What Is Lymphedema?

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Lymphedema is a buildup of protein and fluid (lymph) in soft tissues that causes swelling, often in an arm or leg. Cancer treatment, as well as cancer itself, are common causes. This is because lymph nodes—small structures throughout the body that help filter and drain fluid—may be removed or damaged. This is often the case with breast cancer.

Improved cancer treatments mean improved survival rates. They also mean more people who may develop lymphedema and have questions about how to deal with it.

This article looks at how lymphedema occurs, why it is linked with cancer, the symptoms it may cause, and how the condition is treated.

Woman wearing compression stockings
ChesiireCat / Getty Images

Why Does Lymphedema Happen?

The lymphatic system is part of the immune system. It is made up of organs, vessels, and tissues that, together, work as a filtration system to protect your body from bacteria, viruses, and other harmful or unnecessary substances.

It does this by taking fluid from your tissues, collecting or killing off anything that shouldn't be there, and pushing that fluid into the blood so that it can eventually be removed in your urine and feces.

The system of channels that make this happen are joined together by lymph nodes. You have about 600 of them throughout the body and they have different “zones” that they tend to.

Lymph nodes in the groin area will drain and filter tissue fluid from the legs. The nodes in the armpits help drain and filter lymph coming from the arms.

All of this works exceptionally well—except when something is impeding the ability of lymph to drain properly. This may lead to lymphedema in the zone of the body near the affected lymph node.

For example, a blockage in the groin can mean swelling in one or both legs. A block in the armpits can do the same to the arms.

Possible causes include:

  • Lymphoma, a type of blood cancer
  • Another type of cancer that's causing a blockage in the lymph system
  • Cancer treatment that can damage lymph drainage routes and cause fluid buildup

There are other causes of arm and leg swelling, however, so your healthcare provider will need to investigate to determine if lymphedema is truly to blame.

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 can be linked.

The swelling can be a complication caused by the cancer, although in rare cases—mostly in women—it also may be a symptom of the cancer.

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.

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 symptoms can include:

  • Skin tightness
  • Reduced ability to move joints
  • Heaviness in affected limbs
  • Discomfort and pain
  • Repeated infection
  • Visible changes in the appearance of the affected area

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.

Treatment

Lymphedema is considered a chronic progressive condition. It can be managed, but it cannot yet be cured.

For now, the standard treatment is called decongestive treatment to "clear the roadblock" in the lymphatic system.

Self-Care

For lymphedema, there are steps you and your healthcare provider can take to improve symptoms. They include:

  • Exercise
  • Wearing a compression garment
  • Caring for your skin to better avoid infection
  • Massaging the site by hand to help the lymph drain away

These practices are a part of standard decongestive treatment for lymphedema. They all are geared toward helping the body to drain lymph away from the affected site.

Lymphedema Surgery

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

The two options are ablative (debulking) surgery and functional (physiologi) 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. In more complex cases, damaged skin may be removed as well. Even with success, people may need to use compression sleeves or bandages for a lifetime.

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, meaning that these procedures need to restore the tiniest of connections in order to achieve results.

Here's how they work.

  • In lymphovenous bypass, working lymphatic vessels are connected to tiny veins 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 restore function to the damaged area. All clinical studies of VLNT so far have shown it helps to improve skin infections after the transfer too. These include ⁠erysipelas (affecting the upper layers of skin), lymphangitis (affecting the lymphatic channels), and cellulitis⁠ (a deep skin infection).

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 to limit their spread. Most types of cancer initially spread into draining lymph nodes before they reach other sites in the body, and taking the nodes out can help prevent this.

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 other cancers, it may be that the lymph nodes are acting as gatekeepers of tumor immunity. That means they are needed in the fight against cancer and 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.

This is a very active area of research that scientists are just beginning to understand.

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 manageable condition. The swelling caused by lymph fluid buildup in arms, legs, or other sites in the body is often linked with cancer and cancer treatment.

But these aren't the only possible causes of blockages in the lymph system. Your healthcare provider 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. But don't ignore it. A healthy lymph system is so important to your progress and overall health.

There are solutions. And if those you're trying aren't effective, talk to your healthcare team.

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  1. Kalemikerakis I, Evaggelakou A, Kavga A, Vastardi M, Konstantinidis T, Govina O. Diagnosis, treatment and quality of life in patients with cancer-related lymphedemaJ BUON. 2021;26(5):1735-1741.

Additional Reading
  • Elgendy IY, Lo MC. Unilateral lower extremity swelling as a rare presentation of non-Hodgkin’s lymphoma. BMJ Case Reports. 2014;2014:bcr2013202424.

  • Ito R, Suami H. Overview of lymph node transfer for lymphedema treatment. Plast Reconstr Surg. 2014;134(3):548-56.

  • Kimura T, Sugaya M, Oka T, Blauvelt A, Okochi H, Sato S. Lymphatic dysfunction attenuates tumor immunity through impaired antigen presentation. Oncotarget. 2015;6(20):18081-18093.

  • Massini G, Hohaus S, D’Alò F, et al. Mantle Cell Lymphoma Relapsing at the Lymphedematous Arm. Mediterr J Hematol Infect Dis. 2013;5(1):e2013016.

  • Tourani SS, Taylor GI, Ashton MW. Vascularized Lymph Node Transfer: A Review of the Current Evidence. Plast Reconstr Surg. 2016;137(3):985-93.