For People at Risk of Lymphedema
Lymphedema (limf-uh-DEE-muh) is a build-up of lymph fluid in the fatty tissues just under the skin. It can develop after treatment for some types of cancer.
Doctors do not fully understand why some people are more likely to have problems with lymphedema than others. And at this time there is no sure way to prevent lymphedema. Still, most experts say there are things you can do to help lower your risk of lymphedema, delay its onset, or reduce its impact.
Am I at risk for lymphedema?
People who have many lymph nodes removed and/or radiation therapy have a higher risk of long-term lymphedema. But at this time there’s no way to predict who will develop it.
Lymphedema can become a problem after surgery or radiation treatment for nearly any type of cancer, but it’s most often linked to treatments for:
- Breast cancer
- Prostate cancer
- Pelvic area cancers (such as bladder, penile, testicular, endometrial, vulvar, or cervical cancer)
- Head and neck cancers
Lymphedema is seen more often in the arms or legs, but it can happen in other parts of the body, too. If lymphedema occurs after breast cancer treatment, it can affect the breast, chest, and underarm, as well as the arm closest to the surgery. After cancer in the abdomen (belly) or pelvis has been treated, lymphedema may appear as swelling of the abdomen, genitals, or one or both legs. Treatment of tumors in the head and neck area has been linked with lymphedema in the face, mouth, eyes, and neck.
Once lymphedema has started, it can’t be cured. Still, early and careful management can reduce symptoms and help keep it from getting worse. The sooner it’s treated, the better the response. What Is Cancer-related Lymphedema has details on the signs and symptoms you should watch for and report to a doctor right away.
Things you can do to help reduce your risk for lymphedema
Get regular medical check-ups.
Regular check-ups should include screening for lymphedema. If you’ve been recording measurements of the affected part of your body, this may be part of the check-up. Talk to your cancer care team about how often you should be checked.
Women should not avoid mammograms.
Mammograms are a key part of breast cancer follow-up and should not be avoided because of worries about lymphedema. At this time, there’s no link between mammograms and the start of or worsening of arm or chest lymphedema. If you do notice breast swelling or soreness after a mammogram, be sure to talk to your doctor or lymphedema therapist.
Report any changes to your doctor.
Over time, you will heal and learn how the affected part of your body normally looks and feels. Any changes in size, color, temperature, feeling, or skin condition should be reported to your doctor right away.
Try to get to and/or stay at a healthy weight.
We know that obese people are at higher risk for lymphedema, and obesity can make it harder to treat. Talk to your cancer care team about what a healthy weight is for you. Get their advice on how to get to and/or stay at that weight.
It’s important to use the part of your body that’s been affected by cancer for normal, everyday activities to help you heal properly and regain strength. Using your muscles also helps the lymph fluid drain like it should. It also helps keep your muscles flexible and helps reduce scarring.
Certain types of exercise can help reduce your lymphedema risk, too, and some exercises can make lymphedema better after it starts. If you’ve had surgery or radiation treatment, ask your doctor or nurse when you can start to exercise and what type of exercises you can do. Avoiding exercise and allowing your body to get out of shape may lead to lymphedema and bouts of swelling that are sometimes called flare-ups.
But keep in mind that some kinds of exercise can increase your risk of lymphedema or make lymphedema worse if you already have it. Overuse, which can result in injury, has also been linked with the start of lymphedema in some people. Work with a trained fitness or health professional to design an exercise plan that’s right for you and starts at a low level of intensity and progresses slowly to avoid overuse. Contact the American Physical Therapy Association (APTA) at www.apta.org or 1-800-999-2782 to find a physical therapist near you who works with people with cancer.
Your doctor or therapist may recommend these tips for exercising safely:
- Use your affected body part as normally as you can. Once you are fully healed, typically about 4 to 6 weeks after surgery or radiation treatment, you can begin to go back to the activities you did before your surgery. But check with your cancer care team first.
- Exercise regularly, but try not to over-tire yourself. Before starting any exercises, talk with your doctor, nurse, or physical therapist. They can help you set goals and limits so that you can work at the level of activity that’s right for you.
- If the affected part of your body starts to ache or swell, lie down and raise it above the level of your heart.
- Avoid overuse of the affected body part. Sudden increases in how long or hard you work out might trigger or worsen lymphedema.
- Avoid vigorous, repeated activities.
- Avoid heavy lifting or pulling.
Any exercise program should be started gradually, increased cautiously, and stopped if you have pain, swelling, or other discomfort. Talk with your doctor if you have any of these problems. If they continue, ask about being referred to a certified lymphedema specialist.
Contacts to find a lymphedema specialist near you:
Lymphology Association of North America (LANA)
National Lymphedema Network (NLN)
Toll-free number: 1-800-541-3259
Try to avoid infections, burns, and injuries.
Your body responds to infection, burn, or injury by sending extra fluid and white blood cells to the area. If lymph nodes and vessels are missing or damaged, it’s harder for your body to move this extra fluid, which can trigger or worsen lymphedema.
Some basic precautions, good hygiene, and careful skin care may help reduce your risk of lymphedema by helping you avoid infections, burns, and injuries. Follow these tips to help you care for the part of your body that had surgery and/or radiation:
- Most doctors recommend having your blood drawn, IVs, and shots done in the unaffected arm if you can. Also get flu shots and vaccinations in your unaffected arm or somewhere else, like the hip. Tell the doctor or nurse that you’re at risk for lymphedema.
- Keep the affected area clean. Careful skin care can help you prevent infections.
- Keep your hands, feet, and cuticles soft and moist by regularly using moisturizing lotion or cream. This will help keep your skin from chapping or cracking. Push your cuticles back with a cuticle stick while they are soft (after a bath) rather than cutting them with scissors. Try not to pick at or bite your cuticles. Cut toenails straight across to help prevent ingrown toenails.
- Clean and protect any openings in your skin caused by cuts, scrapes, scratches, bug bites, hangnails, or torn cuticles.
- Watch for early signs of infection, like pus coming from a cut or scrape, rash, red blotches or streaks, swelling, increased heat, tenderness, chills, or fever. Call your doctor right away if you think you have an infection.
- Keep pets’ claws trimmed to avoid getting scratched.
- If your arm is affected, wear protective gloves with sleeves when doing household chores that use harsh chemical cleansers or steel wool, when gardening or doing yard work, and when working with animals that might scratch or bite. Wear a thimble when sewing to cut down on needle and pin pricks to your fingers.
- Be extra careful when shaving, and use a clean razor on clean skin.
- Use an insect repellent to help prevent bug bites when outdoors. If you’re bit or stung in the affected area, clean and raise the limb, and put ice on the bite or sting. Keep it clean, and call your doctor if it shows any signs of infection.
- Avoid activities that irritate or chap your skin.
- Protect your body, especially treated areas, from sunburn. Cover these areas with tightly woven clothing, or use a broad spectrum sunscreen that is labeled SPF 30 or higher, and try to stay out of the sun between 10 a.m. and 4 p.m., when the ultraviolet (UV) rays are strongest.
- Your affected limb might not sense hot or cold as well as it did in the past. Test bath water temperatures with an unaffected limb.
- Be careful when frying foods, boiling liquids, and removing food from a microwave oven. Use oven mitts.
- Avoid high heat, such as from hot tubs and saunas. If you use a heating pad or ice pack on the affected area, limit the length of time you use it until you know how your body responds. Both heat and cold can damage tissues and can increase fluid build-up. Some doctors may advise you to stay away from all sources of extreme temperatures.
- Do what you can to protect yourself against falls, fractured bones, and serious burns.
Try to avoid constriction.
Constriction or squeezing of the arm or leg may increase the pressure in nearby blood and lymph vessels. This can lead to increased fluid and swelling (much like water building up behind a dam). Some people have linked this with the start of lymphedema.
Tips if your arm is affected include:
- Wear loose jewelry, clothing, bras, and gloves. Avoid anything that fits too tightly or puts pressure around your chest, arm, or wrist. Clothing and compression garments should be supportive and have smooth, even compression.
- Do not use shoulder straps when carrying briefcases and purses.
- Wear a loose-fitting bra with padded straps that don’t dig into your shoulder. Make sure underwires don’t put pressure on your breast or chest. After a mastectomy, use a lightweight prosthesis (breast form). A heavy prosthesis might put too much pressure on the area.
- Many doctors recommend you have your blood pressure taken on the unaffected arm, if possible. If both arms are affected, blood pressure can be taken on your thigh. Or, you can ask that blood pressure be measured by someone using a hand pump and stethoscope rather than using a machine; the machines often use high pressures for a longer time.
Tips if your lower body or leg is affected include:
- Wear loose clothing. Avoid anything that fits too tightly or puts pressure around your waist, legs, or genitals, such as undergarments or pants with tight elastic bands.
- Wear well-fitting, closed shoes instead of sandals or slippers. Do not go barefoot.
- Keep your feet clean and dry. Wear soft protective socks (cotton or padded types).
- Avoid socks or stockings with tight elastic bands.
- Try not to stand or sit in one place for too long (more than 30 minutes). Do not cross your legs when sitting.
- Some people at risk of leg lymphedema might benefit from wearing a compression stocking when up and walking around. A compression stocking can help squeeze the lymph fluid through the remaining vessels before it builds up. The stocking must be well fitted to apply the right pressure while avoiding too much tightness near the top of the stocking. Ask your doctor, nurse, or therapist if you should be fitted for a compression stocking.
Be aware of cellulitis.
Cellulitis is an infection in the tissues just under your skin. Signs and symptoms of this problem include redness, warmth, fever, pain, and flu-like symptoms. This is an urgent medical problem that you need to tell your doctor about right away.
Cellulitis can lead to or worsen lymphedema. In fact, if it becomes a repeated problem, antibiotics may be needed to keep it under control.
Compression garments are fitted sleeves or stockings that can help prevent swelling by moving lymph fluid from the arm or leg back into the body. Careful fitting is needed, and you should follow your health care provider’s advice on use and care of the garment.
Compression garments are most often used by people who already have lymphedema. But if you’re at risk for lymphedema, you might want to use one to help lower your risk in certain situations. For instance, lymphedema might be linked with air travel, possibly because of air pressure changes. But there are pros and cons to using a compression garment on long or frequent flights. Ask your doctor or therapist if you should be fitted for a garment to wear during air travel. You might also want to discuss ways to safely raise your affected body part and exercise it during long flights.
Be sure compression garments fit well and are worn properly. Do not use a poorly-fitting compression garment under any circumstances. This may increase your risk for lymphedema or make it worse.
You usually don’t need a compression garment to prevent lymphedema during exercise. But if you’ve noticed swelling while exercising, talk to your doctor or therapist.
Eyigör S, Cinar E, Caramat I, Unlu BK. Factors influencing response to lymphedema treatment in patients with breast cancer-related lymphedema. Support Care Cancer. 2015;23(9):2705-2710.
Ferguson CM, Swaroop MN, Horick N, et al. Impact of ipsilateral blood draws, injections, blood pressure measurements, and air travel on the risk of lymphedema for patients treated for breast cancer. J Clin Oncol. 2015;34(7):691-698.
Hayes SC, Johansson K, Stout NL, et al. Upper-body morbidity after breast cancer: incidence and evidence for evaluation, prevention, and management within a prospective surveillance model of care. Cancer. 2012;118(8 Suppl):2237-2249.
Mitra D, Catalano PJ, Cimbak N, et al. The risk of lymphedema after postoperative radiation therapy in endometrial cancer. J Gynecol Oncol. 2016 Jan;27(1):e4.
National Cancer Institute. Lymphedema (PDQ®) – Health Professional Version. July 17, 2015. Accessed at http://www.cancer.gov/about-cancer/treatment/side-effects/lymphedema/lymphedema-hp-pdq#section/_7 on June 29, 2016.
National Lymphedema Network. Position Paper: Exercise. October 2013. Accessed at www.lymphnet.org/resources/position-paper-exercise on June 29, 2016.
National Lymphedema Network. Healthy Habits for Patients at Risk for Lymphedema. Accessed at www.lymphnet.org/resources/healthy-habits-for-patients-at-risk-for-lymphedema on June 29, 2016.
National Lymphedema Network. Position Paper: Lymphedema Risk Reduction Practices. May 2012. Accessed at www.lymphnet.org/resources/position-paper-lymphedema-risk-reduction-practices on June 29, 2016.
National Lymphedema Network. Position Paper: Screening and Measurement for Early Detection of Breast Cancer Related Lymphedema. December 2013. Accessed at www.lymphnet.org/resources/position-paper-screening-and-measurement-for-early-detection-of-breast-cancer-related on June 29, 2016.
National Lymphedema Network. NLN Position Paper: The Diagnosis and Treatment of Lymphedema. 2011. Accessed at www.lymphnet.org/resources/nln-position-paper-the-diagnosis-and-treatment-of-lymphedema on June 29, 2016.
Shaitelman SF, Cromwell KD, Rasmussen, JC, et al. Recent progress in the treatment and prevention of cancer-related lymphedema. CA Cancer J Clin. 2015;65:55-81.
Last Medical Review: July 7, 2016 Last Revised: July 7, 2016