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Lymphedema

Lymphedema is a condition characterized by the buildup of lymph fluid in the interstitial tissue, leading to swelling in areas such as the limbs, neck, trunk, or genitals, and is associated with solid tumours caused by melanoma, breast, genitourinary, gynaecological, and head and neck cancer​
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Why does lymphedema happen? 
It is a common side effect of cancer treatment, and can occur due to blockage or damage to the lymphatic system can occur due to tumor pressure on the lymph nodes or vessels, the spread of cancer cells into the lymphatic channels (known as lymphangitic carcinomatosis), removal or surgery on lymph nodes, or as a result of radiation therapy or chemotherapy.
 
At first, the affected area can become slightly swollen, uncomfortable, and “tingly,” and then may get more swollen over time. If the lymphedema progresses, the limb (or other areas) can become even more swollen, uncomfortable, heavy, or numb. Early treatment of lymphedema is important, so you should tell your doctor if you experience any of these symptoms. Your doctor may also rule out other causes like recurrent breast cancer, infection or thrombosis. The good news is that today there are more options than ever, for treating lymphedema, and most have demonstrated effectiveness in research studies.
 

Stage 0

No swelling but there may be subtle symptoms, such as:

  • A heavy feeling in a limb

  • Feeling of fatigue in a limb

Stage 1

Swelling can be seen on the side of body that was treated

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Swelling in a limb is reduced with elevation

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An indent in the skin may occur when pressure is applied (called pitting)

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Area with lymphedema is larger, heavier, or stiffer

Stage 2

The swollen area has a spongy texture

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Swelling in limb does not decrease with elevation

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An indent in the skin (pitting) is less visible as swelling increases

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Scar tissue may form making the swollen area larger and feel hard

Stage 3

Swelling has further increased making the area larger

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Skin of swollen area is severely dry, scaly, or thickened

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In the limbs, fluid leakage and blisters are common

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Moving limbs or turning your neck may be limited

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Skin of swollen area may have fungal infections or benign tumors

Self-care management:

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  •  Apply gentle pressure and keep your hands soft and relaxed​
     

  • Use just enough pressure to softly stretch the skin to its natural extent, then ease up and allow the skin to return to its original position. If you can feel the muscles beneath your fingers, you're pressing too hard.
     

  • Use the palms of your hands instead of your fingertips to maximize contact with the skin and effectively stimulate the lymphatic vessels.
     

  • Perform the massage in the direction of parts of your body that haven't been affected by cancer treatment.
     

  • Ensure you're comfortable during the process. You might support the arm on the side that had cancer treatment with a table or pillows, allowing your shoulder and arm to relax. You can do self-massage while sitting, standing, or lying down, whichever position feels best for you.
     

  • Incorporate self-massage into your routine (similar to other self-care activities) in a way that suits your lifestyle.

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​Compression

  • Compression bandaging: Multi-layered “short-stretch” bandages are used to reduce swelling

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  • Compression garment: A compression sleeve may be used to prevent lymphedema, as it can delay or prevent lymphatic fluid buildup and swelling

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  • Manual lymphatic draining: Manual lymphatic draining focuses on opening the lymphatic pathway, softening the scar tissues, and to promote and stimulate lymphatic drainage

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  • Pneumatic compression pump: Pneumatic devices are medical devices that use a series of inflatable sleeves placed around the affected limb. These sleeves automatically and gently inflate and deflate in a controlled sequence, applying pressure to help move excess lymphatic fluid out of the limb.

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  • Electrically stimulated lymphatic drainage: A less commonly used intervention that involves applying electrical currents to tissues, which can influence cellular and molecular processes

Progressive resistance training

  • This training involves gradually increasing the intensity (weight) or volume (sets and repetitions) in very small increments over time, with careful monitoring​

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  • This approach is ideally supervised by a lymphedema specialist to ensure safety and effectiveness, especially for individuals at risk of or managing lymphedema

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  • These exercises are found to be effective: 

    • Arm lifts (front and side)

    • Chest expansion exercises

    • Forearm flexion and extension

Medical therapies

  • ​Some oral medications, such as benzopyrones, have been tested in clinical trials to evaluate their potential to help reduce swelling, however there is no strong evidence​

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