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Lymphedema is a collection of
fluid that causes swelling (edema) in the arms and legs.
One of the causes of
lymphedema is surgery to remove
lymph nodes, usually during cancer treatment. Normally, lymph nodes filter
fluid as it flows through them, trapping bacteria, viruses, and other foreign
substances, which are then destroyed by special white blood cells called
lymphocytes. Without normal
lymph drainage, fluid can build up in the affected arm
or leg, and lymphedema can develop. Medicines such as tamoxifen (Nolvadex),
radiation therapy, and injury to the lymph nodes can
also cause lymphedema. This type is called secondary lymphedema.
Primary lymphedema can be present at birth or develop during puberty or
adulthood. The cause of primary lymphedema is not known.
Symptoms of lymphedema
include feeling as though your clothes, rings, wristwatches, or bracelets are
too tight; a feeling of fullness in your arms or legs; and less flexibility in
your wrists, hands, and ankles.
Treatment for lymphedema
depends on its cause and includes wearing compression garments such as
stockings or sleeves, proper diet and skin care, and fluid drainage.
Elevating an arm or leg that has swelling can help ease the drainage of
lymph fluid from the affected limb. Whenever possible, rest a swollen arm or
leg on a comfortable surface, above the level of your heart. Don't put pressure
on your armpit or groin area, and don't hold a limb up without support for very
long since this can increase swelling.
Gentle exercise can help
reduce swelling. The use of muscles during exercise naturally helps lymph fluid
to circulate, which can reduce swelling. But exercise also increases blood
flow to the muscles being used, which can increase the amount of lymph fluid
present. If you have swelling, it is important to properly bandage an affected
limb before exercising. Ask your doctor how to use a bandage for
this purpose and what exercises are appropriate for your condition.
After surgery or radiation treatment
If you have had surgery to
remove some lymph nodes, use your affected arm or leg as normally as possible.
Most people are healed about 4 to 6 weeks after surgery, and able to go back to
their normal activities.
If you have had lymph nodes
removed or have had radiation therapy as part of cancer treatment, you may be
able to avoid
lymphedema or keep it under control by following the
If you have lymphedema, you may want to wear a lymphedema
alert bracelet. These bracelets, available through the National Lymphedema
Network, are worn to protect those who have lymphedema from receiving treatment
such as blood pressure readings, injections, or blood draws to their affected
limbs that could make their condition worse.
Other Works Consulted
Lawenda BD, et al. (2009). Lymphedema: A
primer on the identification and management of a chronic condition in oncologic
treatment. CA: A Cancer Journal for Clinicians, 59:
Vargo MM, et al. (2008). Lymphedema section
of Rehabilitation of the cancer patient. In VT DeVita et al., eds.,
DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology, 8th ed., vol. 2, pp. 2867. Philadelphia:
Lippincott Williams and Wilkins.
June 28, 2011
Sarah Marshall, MD - Family Medicine & Douglas A. Stewart, MD - Medical Oncology
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