This page was reviewed under our medical and editorial policy by

Maurie Markman, MD, President, Medicine & Science

This page was updated on March 2, 2022.

Lymphedema is a common side effect of cancer and cancer treatment. It may be emotionally discouraging and physically painful, but knowing the signs and symptoms of lymphedema may allow patients to get help more quickly.

What is the lymphatic system?

Lymphedema affects the lymphatic system, a network that carries a specific fluid called lymph throughout the body. The lymphatic system is made up of the following components listed below.

Lymph: This colorless fluid flows through the lymph vessels carrying T-cells and white blood cells known as B lymphocytes or B-cells.

Lymph vessels: These vessels return lymph to the bloodstream by collecting it from other parts of the body.

Lymph nodes: These bean-like structures in the neck, underarm, pelvis, groin and abdomen help fight infection by filtering lymph and storing white blood cells.

What is lymphedema?

Lymphedema is the buildup of lymph fluid in the soft body tissues, often in the arms and legs. It results in visible swelling.

Swelling may develop over the course of several weeks or months. In other cases, however, it may come on quickly and without warning.

What causes lymphedema?

Lymphedema may be caused by cancer treatment or the disease itself. In some instances, cancerous tumors may block the lymph system. In other cases, lymph node removal surgery or radiation therapy that damages lymph nodes may result in lymph fluid building up in nearby tissues. 

When the lymph system is functioning effectively, lymph travels through the body. When it can’t flow through the body properly—because the lymph system is damaged or blocked, preventing lymph from circulating normally—lymphedema occurs.

Types of lymphedema

The two different types of lymphedema are listed below.

Primary lymphedema

Primary lymphedema occurs if the lymph system develops abnormally. Symptoms may present at birth, but not always.

Secondary lymphedema

Secondary lymphedema occurs when the lymph system is damaged. It's the more common type among cancer patients. 

Lymphedema symptoms

Recognizing the symptoms of lymphedema may help patients get treatment more quickly. Symptoms may include:

  • Swelling, particularly in an arm or leg (including fingers and toes)
  • Tight, thick and leather-like skin
  • Tightness in the area, perhaps with a tingling sensation as if the arm or leg “fell asleep”
  • Trouble sleeping
  • Skin changes, such as blisters or warts
  • Loss of hair
  • Itchy, warm or red skin, with or without a rash

These changes may seem insignificant at first, but may worsen over time.

Lymphedema diagnosis and detection

Patients who are experiencing lymphedema symptoms should contact their care team. It may be confirmed in a number of ways, as listed below.

Physical exam: The care team checks the patient's overall health and looks for signs of lumps. They'll compare the swollen arm or leg to the other one.

Lymphoscintigraphy: Doctors use this method to check the lymph system for disease. It requires injecting a small amount of radioactive fluid into the body. This fluid flows through the lymph ducts, and a scanner or probe tracks its movement.

Magnetic resonance imaging (MRI): This painless imaging test involves magnets, radio waves and a computer to create detailed photos of the body’s interior.

Lymphedema stages

The four stages of lymphedema are listed below.

Stage 0 lymphedema: Swelling has not yet developed, but subtle symptoms, like a feeling of fullness or tightness in the affected area, may be noticeable.

Stage 1 lymphedema: Swelling occurs, possibly with increased stiffness or size of the affected area. Doctors may diagnose stage 1 lymphedema when they press on the swollen area and notice a dent. Lymphedema at this stage may resolve without treatment.

Stage 2 lymphedema: Pressing on the affected area doesn’t leave a dent, and tissue fibrosis may cause the area to feel hard or spongy.

Stage 3 lymphedema: This stage shows large areas of swelling, and may lead to an inability to move the affected limb. The skin may be thick, potentially with leaking blisters.

Lymphedema treatment

If a tumor is causing the patient's lymphedema, cancer surgery may resolve the blockage. If the lymphedema is a result of surgery, various treatments and types of self-care may help the patient feel more comfortable, as listed below.

Exercise: Though the patient may be in pain, moving around helps drain fluid and reduce swelling.

Compression sleeves or socks: The care team may suggest wearing specific tight-fitting garments over the affected areas to reduce swelling by pushing lymph fluid.

Manual lymph drainage (MLD): This is a very specific type of massage therapy done by a trained professional to get lymph fluid moving.

Sit with legs uncrossed: Crossing legs may prevent fluids from moving. Also, the patient should switch his or her sitting position every 30 minutes.

Avoid pressure and restriction: Avoid tight-fitting clothes, jewelry or carrying bags on the shoulders.

Complete decongestive therapy (CDT): During this treatment, a CLT or doctor will work with the patient on a series of modalities including exercise, MLD, skin care and compression.

Skin care: To reduce the risk of infection, avoid cuts on the affected area, and keep it clean and moisturized.

Complications of lymphedema

Left untreated, lymphedema may cause a ripple effect. For example, cells that help fight off infectious germs may have trouble getting to an affected area of the body, heightening the risk of infection. Wounds may take longer to heal, and the patient may experience soreness and stiffness.

Mentally, it may be challenging, particularly if the patient is also going through cancer treatment or if it’s the result of a cancerous tumor.

It’s important to remember that physical and mental health treatments are available.

Lymphedema prevention

No specific steps are guaranteed to prevent lymphedema. However, because lymphedema may occur after cancer surgery, speak with the care team in advance for advice on how to lower risk.

One helpful step is exercise. Even gentle exercise helps keep lymph moving.

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