Lymphedema and Cancer : Management

by National Cancer Institute

(Page 2 of 3)

Prevention

Patients at risk for lymphedema should be identified early, monitored, and taught self-care. A patient may be more likely to develop lymphedema if he or she eats an inadequate diet, is overweight, is inactive, or has other medical problems. To detect the condition early, the following should be examined:

• Comparison of actual weight to ideal weight.
• Measurements of the arms and legs.
• Protein levels in the blood.
• Ability to perform activities of daily living.
• History of edema, previous radiation therapy, or surgery.
• Other medical illnesses such as diabetes, high blood pressure, kidney disease, heart disease, or phlebitis (inflammation of the veins).

It is important that the patient know about his or her disease and the risk of developing lymphedema. Poor drainage of the lymphatic system due to surgical removal of the lymph nodes or to radiation therapy may make the affected arm or leg more susceptible to serious infection. Even a small infection may lead to serious lymphedema. Patients should be taught about arm, leg, and skin care after surgery and/or radiation (see Considerations for Teaching Patients Prevention and Control of Lymphedema below). It is important that patients take precautions to prevent injury and infection in the affected arm or leg because lymphedema can occur 30 or more years after surgery. Breast cancer patients who follow instructions about skin care and proper exercise after mastectomy are less likely to experience lymphedema.

Lymphatic drainage is improved during exercise; therefore, exercise is important in preventing lymphedema. Breast cancer patients should do hand and arm exercises as instructed after mastectomy. Patients who have surgery that affects pelvic lymph node drainage should do leg and foot exercises as instructed. The doctor decides how soon after surgery the patient should start exercising. Physiatrists (doctors who specialize in physical medicine and rehabilitation) or physical therapists should develop an individualized exercise program for the patient.

Better recovery occurs when lymphedema is discovered early, so patients should be taught to recognize the early signs of edema and to tell the doctor about any of the following symptoms:

• Feelings of tightness in the arm or leg.
• Rings or shoes that become tight.
• Weakness in the arm or leg.
• Pain, aching, or heaviness in the arm or leg.
• Redness, swelling, or signs of infection.

Considerations for Teaching Patients Prevention and Control of Lymphedema

1. Keep the arm or leg raised above the level of the heart, when possible. Avoid making rapid circles with the arm or leg to keep blood from collecting in the lower part of the limb.

2. Clean the skin of the arm or leg daily and moisten with lotion.

3. Avoid injury and infection of the arm or leg.

Arms:

• Use an electric razor for shaving.
• Wear gardening and cooking gloves.
• Use thimbles for sewing.
• Take care of fingernails; do not cut cuticles.

Legs:

• Keep the feet covered when outdoors.
• Keep the feet clean and dry; wear cotton socks.
• Cut toenails straight across; see a podiatrist as needed to prevent ingrown nails and infections.

Either arms or legs:

• Suntan gradually; use sunscreen.
• Clean cuts with soap and water, then use antibacterial ointment.
• Use gauze wrapping instead of tape; do not wrap so tight that circulation is cut off.
• Talk to the doctor about any rashes.
• Avoid needle sticks of any type in the affected arm or leg.
• Avoid extreme hot or cold such as ice packs or heating pads.
• Do not overwork the affected arm or leg.

4. Do not put too much pressure on the arm or leg.

• Do not cross legs while sitting.
• Wear loose jewelry; wear clothes without tight bands.
• Carry a handbag on the unaffected arm.
• Do not use blood pressure cuffs on the affected arm.
• Do not use elastic bandages or stockings with tight bands.
• Do not sit in one position for more than 30 minutes.

5. Watch for signs of infection, such as redness, pain, heat, swelling, and fever. Call the doctor immediately if any of these signs appear.

6. Do prescribed exercises regularly as instructed by the doctor or therapist.

7. Keep regular follow-up appointments with the doctor.

8. Check all areas of the arms and legs every day for signs of problems.

• Measure around the arm or leg at regular intervals as suggested by the doctor or therapist.
• Measure the arm or leg at the same two places each time.
• Tell the doctor if the limb suddenly gets larger.

9. The ability to feel sensations such as touch, temperature, or pain in the affected arm or leg may be lessened. Use the unaffected limb to test temperatures for bath water or cooking.

Treatment

Lymphedema is treated by physical methods and with medication. Physical methods include supporting the arm or leg in a raised position, manual lymphatic drainage (a specialized form of very light massage that helps to move fluid from the end of the limb toward the trunk of the body), wearing custom-fitted clothes that apply controlled pressure around the affected limb, and cleaning the skin carefully to prevent infection. Lymphedema may be treated by combining several therapies. This is known as complex physical therapy (or complex decongestive therapy), which consists of manual lymphedema treatment, compression wrapping, individualized exercises, and skin care followed by a maintenance program. Complex physical therapy must be performed by a professional trained in the techniques.

Surgery for treating lymphedema usually results in complications and is seldom recommended for cancer patients.

About the Author

www.nci.nih.gov
The National Cancer Institute's research programs are extensive and contain many innovative initiatives. I invite you to explore our Web site to find out more about the exciting work being conducted here at NCI and by NCI-supported scientists throughout the country.