Lymphedema

Facts

Lymphedema can occur to anyone undergoing a surgical lymph node biopsy or radiation therapy. Lymphedema is a swelling (edema) that can occur anywhere in the body including the breast, trunk, arms, legs, as well as head and neck. For patients undergoing breast cancer treatment, the areas affected are generally the arm, breast or chest wall.  There are two types of lymphedema: primary lymphedema and secondary lymphedema. Primary lymphedema results from congenital or genetic abnormalities. Secondary lymphedema results from damage to the lymphatic system and can develop as a side effect from cancer treatment. SCCA’s physical therapists help cancer patients manage secondary lymphedema—SCCA does not treat primary lymphedema.

Biopsy The removal of a sample of tissue or fluid that is examined to see whether cancer is present. This may be done with a large needle or through surgical removal of tissue or fluids. Lymphedema A condition in which extra lymph fluid builds up in tissues and causes swelling. It may occur in an arm or leg if lymph vessels are blocked, damaged or removed by surgery. Lymph system The tissues and organs that produce, store and carry white blood cells that fight infections and other diseases. The tissues and organs that produce, store and carry white blood cells that fight infections and other diseases. This system includes the bone marrow, spleen, thymus, lymph nodes and lymphatic vessels (a network of thin tubes that carry lymph and white blood cells). Lymphatic vessels branch, like blood vessels, into all the tissues of the body. Radiation therapy The use of high-energy radiation from X-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. The use of high-energy radiation from x-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores.

The Lymphatic System and Lymphedema

The lymphatic system works in parallel with the body’s circulatory system. But instead of blood, the lymphatic system collects and circulates lymph—about three liters per day—through a complex series of vessels and lymph organs, including lymph nodes, tonsils, thymus, spleen, and bone marrow.

One function of the lymphatic system is to clean up and remove waste—it’s a central component of your body’s immune system. As lymph circulates, it gets filtered by the lymph nodes. Your body contains several hundred of these pear-shaped nodes that work to trap and kill harmful substances such as bacteria and viruses.  

Many types of cancer use the lymph system as a way to spread (or metastasize) to other parts of the body. Along the way these cancer cells—like other foreign substances—are trapped in the lymph nodes. This is why surgeons remove lymph nodes (biopsy) so that a pathologist can examine and determine whether and how much cancer has spread. If nodes are removed or damaged, the flow of the lymph can be blocked. Lymph flows inward from the extremities and is returned to the blood system. When the lymphatic system gets blocked, swelling occurs in the head, neck, trunk, arms and legs. In addition to lymph node biopsies, radiation therapy can also affect the lymphatic system. Radiation therapy can cause the formation of scar tissue that makes it harder for the lymphatic system to move fluid and increases the risk of lymphedema. Patients with late-stage cancer who have a heavy tumor burden are also susceptible to developing lymphedema.

Biopsy The removal of a sample of tissue or fluid that is examined to see whether cancer is present. This may be done with a large needle or through surgical removal of tissue or fluids. Bone marrow The soft, spongy material in the center of your bones that produces all your blood cells, such as white blood cells, red blood cells and platelets. Lymphedema A condition in which extra lymph fluid builds up in tissues and causes swelling. It may occur in an arm or leg if lymph vessels are blocked, damaged or removed by surgery. Lymph system The tissues and organs that produce, store and carry white blood cells that fight infections and other diseases. The tissues and organs that produce, store and carry white blood cells that fight infections and other diseases. This system includes the bone marrow, spleen, thymus, lymph nodes and lymphatic vessels (a network of thin tubes that carry lymph and white blood cells). Lymphatic vessels branch, like blood vessels, into all the tissues of the body. Lymph system The tissues and organs that produce, store and carry white blood cells that fight infections and other diseases. The tissues and organs that produce, store and carry white blood cells that fight infections and other diseases. This system includes the bone marrow, spleen, thymus, lymph nodes and lymphatic vessels (a network of thin tubes that carry lymph and white blood cells). Lymphatic vessels branch, like blood vessels, into all the tissues of the body. Pathologist A physician who has special training in identifying diseases by studying cells and tissues under a microscope. Radiation therapy The use of high-energy radiation from X-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. The use of high-energy radiation from x-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Spleen An organ that is part of the lymphatic system. The spleen makes lymphocytes, filters the blood, stores blood cells and destroys old blood cells. It is on the left side of the abdomen near the stomach. Thymus An organ that is part of the lymphatic system, in which T lymphocytes grow and multiply. The thymus is in the chest behind the breastbone. Tonsils Two small masses of lymphoid tissue on either side of the throat.

Diagnosing Lymphedema

Swelling is a common side effect of surgery, but not every instance of swelling is the result of lymphedema. Sometimes lymphedema does not occur until sometime after surgery, or until something occurs—such as an insect bite or burn—that causes an extra burden on the lymphatic system. Lymphedema usually develops slowly over time. Some of the first signs of lymphedema can be a feeling of fullness or heaviness in the affected area, tightness of skin and/or decreased movement or flexibility. The swelling can range from mild to severe and can develop soon after surgery, or months and even years later. 

There is no cure for lymphedema. Early detection and treatment of lymphedema is critical—the later symptoms are addressed, the harder they can be to treat.

Lymphedema A condition in which extra lymph fluid builds up in tissues and causes swelling. It may occur in an arm or leg if lymph vessels are blocked, damaged or removed by surgery. Lymph system The tissues and organs that produce, store and carry white blood cells that fight infections and other diseases. The tissues and organs that produce, store and carry white blood cells that fight infections and other diseases. This system includes the bone marrow, spleen, thymus, lymph nodes and lymphatic vessels (a network of thin tubes that carry lymph and white blood cells). Lymphatic vessels branch, like blood vessels, into all the tissues of the body. Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores. Sign In medicine, a sign is something found during a physical exam or from a laboratory test that shows that a person may have a condition or disease. In medicine, a sign is something found during a physical exam or from a laboratory test that shows that a person may have a condition or disease. Some examples of signs are fever, swelling, skin rash, high blood pressure and high blood glucose. Symptom A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. Some examples of symptoms are headache, fatigue, nausea and pain.