lymphedema A buildup of protein and fluid (lymph) in soft tissue that causes swelling, usually in the arms or legs. 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 fluids — can be removed or damaged. This is usually the case with breast cancer.
Improving cancer treatment means improving survival. It also means that more people may develop lymphedema and have questions about how to deal with it.
This article looks at how lymphedema occurs, why it is associated with cancer, the symptoms it can cause, and how to treat the condition.
Why does lymphedema occur?
The lymphatic system is part of the immune system. It is made up of organs, blood vessels, and tissues that together act as a filter system that protects your body from bacteria, viruses, and other harmful or unwanted substances.
It works by extracting fluid from your tissues, collecting or killing anything that shouldn’t be there, and pushing that fluid into your bloodstream so that it can eventually be removed from your urine and feces.
The system of passages that make this happen are held together by lymph nodes. You have about 600 of them all over your body, and they have different “zones” that they tend to.
Lymph nodes in the groin area will drain and filter tissue fluid from the leg. Lymph nodes in the armpit help drain and filter lymph fluid from the arm.
All of these are very effective – unless something hinders the ability of the lymph to drain properly. This can lead to lymphedema in the area of the body near the affected lymph nodes.
For example, a blockage in the groin can mean swelling in one or both legs. A lump under the arm can do the same to the arm.
Possible reasons include:
- lymphomaa blood cancer
- Another cancer that causes blockage of the lymphatic system
- Cancer treatments that can disrupt lymphatic drainage pathways and cause fluid to build up
However, there are other causes of swollen arms and legs, so your healthcare provider will need to investigate to determine if lymphedema is really the culprit.
Lymphedema and Lymphoma
Lymphoma is a type of blood cancer and there are two main types, Hodgkin lymphoma and non-Hodgkin lymphoma. It is quite different from lymphedema, although the two can be linked.
Swelling can be a complication of cancer, although in rare cases – mostly in women – it can also be a symptom of cancer.
There have been reports of leg swelling as the first sign of lymphoma, usually an enlarged lymph node in the groin area or a growth of cancer cells in the abdomen. Lymphedema can also be caused by a growing clump of cells blocking the flow of lymph.
What everyone with breast cancer should know about lymphedema
Symptoms and Complications
If extra fluid and protein build up in the tissue, it can lead to inflammation. Affected body parts may experience permanent mild to severe swelling due to fatty deposits and scarring.
Symptoms of lymphedema may include:
- tight skin
- Decreased joint mobility
- The affected limb is heavy
- discomfort and pain
- recurrent infection
- A noticeable change in the appearance of the affected area
The body’s lymphatic system is designed to drain fluid from the body’s tissues and return it to the veins. Swelling in the arms or legs occurs when the lymphatic system is blocked, which often occurs after cancer treatment. More people are expected to have lymphedema in the future as more people survive cancer.
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Lymphedema is considered a chronic progressive disease. It can be managed, but it cannot be cured yet.
Currently, the standard treatment is called decongestant therapy to “clear the blockage in the lymphatic system”.
With lymphedema, there are things you and your healthcare provider can do to improve symptoms. They include:
- wearing tights
- Take care of your skin to better avoid infection
- Massage the area with your hands to help lymphatic drainage
These practices are part of standard decongestant treatment for lymphedema. They are both designed to help the body drain lymph fluid from the affected area.
In severe cases, or when there is no improvement with any standard decongestant treatment, surgery is sometimes necessary.
The two options are ablative (reductive) surgery and functional (physiological) surgery.
Ablation or debulking procedures have been in use since the early to mid-20th century. These techniques can reduce the volume of swollen limbs, but they can lead to scarring and other complications.
Liposuction can be used to remove fatty tissue and restore the limb to its normal size. In more complex cases, damaged skin can also be removed. Even with success, people may need a compression sleeve or bandage for life.
Functional or physiologic procedures including vascular lymph node metastasis (VLNT) and lymphovenous bypass. These are newer techniques, so little is known about the results or which techniques will ensure the greatest gains. Still, the results so far have been promising.
Both techniques attempt to direct some of the trapped lymph back into the venous system. Both are considered fairly complex microsurgeries, which means these procedures need to restore the tiniest of connections to be effective.
Here’s how they work.
- In a lymphovenous bypass, working lymphatic vessels are connected to tiny veins in a complex microsurgery, basically “reconnecting the pipes.”
- In VLNT, the surgeon borrows lymph nodes from one area of the body and transplants them into the area affected by lymphedema.
Notably, in VLNT, the graft includes blood vessels and adipose tissue to restore function to the damaged area. All clinical studies of VLNT to date have shown that it also helps improve skin infections after transplantation. These include erysipelas (affecting the upper layers of the skin), lymphangitis (affecting the lymphatic vessels), and cellulitis (a deep skin infection).
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Link to Cancer Risk
Is there a link between lymphedema and cancer risk? There is no evidence so far, but researchers are working to better understand the interaction between the immune system and cancer.
On the one hand, lymph nodes are often removed in various types of cancer to limit their spread. Most types of cancer first spread to the draining lymph nodes before reaching the rest of the body, and removing the lymph nodes can help prevent this.
On the other hand, some researchers point out that lymph node surgery for melanoma of the extremities is no Recommended as it does not improve survival. In these cases, and perhaps for some other cancers, the lymph nodes may be gatekeepers to tumor immunity. This means they are essential in the fight against cancer, and unnecessary removal can lead to a poor prognosis.
Several findings from animal studies support the second view. They believe that lymphatic flow plays a key role in the immune response, and that severe lymphatic dysfunction may 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 lymphatic system and its role in immunity are linked to cancer risk.
Lymphedema is considered a chronic but usually manageable disease. Swelling caused by a buildup of lymph fluid in the arms, legs, or other parts of the body is often associated with cancer and cancer treatment.
But these are not the only possible causes of a blocked lymphatic system. Your healthcare provider can help find the cause and start treating the affected area.
Especially for cancer survivors, finding a swollen arm or leg can be frustrating. After all, lymphedema appears to be a new problem to deal with. But don’t ignore it. A healthy lymphatic system is very important to your progress and overall health.
There are solutions. If what you’ve tried doesn’t work, talk to your healthcare team.