Lymphedema and Cancer : Management, Part 2

by National Cancer Institute

(Page 3 of 3)

Compression garments

When pressure garments are used, they should cover the entire area of edema. For example, a stocking that reaches only to the knee tends to become tight and block the lymphatic vessels and veins if there is edema in the thigh. Pumps connected to cuffs that wrap around the arm or leg and apply pressure on and off may be helpful; however, some physicians and therapists feel these pumps are not effective and may make the edema worse. The cuff is inflated and deflated according to a controlled time cycle. This pumping action is believed to increase the movement of fluid in the veins and lymphatic vessels and keeps fluid from collecting in the arm or leg. Compression pumps should be used only under the supervision of a trained health care professional because high external pressure can damage the lymphatic vessels near the skin surface.

Drug therapy

Antibiotics may be used to treat and prevent infections. Other types of drugs such as diuretics or anticoagulants (blood thinners) are generally not helpful, and may make the problem worse.

Finding the exact cause of the swelling and treating it correctly is important. Edema often leads to infection, which then increases fluid and protein deposits in the tissues. If an infection is diagnosed, appropriate antibiotics should be given. Blood clots should be ruled out because massage and other therapy techniques to encourage drainage may cause the clots to move through the bloodstream and cause more serious heart or lung problems. If blood clots are found, they should be treated with anticoagulants.

Coumarin is a dietary supplement that has been studied as a treatment for lymphedema. In the United States, dietary supplements are regulated as foods, not drugs. Supplements are not required to be approved by the Food and Drug Administration (FDA) before being put on the market. Because there are no standards for manufacturing consistency, dose, or purity, one lot of dietary supplements may differ considerably from the next.

Coumarin was once used in some foods and medications in the United States. It was found to cause liver damage, and its use in foods and medications in the United States has been banned since the 1950s. Coumarin is available in several countries, but has not been approved for use in the United States or Canada.

Dietary Management

The nutritional status of the patient should be evaluated and appropriate dietary recommendations should be made. Blood protein levels and weight should be monitored regularly, and patients should be encouraged to eat protein-rich foods.

Pain Management

Patients with lymphedema may experience pain caused by the swelling and pressure on nerves; loss of muscle tissue and function; or scar tissue causing shortening of muscles and less movement at joints. Pain may be treated with medications, relaxation techniques, and/or transcutaneous electric nerve stimulation (TENS); however, the most successful treatment is to decrease the lymphedema.

Complications

Edema can make tissues less able to take in nutrients and more likely to be damaged if the affected limb is not moved for long periods. Therefore, patients with lymphedema should be monitored for areas of skin breakdown, especially over areas with very little tissue between the skin and bone (i.e., hips, knees, and elbows).

Bladder emptying problems can develop from lymphedema in the pelvic or groin areas. Patients with lymphedema who are also taking opioids may develop bowel problems. Bowel and bladder status should be monitored regularly for any signs of urine retention or constipation.

Psychosocial considerations

Because lymphedema is disfiguring and sometimes painful and disabling, it can create mental, physical, and sexual problems. Several studies have noted that women who develop lymphedema after treatment for breast cancer have more mental, physical, and sexual difficulties than women who do not develop lymphedema. The added stresses associated with lymphedema may interfere with treatment that is often painful, difficult, and time-consuming.

Coping with lymphedema in the arm after breast cancer treatment is especially difficult for patients who have little social support. Some patients may react to the problem by withdrawing. Coping is also difficult for patients with painful lymphedema. Patients with lymphedema may be helped by group and individual counseling that provides information about ways to prevent lymphedema, the role of diet and exercise, advice for picking comfortable and flattering clothes, and emotional support.

Complications

In addition to the complications associated with chronic lymphedema noted in previous sections, a rare but fatal complication of lymphedema is lymphangiosarcoma, a tumor of the lymphatic vessels. The average time between mastectomy and the appearance of lymphangiosarcoma is about 10 years. After a patient develops lymphangiosarcoma, the average survival time is a little more than 1 year.

The cause of lymphangiosarcoma is not known. It appears as one or more bluish-red bumps on the affected arm or leg. First, one purple-red, slightly raised area in the skin of the arm or leg appears. The patient usually describes it as a bruise. Later, more tumors appear, and the bumps grow. Death usually results from metastases to the lungs.

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