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Questions and Answers about Lymphedema

What It Is, Who’s at Risk, and What You Can Do about It

by Stanley G. Rockson, MD, FACP, FACC

Photo by Cancer Type

Lymphedema is the accumulation of a protein-rich body fluid called lymph, typically in one part of the body, when the lymphatic system for fluid transport is damaged. For example, if lymph nodes are removed from the armpit region during breast cancer treatment, lymphedema can occur in that arm.

Why is the lymphatic system important?
The lymphatic system is part of the im­mune system. It fulfills the function of immune trafficking, the process whereby infection-fighting cells can be mobilized to the tissues that require assistance. When the lymphatic system is compro­mised by surgery, trauma, or improper development, the affected part of the body is prone to recurrent infection.

How does surgery affect my risk of lymphedema?
Your risk of developing lymphedema is chiefly aligned with lymph node removal. For instance, individuals who have undergone lumpec­tomy without lymph node removal are at such low risk that it is impossible to estimate. However, sentinel node removal, a technique that involves the removal of no more than four lymph nodes, increases the risk of develop- ing lymphedema to about 6 percent. If you have more than four lymph nodes removed, your risk rises to 15 to 25 percent.

Does radiation increase the risk of lymphedema?
Yes, radiation alone can traumatize the lymphatic system just as much as surgery can. In general, the risk of lymphedema following radia­tion therapy is roughly equal to that of axillary lymph node dissection. More­over, radiation therapy increases the lymphedema risk associated with sur­gery if both treatments are performed.

Author of Article photo

Dr. Stanley Rockson

If I’ve had lymph nodes removed under one arm, do I have to worry about the lymph nodes in other areas of my body?
No. The lymphatic system is present throughout the body, but lymphedema affects only the part of the body that’s been treated.

Do I have to worry about lymphedema for the rest of my life?
A better way to phrase it is you’ll have to stay vigilant. The primary risk for lymphedema de­velopment is in the first year following surgery or radiation therapy, when 90 percent of lymphedema cases occur. By the end of three years, 95 percent of lymphedema cases will have appeared. If you don’t have lymphedema after three years of vigilance, the risk remains but is quite small. If you take the proper precautions and watch out for signs of lymphedema, your risk will remain relatively small.

Is it safe to exercise after cancer surgery?
While exercise is beneficial in the long run, it’s important to give your body adequate time for healing after surgery. In general, for the first three to four weeks following surgery, you should remain relatively inactive. After that time, you can slowly and progressively increase your activity. Your doctor can give you specific guidelines based on your condition.

What about exercise during radiation therapy?
You can expect a certain amount of inflammation related to the radiation, and you need to avoid over-taxing your lymphatic system. Accordingly, it is reasonable to take it easy during radiation.

Prior to my cancer diagnosis, I led an active lifestyle. Now I’m worried that my former activities could cause lymphedema to emerge. What should I do?
As a cancer survivor, you must enjoy the gift of life. This means not placing boundaries on your definition of living well. With certain activities, there is a small, finite risk of lymph­edema appearing for the first time if cancer treatment has affected your lymph nodes, or of lymphedema becoming worse if you already have it. However, with the appropriate precautions, those risks remain quite small.

You should weigh the risk-to-benefit ratio of each activity you’re interested in. Yes, there is some risk of lymphedema with activities like surfing or rock climb­ing, for example, but you have to weigh the importance of those activities in your life against the risk involved in continuing them.

With or without risky activities, appropriate treatment is essential if lymphedema appears. It’s important to use the compression garment that is provided to you (particularly during activities that pose theoretical risk) and to watch for changes in the at-risk limb. Take precautions against infection when you have breaks in your skin, and seek medical attention early if you notice any skin changes. When you go outside, put on a sun block, because sunburn can aggravate lymphedema. Be careful when you’re working in the kitchen. When you’re in the garden, wear gloves to avoid cuts and scratches. Talk with your doctor about any specific guidelines you should follow, but in general, you should be able to do what you want to do and go where you want to go as long as you’re careful.

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Dr. Stanley G. Rockson is the Allan and Tina Neill Professor of Lymphatic Research and Medicine at Stanford University School of Medicine in Stanford, CA. He is a mem­ber of Lymphatic Education & Research Network’s Scientific/Medical Advisory Council.

The Lymphatic Education & Research Network is a nonprofit organization whose mission is to fight lymphedema and lymphatic disease through education, research, and advocacy. Learn more at

Reprinted with permission from © 2015 Lymphatic Education & Research Network.

This article was published in Coping® with Cancer magazine, March/April 2015.