What Is Head and Neck Lymphedema?

Most people with cancer will experience side effects at some point. Depending on the type of cancer you have and the kind of treatment you receive, those effects can vary widely. For people with cancers involving the head, neck, or chest, one common side effect is called lymphedema.

“Head and neck lymphedema can appear as swelling in the face, mouth, throat, jaw, neck, or under the chin. It can be visible on the outside or it can primarily impact the internal structures, where it may be less visible but can still cause symptoms,” said Lauren Shih, MD, an American Society of Clinical Oncology (ASCO) expert and medical oncologist specializing in head and neck cancers at Fred Hutch Cancer Center.

What is head and neck lymphedema?

Lymphedema is a buildup of fluid that causes swelling. Lymphedema can happen whenever there is damage to the body’s lymphatic system. The lymphatic system is a network of lymph vessels and lymph nodes that help move fluid throughout the body. The lymph vessels carry the fluid. The lymph nodes are tiny glands on these vessels that help filter waste.

When lymphedema affects structures, tissues, and organs found in the head and neck, it can have a big impact on a person’s daily life. This type of lymphedema can cause:

• Changes in the appearance of the face and neck
• Pain or discomfort
• A feeling of firmness in the face or neck
• A puffy or tight feeling in the skin on the face or neck
• A more limited range of motion, including how well a person can move their neck
• Difficulty swallowing
• Changes in voice or speech
• Breathing problems

“Head and neck lymphedema can impact eating, communication, and overall quality of life,” said Dr. Shih.

What causes poor lymphatic drainage in the neck and face?

Different types of cancer and cancer treatment can block or damage the lymph nodes in the neck and face. This can affect how well lymph fluid is able to drain.

People with head and neck cancers are most likely to experience this side effect. “They are particularly vulnerable to lymphedema because there are many lymph nodes in the head and neck region that can be impacted by cancer treatment,” said Dr. Shih. “A majority of patients who are treated for head and neck cancers will develop at least some degree of lymphedema, which can be mild in some cases and more severe and symptomatic in others.”

Some of the head and neck cancers that most commonly lead to lymphedema include:

• Oral cavity (mouth) and oropharyngeal (throat) cancer
• Nasopharyngeal (upper throat) cancer
• Laryngeal (throat box) cancer
• Salivary gland cancer

Other cancers that impact the lymph nodes in the neck and chest area can also cause head and neck lymphedema. These include:

• Lung cancer
• Lymphoma
• Mesothelioma
• Breast cancer

Which cancer treatments can cause lymphedema in the neck and face?

Surgery and radiation therapy for head and neck cancers are most likely to cause head and neck lymphedema. When someone gets surgery to remove the cancer, lymph nodes are also likely to be removed. This can lead to lymphedema. So can radiation therapy, which can cause damage and scarring to the lymph nodes if they’re included in the radiation field. Having multiple treatments can also increase a person’s chances of developing lymphedema, said Dr. Shih.

How serious can head and neck lymphedema be?

Recognizing head and neck lymphedema early can make a big difference in how much the condition affects a person’s daily life. Identifying symptoms as soon as possible can help your care team manage them more effectively. If lymphedema in the neck and face is not found or noticed when symptoms start to show, the swelling can become worse. This can be a sign of a more serious condition called superior vena cava syndrome (SVCS). SVCS is caused by an obstruction of the veins that return blood to the heart.

People with lung cancer are at the highest risk for SVCS, while people with head and neck cancers are less likely to develop it. No matter what type of cancer you have, you should tell your doctor right away if you experience any new or worsening swelling in your neck or face. They can help figure out the underlying cause and how best to treat the condition.

What kind of treatments can help drain lymph nodes in the neck and face?

Head and neck lymphedema is typically managed with a combination of therapies to help reduce swelling and skin effects. The most common treatment for head and neck lymphedema is called complete decongestive therapy (CDT). CDT includes several techniques that help remove extra fluid from the area and decrease swelling, including:

• Massaging the affected area to drain the fluid manually
• Compression with special clothing or wraps to keep the fluid from building up
• Exercises aimed at keeping the fluid flowing
• Skin care practices to moisturize the skin and prevent infection

“These techniques are often taught to patients by physical therapists or lymphedema specialists who will develop a plan with them,” said Dr. Shih. “Patients will often then continue these techniques at home as part of their long-term care.”

If you experience symptoms of head and neck lymphedema, talk with your doctor. They can help guide a care plan for you or refer you to another specialist for help.

“Being proactive is very important,” said Dr. Shih. “There are so many different things that patients and their doctors are focusing on during and after cancer. Sharing issues that impact day-to-day quality of life and function can help refocus the team.”

Dr. Shih is an ASCO member.