Lymphedema: Prevention/Management

Lymphedema Identification, Prevention, and Management

Lymphedema is one of the most overlooked topics amongst cancer patients.

Lymphedema is swelling produced by an accumulation of lymph fluid in the tissue. For breast cancer clients, the swelling occurs in the arm of the affected side due to damage to the lymph vessels in the armpit area caused by the removal of the axillary lymph nodes or from radiation to that area. for those of you who have had lymph nodes removed or irradiated elsewhere in your body, you will be at risk in that area as well as surrounding tissue.
Lymphedema Cancer Exercise Training InstituteThe job of the lymphatic vessels is to drain fluid from the tissue cells in the body, along with protein molecules, bacteria, cellular waste products, and other unusable matter. This protein-rich fluid, called lymph once it is in the lymphatic system, travels in one direction: toward the heart. It is transported through the lymphatic vessels to the lymph nodes, where it is filtered and cleansed before returning to the venous system and moving on to the heart. In the heart, the fluid is simply returned to the blood to be recirculated by the body.


Who is a candidate for lymphedema?

Anyone who has had radiation to or removal of the lymph nodes anywhere in their body is at risk for lymphedema

Other factors that increase your risk include:

  • Being overweight
  • Elderly
  • In poor health
  • Poor nutrition
  • Infection

What are the stages of lymphedema?

  • STAGE 0 LYMPHEDEMAStage O lymphedema, which is also known as the latent or preclinical stage, is the newly added classification. At this stage the patient is at risk of developing lymphedema; however no swelling or other visible evidence of impaired lymph transport is present. Stage 0 can be present for months, or years, before any more serious signs appear.Studies have indicated that through the use of bioimpedance it is possible to identify changes in the at risk limb before they become visible. When changes develop, if specialized treatment is started immediately, it may be possible to prevent the development of further stages of lymphedema. (Bioimpedance is a non-invasive method of determining the composition of body tissues to evaluate the presence of body fluids such as lymphedema. Such measurements have been studes to establish a baseline at the time of breast cancer treatment.)
  • STAGE 1 LYMPHEDEMAStage I lymphedema is an early accumulation of fluid that is relatively high in protein content.
    • There is visible swelling with this protein-rich lymph.
    • This swelling can be temporarily reduced by elevation of the limb; however, the swelling soon returns when the limb is returned to a normal position.
    • The swollen tissues are soft and pitting edema is present.

    Lmphedema treatment should be begun as soon as signs are early detected. Waiting for the swelling to increase, or for an infection to develop, only makes the condition more difficult to treat. Prompt treatment of this stage can often control the condition and may prevent it from becoming more severe.

  • STAGE II LYMPHEDEMAStage II lymphedema is an increase in the swelling and a change in the tissues.
    • Elevation of the limb will not reduce the swelling.
    • The tissues become increasing firm due to fibrosis. Fibrosis is the formation of fine scar-like structures within the tissues that cause them to harden.
    • Pressure against the limb produces only a slight indentation or in indentation at all.
    • The tissue changes at this stage increase the risks of even greater swelling, fibrosis, infections, and skin problems.
    • Stage II lymphedema can usually be improved with intense treatment.
  • STAGE III LYMPHEDEMA

    Stage III lymphedema, which is also known as lymphostatic elephantiasis, is a condition in which the tissue becomes extremely swollen and thickened due to a blockage in the flow of lymph and a buildup of fluid in tissues.

    • The tissues become increasingly fibrotic (hardened). Pressure does not produce any pitting.
    • Normal elasticity is lost and the skin hangs in folds.
    • The skin may change color.
    • Papillomas are small solid benign tumors that project above the surrounding tissue, may develop.
    • Hyperkeratosis is an increase in the thickness of the outer layer of the skin, can develop.
    • These changes in the texture of the skin are disfiguring and can limit mobility.
    • Infections become more common because of increased risks of breaks in the skin. These infections include fungal infections and open wounds that form within the folds of skin.

    With intense therapy, Stage III lymphedema can be improved and potentially be prevented from becoming worse; however, it is rarely reversed to an earlier stage.

    One treatment to reduce the size of the limb is surgical debulking. Healing from this surgery can be difficult and, because the skin is still hardened, it still hangs in folds and deep creases are still present. These areas remain at risk for infections and open wounds


How can I prevent lymphedema?

  • Avoid insect bites, burns, skin irritants, hangnails, and torn cuticles.
  • Wear loose fitting clothing on affected area. Avoid tight fitting jewelry on the affected arm or hand Don’t overheat – avoid saunas, whirlpools, steam rooms, hot baths, and sun bathing.
  • Don’t receive shots, have blood drawn, or have blood pressure taken on affected arm.
  • If you are overweight and have experienced swelling, losing weight can help reduce it by reducing the amount of fatty tissue which retains fluid and blocks lymphatic pathways.
  • Remember that tennis, racquetball, golf, and bowling are all considered risky sports for upper extremity lymphedema and that soccer, running, skating etc…. are risky sports for lower extremity lymphedema.
  • Keep the at-risk area(s) spotlessly clean and use lotion after bathing.
  • Avoid repetitive movements with the affected area.
  • Avoid heavy lifting with the affected or at-risk arm. Never carry heavy handbags or bags with over-the-shoulder straps on the affected arm.
  • When traveling by air, wear compression sleeves or stockings.


Where can I get more information