Treating lymphedema

Lymphedema is a chronic condition that affects a number of cancer patients. It occurs most commonly in women with breast cancer, who typically experience swelling in the upper limbs, but the condition also impacts women with gynecologic cancer, who most often have swelling in the lower limbs.

Lymphedema develops when the lymph system is damaged or blocked, preventing lymph—the colorless, watery fluid that flows through lymph vessels—from moving throughout the body properly. This blockage results in the buildup of lymph in soft body tissues, often in the arms and legs, causing visible swelling.

Lymphedema most often occurs when lymph nodes are removed during surgery or damaged during radiation treatment. Advances in cancer treatments have helped reduce the incidence of severe lymphedema. Less invasive procedures like sentinel lymph node biopsies, for example, are now performed to help stage vulvar and cervical cancers. With this technique, a patient may be able to avoid more extensive lymph node surgery.

Lymphedema can be managed. Recognizing the signs is important to diagnosing the condition at an early stage, when it’s easier to treat. When lymphedema occurs after gynecologic cancer treatment, symptoms may include:

• Swelling in the abdomen, groin area, legs or feet
• A feeling of heaviness in the legs or feet
• Numbness, tingling or achiness in the legs or feet

Learn more about lymphedema

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Non-surgical treatments

If you’re diagnosed with lymphedema after gynecologic cancer treatment, your doctor may recommend complete decongestive therapy, or CDT, which is a comprehensive approach to treating the condition, often involving a combination of home-based treatments led by a physical therapist. The goal of this therapy is to reduce swelling in the affected limb and prevent or soften scarring.

CDT includes:

• Manual lymphatic drainage, or MLD: This key component of CDT is similar to massage. It redirects the fluid to healthy lymph nodes, where the swelling can be absorbed. A licensed lymphedema specialist typically performs this treatment daily until the patient can do it herself at home.
• Compression therapy: Compression bandages, stockings or garments are specially fitted after swelling is reduced to help prevent lymph from reaccumulating in pockets where the fluid was rerouted by MLD. Compression materials should fit snugly on the swollen area. Compression therapy may also involve the use of lymphatic pumps, or pneumatic compression devices, either in a clinic or at home. These devices may be used in combination with other lymphedema treatments to reduce swelling and improve quality of life.
• Exercise: With compression, certain exercises are used to help pump lymph out of the swollen area. These may include elevating swollen limbs above heart level, which may help promote drainage. Performing this activity several times a day for 10 to 15 minutes at a time may help enhance lymphatic flow, mobility and protein absorption.
• Skin care: Preventing infection is critical with lymphedema, so adequate skin and nail care is an important part of managing the condition. Any cut on the skin of the swollen limb, even an insect bite, provides an opening for bacteria to enter the body, which may lead to infection if the lymphatic system can’t fight it off.
• Other self-care: Managing lymphedema involves certain lifestyle changes. For example, you should:
  • Apply bug spray when outdoors.
  • Avoid hot weather, hot showers and baths, including hot tubs.
  • Avoid tight clothes and elastic bands on socks or underwear (if the leg or ankle is affected).
  • Avoid walking around barefoot. o Use an electric razor for hair removal.
  • Wear clothes that fit properly.

Without proper management, lymphedema may become worse.

Surgical treatments

Most patients respond to non-surgical treatments for lymphedema. However, they don’t always work.

If your lymphedema isn’t responding to non-surgical therapies, your doctor may recommend surgery. Surgery for lymphedema generally falls into one of two categories: excisional or physiologic.

Excisional approach

• Debulking surgery: This type of surgery involves removing the excess fatty tissue that may develop when lymphedema progresses. Typically, this procedure is performed using liposuction. Debulking surgery may be viewed as a cosmetic procedure by insurance, though, preventing it from being covered. The surgery also doesn’t address the underlying issue of a blocked or damaged lymphatic system, and it requires lifelong compression adherence because lymph fills up the spaces left by the removed scar tissue.

Physiologic approach

• Lymphaticovenular, or lymphatic, bypass: This microsurgery connects lymphatic vessels in the affected limb directly to veins to reroute the flow of lymphatic fluid and ease swelling. This type of surgery has better outcomes when lymphedema is diagnosed early, because doctors have a better chance of finding healthy lymphatic vessels to connect.
• Vascularized lymph node transfer: In this surgery, unnecessary lymph nodes are harvested from one part of the body and surgically transplanted in the affected area to help rebuild the lymphatic system. This procedure may involve moving lymph nodes from the chest or lower neck, for example, to an area near the ankle.

In general, most doctors and patients prefer the physiologic approach of trying to restore lymphatic function. Your doctor may recommend lymphaticovenular bypass first because vascularized lymph node transfer surgery tends to be more extensive and requires a longer recovery time. These surgical approaches may also be combined.

Quality-of-life concerns

At City of Hope, our focus on comprehensive, holistic care means your quality of life is at the center of all we do.

That’s why, in addition to doctors, nurses and physical therapists, your lymphedema care team may include integrative care providers who help address side effects you may experience during and after treatment.

Women diagnosed with lymphedema after undergoing gynecologic cancer treatment, for example, may see a pelvic floor therapist to help with pelvic and sexual dysfunction. They may also consult with a behavioral health therapist to help ease stress and improve mood and energy levels.