What Is Lymphedema

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Lymphedema is a buildup of fluid, or lymph, in soft tissue that causes swelling. When a person has lymphedema, it is often in a swollen arm or leg. One common cause is cancer treatment, because lymph nodes may be removed or damaged during care. This is often the case with breast cancer.

Yet lymphedema can occur in survivors of many types of cancer, including lymphoma—a completely different condition. Improved cancer survival rates mean there are more people who have, or will have, this swelling, and that's good news. But it also means that more people have questions about what lymphedema is and how to deal with the condition.

This article looks at how lymphedema is linked with cancer, the symptoms you may see, and how they are treated.

Woman wearing compression stockings
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Causes

Your circulatory system moves blood throughout the body, and the lymphatic system is much the same except in reverse. It collects fluid in the body’s tissues instead, and then sends it back into your veins. The system of canals, joined together by lymph nodes, has different “zones” in the body.

Lymph nodes in the groin area, for example, drain and filter tissue fluid and lymph from the legs. The nodes in the armpits help drain and filter lymph coming from the arms. But when the flow of lymph is blocked, it may lead to lymphedema in the affected zone.

A blockage in the groin can mean swelling in one or both legs. A block in the armpits can do the same, especially if scarring or other damage was caused by breast cancer treatment. There are other causes of arm and leg swelling, to be sure, and your doctor will help pinpoint the cause.

Symptoms and Complications

If a buildup of extra fluid and protein in the tissues persists, this can lead to an inflammation. There may be permanent, mild-to-severe swelling of the affected body parts, caused by fat deposits and scarring. Lymphedema can cause troubling symptoms that include:

  • Skin tightness
  • Reduced ability to move joints
  • Heaviness in affected limbs
  • Discomfort and pain
  • Repeated infection

When the flow of lymph fluid is blocked, it can cause edema, or swelling, in the affected sites of the body. This may cause mobility issues and discomfort, along with concerns over appearance.

Lymphedema and Lymphoma

Lymphoma is a class of blood cancers with two main types, Hodgkin lymphoma and non-Hodgkin lymphoma. It is not at all the same as lymphedema, although the two are linked. The swelling can be caused by the cancer, although in rare cases—mostly in women—it also may be a symptom.

There are reports of leg swelling as the first sign of lymphoma, often with swollen lymph nodes in the groin area or a cancer growing in the abdomen. The lymphedema also may be caused by a growing mass of cells that is blocking the lymph from flowing. Recall, too, that cancer treatments involving the lymph system can damage its drainage routes and cause fluid buildup in the body.

Management

Lymphedema is considered a chronic progressive condition. It can be managed, but it cannot yet be cured. It's a medical issue that researchers are still working on ways to improve.

For now, the standard treatment is called decongestive treatment. Think of congestion in the same way you would a highway traffic jam: the goal is to clear the road block. For lymphedema, ways to clear the congestion include exercise, wearing a compression garment, caring for your skin, and massaging the site by hand to help the lymph drain away.

Surgery is sometimes needed in severe cases, or in cases that don't improve with any of the standard decongestive treatments.

Recap

The body's lymphatic system is designed to drain fluid from tissues in your body and return it to your veins. Swelling in the arm or leg happens when the lymph system is blocked, as is often the case after cancer care. More people are expected to have lymphedema in the future because more people are surviving cancer.

Treatments

Treatment for lymphedema includes two basic types of surgery. They are called ablative or debulking surgery, and functional or physiologic surgery.

Ablative or debulking procedures have been in use since the early- to mid-20th century. These techniques reduce the volume of swollen limbs, but they can cause scarring and other complications. Liposuction may be used to remove fat tissue and return the limb to normal size, but for many people that means a lifetime of compressive therapy will follow.

Functional or physiologic surgeries include vascular lymph node transfer (VLNT) as well as lymphovenous bypass. These are newer techniques, so less is known about outcomes or which techniques will ensure the most benefit. Nonetheless, results have been promising thus far.

Both techniques try to channel some of the trapped lymph fluid back into the venous system. Both also are considered fairly complicated microsurgeries because of the tiny connections needed to achieve results. Here's how they work.

  • In lymphovenous bypass, working lymphatic vessels are connected to tiny venules⁠ in a complex microscopic surgery that basically "reconnects the plumbing."
  • In VLNT, surgeons borrow lymph nodes from one area of the body and transplant them to the area affected by lymphedema.

Notably, in VLNT the transplant includes blood vessels and fat tissue to create an "immunological center" in the damaged area. All clinical studies of VLNT so far have shown it helps to improve skin infections after the transfer too, with ⁠erysipelas, lymphangitis, and cellulitis⁠ among them.

Link to Cancer Risk

Is there a link between lymphedema and cancer risk? There is no evidence to date, but researchers are working to better understand the interactions between the immune system and cancer.

On the one hand, lymph nodes are often removed in various types of cancers. Most types of cancer initially spread into draining lymph nodes before they spread to other sites in the body, so lymph nodes in cancer patients are often surgically removed in affected areas.

On the other hand, some researchers point out that lymph node surgery in melanoma of the limbs is not recommended since it does not improve survival. In these cases, and perhaps for some cancers, it may be that the lymph nodes are acting as gatekeepers of tumor immunity. That means that their unnecessary removal could result in a poor prognosis.

Some findings in animal studies support this second view. They suggest that the flow of lymph plays a key role in immune response, while severe lymphatic dysfunction might actually support tumor growth. Science is just beginning to understand the "tumor microenvironment" and tumor immunology, and this is a very active area of research.

There is no clear link between cancer risk and lymphedema. Medical researchers continue to explore how the lymph system, and its role in immunity, may be connected with cancer risk.

Summary

Lymphedema is considered a chronic but usually treatable condition. The swelling caused by lymph fluid buildup in arms, legs, or other sites in the body is often linked with cancer treatment. As more people survive cancer, there are more people dealing with the symptoms of lymphedema.

Fortunately, there are treatments available to deal with the swelling. But cancer care isn't the only cause of blockages in the lymph system, and sometimes these blockages may actually be a sign of another condition. Your doctor can help to find the cause and start treating the affected site.

A Word From Verywell

For cancer survivors especially, it can be discouraging to find a swollen arm or leg. Lymphedema may seem yet another new problem to deal with, after all you've been through. Don't ignore it, though, because a healthy lymph system is so important to your progress and your well-being.

The swelling can be managed with relatively simple techniques in most cases. Surgery is an option if your lymph blockage doesn't respond to them. There are solutions, so try and stay positive despite your frustration with how lymphedema looks and feels.

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