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What Cancer Survivors Need to Know about Lymphedema

 

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To help prevent lymphedema-worsening infections, use cream or lotion to keep the skin moist.

Lymphedema is the build-up of fluid in soft body tissues. The condition occurs when lymph is not able to flow through the body the way that it should. When part of the lymph system is damaged or blocked, fluid cannot drain from nearby body tissues. Fluid builds up in the tissues and causes swelling. In cancer survivors, lymphedema is caused when the lymph system is damaged or blocked by infection, injury, cancer, re­moval of lymph nodes, radiation to the affected area, or scar tissue from radia­tion therapy or surgery.

Signs & Symptoms
Possible signs of lymphedema include swelling of the arms or legs. Talk to your doctor if you notice any of the following lymphedema signs or symptoms:
Swelling of an arm or leg, which may include fingers and toes
A full or heavy feeling in an arm or leg
A tight feeling in the skin
Trouble moving a joint in the arm or leg
Thickening of the skin, with or with­out skin changes such as blisters or warts
A feeling of tightness when wearing clothing, shoes, bracelets, watches, or rings
Itching of the legs or toes
A burning feeling in the legs
Trouble sleeping
Loss of hair

These symptoms may occur very slowly over time or more quickly if there is an infection or injury to the arm or leg. Daily activities and the ability to work or enjoy hobbies also may be affected by lymphedema.

Cancer and its treatment are risk factors for lymphedema.
It can occur after any cancer or treatment that affects the flow of lymph through the lymph nodes.

Risk Factors
Cancer and its treatment are risk factors for lymphedema. It can occur after any cancer or treatment that affects the flow of lymph through the lymph nodes, such as removal of lymph nodes. It may develop within days or many years after treatment. However, most lymphedema develops within three years of surgery.

Risk factors for lymphedema include the following:
Removal or radiation of lymph nodes in the underarm, groin, pelvis, or neck. The risk of lymphedema increases with the number of lymph nodes affected. There is less risk with the removal of only the sentinel lymph node (the first lymph node to receive lymphatic drain­age from a tumor).
Being overweight or obese
Slow healing of the skin after surgery
A tumor that affects or blocks the left lymph duct or lymph nodes or vessels in the neck, chest, underarm, pelvis, or abdomen
Scar tissue in the lymph ducts under the collarbones, caused by surgery or radiation therapy

Lymphedema often occurs in breast cancer survivors who had all or part of their breast removed and axillary (under­arm) lymph nodes removed. Lymphedema in the legs may occur after surgery for uterine cancer, prostate cancer, lym­phoma, or melanoma. It may also occur with vulvar cancer or ovarian cancer.

Managing Lymphedema
If you’re at risk for lymphedema, taking preventive steps may keep lymphedema from de­veloping. Talk to your doctor about what you can do to help prevent lymphedema.

If lymphedema has developed, these steps may keep it from getting worse:

◊ Tell your doctor right away if you notice symptoms of lymphedema. The chance of improving the condition is better if treatment begins early. Untreated lymphedema can lead to problems that cannot be reversed.

◊ Keep skin and nails clean and cared for, to prevent infection. Bacteria can enter the body through a cut, scratch, insect bite, or other skin injury. Fluid that is trapped in body tissues by lymph­edema makes it easy for bacteria to grow and cause infection. Look for signs of infection, such as redness, pain, swelling, heat, fever, or red streaks below the surface of the skin. Call your doctor right away if any of these signs appear. Careful skin and nail care can help prevent infection:
Use cream or lotion to keep the skin moist.
Treat small cuts or breaks in the skin with an antibacterial ointment.
Avoid needle sticks of any type into the arm or leg with lymphedema. This includes shots or blood tests.
Use a thimble for sewing.
Avoid testing bath or cooking water using the limb with lymphedema. There may be less feeling in the affected arm or leg, and skin might burn in scalding water.
Wear gloves when gardening and cooking.
Wear sunscreen and shoes when outdoors.
Cut toenails straight across. See a podiatrist as needed to prevent ingrown nails and infections.
Keep feet clean and dry, and wear cotton socks.

◊ Avoid blocking the flow of fluids through the body. It is important to keep body fluids moving, especially through an affected limb or in areas where lymphedema may develop.
Do not cross your legs while sitting.
Change your sitting position at least every 30 minutes.
Wear only loose jewelry and clothes without tight bands or elastic.
Do not carry handbags on the arm with lymphedema.
Do not use a blood pressure cuff on the arm with lymphedema.
Do not use elastic bandages or stock­ings with tight bands.

◊ Keep blood from pooling in the affected limb. To do this, keep the limb with lymphedema raised higher than the heart when possible. Do not swing the limb quickly in circles or let the limb hang down. This makes blood and fluid collect in the lower part of the arm or leg. And do not apply heat to the limb.

Exercise
Studies have shown that carefully controlled exercise is safe for people with lymphedema. Exercise does not increase the chance that lymphedema will develop in those who are at risk. In the past, those at risk for lymphedema were advised to avoid exercising the affected limb. Studies have now shown that slow, carefully controlled exercise is safe and may even help keep lymph­edema from developing. Studies have also shown that, in breast cancer sur- vivors, upper-body exercise does not increase the risk that lymphedema will develop.

Treatment
While damage to the lymph system cannot be repaired, treatment is given to control the swelling caused by lymphedema and keep other problems from developing or getting worse. Physical (non-drug) therapies are the standard treatment. Treatment may be a combination of several physical methods. The goal of these treatments is to help people with lymphedema continue with activities of daily living, to decrease pain, and to improve the ability to move and use the limb with lymph­edema. Drugs are not usually used for long-term treatment of lymphedema.

Treatment of lymphedema may include the following:
Pressure garments
Exercise
Bandages
Skin care
Compression device
Weight loss
Laser therapy
Massage therapy

When lymphedema is severe and does not get better with treatment, other problems may be the cause. Sometimes severe lymphedema does not get better with treatment, or it develops several years after surgery. If there is no known reason, doctors will try to find out if the problem is something other than the original cancer or cancer treatment, such as another tumor.

Lymphangiosarcoma is a rare, fast-growing cancer of the lymph vessels. It occurs in some breast cancer survi­vors, appearing about 10 years after mastectomy. Lymphangiosarcoma begins as purple lesions on the skin, which may be flat or raised. A CT scan or MRI is used to check for lymphangiosarcoma.

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Source: National Cancer Institute, cancer.gov

This article was published in Coping® with Cancer magazine, January/February 2016.