lead to discomfort, pain and infection. It may make it difficult for patients to find clothes that fit. Lymphedema can also lead to skin infections.

Fortunately, lymphedema can be treated through massage, exercise, bandaging and, in some cases, surgery. We spoke with plastic surgeons Mark Schaverien, M.D., and Ed Chang, M.D., to learn more.

When does lymphedema occur?

Lymphedema occurs when the lymphatic system doesn’t drain properly and fluid builds up. It often results after lymph nodes have been removed or become obstructed.

Are certain patients more likely to develop lymphedema?

Cancer patients who have lymph nodes removed are at risk for lymphedema. So are patients who receive radiation therapy. Patients who have had both radiation therapy and lymph nodes removed are at an even higher risk of developing lymphedema.

Anyone can develop lymphedema, but it’s most common in breast cancer patients who have all or parts of their breast removed, along with lymph nodes. Lymphedema often occurs in patients with uterine, prostate, vulvar, ovarian cancers, lymphoma and melanoma, too.

Patients who are overweight are also at increased risk for lymphedema.

How is lymphedema diagnosed and treated?

First, a doctor or lymphedema therapist will evaluate you and determine if you have lymphedema through a clinical exam. During this exam, they’ll measure the difference in size between limbs. In some cases, they may use scans, like MRIs and CTs, and ultrasounds, or a test called a lymphoscintigraphy in which dye is used to highlight the lymphatic system and illustrate blockages. Then, they’ll create a personalized treatment plan. It may include a number of different treatments. We often use massage to reduce swelling because it mobilizes and directs fluid into other pathways. Similarly, we may give some exercises that can loosen the tissues and help reduce fluid build-up. Bandages and compression garments are used to apply pressure and keep fluid moving.

If those non-invasive treatment methods don’t help alleviate lymphedema symptoms and if compression garments are required to manage the swelling, then we may recommend lymphedema surgery.

We do three types of lymphedema surgeries here at MD Anderson. One is a called a lymphedema bypass. This is a type of microsurgery in which surgeons use high-powered microscopes and specialized instruments to redirect very small lymphatic vessels to veins, improving the flow of fluid.

The second surgery is called vascularized lymph node transfer. In this procedure, the surgeon removes lymph nodes from an area where swelling is less likely to occur, like the patient’s neck, groin or abdomen. Then, these lymph nodes are reattached to the blood vessels in the affected area using microsurgery. In their new location, the lymph nodes will continue to function normally and help keep the fluid moving, reducing swelling.

The third surgery is suction-assisted lipectomy. This surgery uses minimally invasive liposuction to remove the build-up of fibrous tissue that builds up in chronic lymphedema and which cannot be removed by procedures that improve the flow of the fluid.

In some cases, surgeons at MD Anderson can combine these surgeries together to give patients the best possible results. 

If you’re an MD Anderson patient with lymphedema, ask your doctor for a referral to our Rehabilitation Services to received lymphedema treatment.

Can lymphedema can be prevented?

Yes, you can lower your lymphedema risk by maintaining a healthy weight and an active lifestyle. Avoid lifting heavy objects, and avoid injury to your arms and legs, since even a small infection can trigger lymphedema.

We’re also looking into using surgical techniques to prevent lymphedema from ever happening. For some patients, lymphedema can be debilitating with no true “cure,” but the treatment we can offer patients now has been remarkably successful and is making a really big difference in patients’ lives.

Request an appointment at MD Anderson online or by calling 1-877-632-6789.