Introduction
Overview

Acute versus gradual-onset lymphedema Temporary versus chronic lymphedema Risk factors Diagnosis

Management

Prevention Treatment         Compression garments         Drug therapy         Dietary Management         Pain Management         Complications Psychosocial considerations

Complications
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Changes to This Summary (07/01/2008)
Questions or Comments About This Summary
About PDQ

Introduction

This patient summary is adapted from the summary on lymphedema written by cancer experts for health professionals. This and other credible information about cancer treatment, screening, prevention, supportive care, and ongoing trials is available from the National Cancer Institute. Lymphedema is the buildup of lymph (a fluid that helps fight infection and disease) in the fatty tissues just under the skin. The buildup of lymph causes swelling in specific areas of the body, usually an arm or leg, with an abnormally large amount of tissue proteins, chronic inflammation, and thickening and scarring of tissue under the skin. Lymphedema is a common complication of cancer and cancer treatment and can result in long-term physical, psychological, and social issues for patients.

Overview

The lymphatic system consists of a network of specialized lymphatic vessels and various tissues and organs throughout the body that contain lymphocytes (white blood cells) and other cells that help the body fight infection and disease. The lymphatic vessels are similar to veins but have thinner walls. Some of these vessels are very close to the skin surface and can be found near veins; others are just under the skin and in the deeper fatty tissues near the muscles and can be found near arteries. Muscles and valves within the walls of the lymphatic vessels near the skin surface help pick up fluid and proteins from tissues throughout the body and move the lymph in one direction, toward the heart. Lymph is slowly moved through larger and larger lymphatic vessels and passes through small bean-shaped structures called lymph nodes. Lymph nodes filter substances that can be harmful to the body and contain lymphocytes and other cells that activate the immune system to fight disease. Eventually, lymph flows into one of two large ducts in the neck region. The right lymphatic duct collects lymph from the right arm and the right side of the head and chest, emptying it into the large vein under the right collarbone. The left lymphatic duct or thoracic duct collects lymph from both legs, the left arm, and the left side of the head and chest, emptying it into the large vein under the left collarbone.

The lymphatic system collects excess fluid and proteins from the body tissues and carries them back to the bloodstream. Proteins and substances too big to move through the walls of veins can be picked up by the lymphatic vessels because they have thinner walls. Edema may occur when there is an increase in the amount of fluid, proteins, and other substances in the body tissues because of problems in the blood capillaries and veins or a blockage in the lymphatic system.

Lymphedema may be either primary or secondary. Primary lymphedema is a rare inherited condition in which lymph nodes and lymph vessels are absent or abnormal. Secondary lymphedema can be caused by a blockage or cut in the lymphatic system, usually the lymph nodes in the groin area and the armpit. Blockages may be caused by infection, cancer, or scar tissue from radiation therapy or surgical removal of lymph nodes. Lymphedema that is secondary to cancer is not usually life-threatening. This summary discusses secondary lymphedema.

There are four types of acute lymphedema. The first type of acute lymphedema is mild and lasts only a short time, occurring a few days after surgery to remove the lymph nodes or after injury to the lymphatic vessels or veins just under the collarbone. The affected limb may be warm and slightly red, but is usually not painful and gets better within a week by keeping the affected arm or leg supported in a raised position and by contracting the muscles in the affected limb (for example, making a fist and releasing it). The second type of acute lymphedema occurs 6 to 8 weeks after surgery or during a course of radiation therapy. This type may be caused by inflammation of either lymphatic vessels or veins. The affected limb is tender, warm or hot, and red and is treated by keeping the limb supported in a raised position and taking anti-inflammatory drugs. The third type of acute lymphedema occurs after an insect bite, minor injury, or burn that causes an infection of the skin and the lymphatic vessels near the skin surface. It may occur on an arm or leg that is chronically swollen. The affected area is red, very tender, and hot and is treated by supporting the affected arm or leg in a raised position and taking antibiotics. A compression pump should not be used and the affected area should not be wrapped with elastic bandages during the early stages of infection. Mild redness may continue after the infection. The fourth and most common type of acute lymphedema develops very slowly and may become noticeable 18 to 24 months after surgery or not until many years after cancer treatment. The patient may experience discomfort of the skin; aching in the neck, shoulders, spine, or hips caused by stretching of the soft tissues or overuse of muscles; or posture changes caused by increased weight of the arm or leg.

Temporary lymphedema is a condition that lasts less than 6 months. The skin indents when pressed and stays indented, but there is no hardening of the skin. A patient may be more likely to develop lymphedema if he or she has one of the following:

• Surgical drains that leak protein into the surgical site.
• Inflammation.
• Inability to move the limb(s).
• Temporary loss of lymphatic function.
• Blockage of a vein by a blood clot or inflammation.

Chronic (long-term) lymphedema is the most difficult of all types of edema to treat. The damaged lymphatic system of the affected area is not able to keep up with the increased need for fluid drainage from the body tissues. This may be caused by one of the following:

• Recurrence or spread of a tumor to the lymph nodes.
• Infection of and/or injury to the lymphatic vessels.
• Periods of not being able to move the limbs.
• Radiation therapy or surgery.
• Inability to control early signs of lymphedema.
• Blockage of a vein by a blood clot.

A patient who is in the early stages of developing lymphedema will have swelling that indents with pressure and stays indented but remains soft. The swelling may easily improve by supporting the arm or leg in a raised position, gently exercising, and wearing elastic support garments. Continued problems with the lymphatic system cause the lymphatic vessels to expand, allowing lymph to flow back into the body tissues and make the condition worse. Pain, heat, redness, and swelling result as the body tries to get rid of the extra fluid. The skin becomes hard and stiff and no longer improves with raised support of the arm or leg, gentle exercise, or elastic support garments.

Patients with chronic lymphedema are at increased risk of infection. No effective treatment is yet available for patients who have advanced chronic lymphedema. Once the body tissues have been repeatedly stretched, lymphedema may recur more easily.

Factors that can lead to the development of lymphedema include radiation therapy to an area where the lymph nodes were surgically removed, problems after surgery that cause inflammation of the arm or leg, a larger number of lymph nodes removed in surgery, and being older. The part of the body treated may affect where lymphedema occurs. For example, lymphedema in the arms may occur after treatment for breast cancer and lymphedema in the legs may occur after treatment for vulvar cancer.

Risk factors for lymphedema include the following:

• Breast cancer, if the patient received radiation therapy or had lymph nodes removed. Radiation therapy to the underarm area after surgical removal of the lymph nodes and having a larger number of lymph nodes removed increases the risk of lymphedema.



• Surgical removal of lymph nodes in the underarm, groin, or pelvic regions.



• Radiation therapy to the underarm, groin, pelvic, or neck regions.



• Scar tissue in the lymphatic ducts or veins and under the collarbones, caused by surgery or radiation therapy.



• Cancer that has spread to the lymph nodes in the neck, chest, underarm, pelvis, or abdomen.



• Tumors growing in the pelvis or abdomen that involve or put pressure on the lymphatic vessels and/or the large lymphatic duct in the chest and block lymph drainage.



• Having an inadequate diet or being overweight. These conditions may delay recovery and increase the risk for lymphedema.

Specific criteria for diagnosing lymphedema do not yet exist. About half of patients with mild edema describe their affected arm or leg as feeling heavier or fuller than usual. To evaluate a patient for lymphedema, a medical history and physical examination of the patient should be completed. The medical history should include any past surgeries, problems after surgery, and the time between surgery and the onset of symptoms of edema. Any changes in the edema should be determined, as should any history of injury or infection. Knowing which medications a patient is taking is also important for diagnosis.

Management

Prevention

Patients at risk for lymphedema should be identified early, monitored, and taught self-care. A patient may be more likely to develop lymphedema if he or she eats an inadequate diet, is overweight, is inactive, or has other medical problems. To detect the condition early, the following should be examined:

• Comparison of actual weight to ideal weight.
• Measurements of the arms and legs.
• Protein levels in the blood.
• Ability to perform activities of daily living.
• History of edema, previous radiation therapy, or surgery.
• Other medical illnesses such as diabetes, high blood pressure, kidney disease, heart disease, or phlebitis (inflammation of the veins).

It is important that the patient know about his or her disease and the risk of developing lymphedema. Poor drainage of the lymphatic system due to surgical removal of the lymph nodes or to radiation therapy may make the affected arm or leg more susceptible to serious infection. Even a small infection may lead to serious lymphedema. Patients should be taught about arm, leg, and skin care after surgery and/or radiation (see Considerations for Teaching Patients Prevention and Control of Lymphedema below). It is important that patients take precautions to prevent injury and infection in the affected arm or leg because lymphedema can occur 30 or more years after surgery. Breast cancer patients who follow instructions about skin care and proper exercise after mastectomy are less likely to experience lymphedema.

Lymphatic drainage is improved during exercise; therefore, exercise is important in preventing lymphedema. Breast cancer patients should do hand and arm exercises as instructed after mastectomy. Patients who have surgery that affects pelvic lymph node drainage should do leg and foot exercises as instructed. The doctor decides how soon after surgery the patient should start exercising. Physiatrists (doctors who specialize in physical medicine and rehabilitation) or physical therapists should develop an individualized exercise program for the patient.

Better recovery occurs when lymphedema is discovered early, so patients should be taught to recognize the early signs of edema and to tell the doctor about any of the following symptoms:

• Feelings of tightness in the arm or leg.
• Rings or shoes that become tight.
• Weakness in the arm or leg.
• Pain, aching, or heaviness in the arm or leg.
• Redness, swelling, or signs of infection.

Considerations for Teaching Patients Prevention and Control of Lymphedema

1. Keep the arm or leg raised above the level of the heart, when possible. Avoid making rapid circles with the arm or leg to keep blood from collecting in the lower part of the limb.



2. Clean the skin of the arm or leg daily and moisten with lotion.



3. Avoid injury and infection of the arm or leg.
   • Arms:
     • Use an electric razor for shaving.
     • Wear gardening and cooking gloves.
     • Use thimbles for sewing.
     • Take care of fingernails; do not cut cuticles.
   • Legs:
     • Keep the feet covered when outdoors.
     • Keep the feet clean and dry; wear cotton socks.
     • Cut toenails straight across; see a podiatrist as needed to prevent ingrown nails and infections.
   • Either arms or legs:
     • Suntan gradually; use sunscreen.
     • Clean cuts with soap and water, then use antibacterial ointment.
     • Use gauze wrapping instead of tape; do not wrap so tight that circulation is cut off.
     • Talk to the doctor about any rashes.
     • Avoid needle sticks of any type in the affected arm or leg.
     • Avoid extreme hot or cold such as ice packs or heating pads.
     • Do not overwork the affected arm or leg.



4. Do not put too much pressure on the arm or leg.
   • Do not cross legs while sitting.
   • Wear loose jewelry; wear clothes without tight bands.
   • Carry a handbag on the unaffected arm.
   • Do not use blood pressure cuffs on the affected arm.
   • Do not use elastic bandages or stockings with tight bands.
   • Do not sit in one position for more than 30 minutes.



5. Watch for signs of infection, such as redness, pain, heat, swelling, and fever. Call the doctor immediately if any of these signs appear.



6. Do prescribed exercises regularly as instructed by the doctor or therapist.



7. Keep regular follow-up appointments with the doctor.



8. Check all areas of the arms and legs every day for signs of problems.
   • Measure around the arm or leg at regular intervals as suggested by the doctor or therapist.
   • Measure the arm or leg at the same two places each time.
   • Tell the doctor if the limb suddenly gets larger.



9. The ability to feel sensations such as touch, temperature, or pain in the affected arm or leg may be lessened. Use the unaffected limb to test temperatures for bath water or cooking.

Lymphedema is treated by physical methods and with medication. Physical methods include supporting the arm or leg in a raised position, manual lymphatic drainage (a specialized form of very light massage that helps to move fluid from the end of the limb toward the trunk of the body), wearing bandages or custom-fitted clothing, such as stockings, that apply controlled pressure around the affected limb, and cleaning the skin carefully to prevent infection. Lymphedema may be treated by combining several of these physical methods. This is known as complex physical therapy (or complex decongestive therapy). which consists of manual lymphedema treatment, compression wrapping, individualized exercises, and skin care followed by a maintenance program. Complex physical therapy must be performed by a professional trained in the techniques.

Surgery for treating lymphedema usually results in complications and is seldom recommended for cancer patients.

When pressure garments are used, they should cover the entire area of edema. For example, a stocking that reaches only to the knee tends to become tight and block the lymphatic vessels and veins if there is edema in the thigh. Pumps connected to cuffs that wrap around the arm or leg and apply pressure on and off may be helpful; however, some physicians and therapists feel these pumps are not effective and may make the edema worse. The cuff is inflated and deflated according to a controlled time cycle. This pumping action is believed to increase the movement of fluid in the veins and lymphatic vessels and keeps fluid from collecting in the arm or leg. Compression pumps should be used only under the supervision of a trained health care professional because high external pressure can damage the lymphatic vessels near the skin surface.

Antibiotics may be used to treat and prevent infections. Other types of drugs such as diuretics or anticoagulants (blood thinners) are generally not helpful, and may make the problem worse.

Finding the exact cause of the swelling and treating it correctly is important. Edema often leads to infection, which then increases fluid and protein deposits in the tissues. If an infection is diagnosed, appropriate antibiotics should be given. Blood clots should be ruled out because massage and other therapy techniques to encourage drainage may cause the clots to move through the bloodstream and cause more serious heart or lung problems. If blood clots are found, they should be treated with anticoagulants.

Coumarin is a dietary supplement that has been studied as a treatment for lymphedema. In the United States, dietary supplements are regulated as foods, not drugs. Supplements are not required to be approved by the Food and Drug Administration (FDA) before being put on the market. Because there are no standards for manufacturing consistency, dose, or purity, one lot of dietary supplements may differ considerably from the next.

Coumarin was once used in some foods and medications in the United States. It was found to cause liver damage, and its use in foods and medications in the United States has been banned since the 1950s. Coumarin is available in several countries, but has not been approved for use in the United States or Canada.

The nutritional status of the patient should be evaluated and appropriate dietary recommendations should be made. Blood protein levels and weight should be monitored regularly, and patients should be encouraged to eat protein-rich foods.

Patients with lymphedema may experience pain caused by the swelling and pressure on nerves; loss of muscle tissue and function; or scar tissue causing shortening of muscles and less movement at joints. Pain may be treated with medications, relaxation techniques, and/or transcutaneous electrical nerve stimulation (TENS); however, the most successful treatment is to decrease the lymphedema.

Edema can make tissues less able to take in nutrients and more likely to be damaged if the affected limb is not moved for long periods. Therefore, patients with lymphedema should be monitored for areas of skin breakdown, especially over areas with very little tissue between the skin and bone (i.e., hips, knees, and elbows).

Bladder emptying problems can develop from lymphedema in the pelvic or groin areas. Patients with lymphedema who are also taking opioids may develop bowel problems. Bowel and bladder status should be monitored regularly for any signs of urine retention or constipation.

Because lymphedema is disfiguring and sometimes painful and disabling, it can create mental, physical, and sexual problems. Several studies have noted that women who develop lymphedema after treatment for breast cancer have more mental, physical, and sexual difficulties than women who do not develop lymphedema. The added stresses associated with lymphedema may interfere with treatment that is often painful, difficult, and time-consuming.

Coping with lymphedema in the arm after breast cancer treatment is especially difficult for patients who have little social support. Some patients may react to the problem by withdrawing. Coping is also difficult for patients with painful lymphedema. Patients with lymphedema may be helped by group and individual counseling that provides information about ways to prevent lymphedema, the role of diet and exercise, advice for picking comfortable and flattering clothes, and emotional support.

(See the PDQ summaries on Normal Adjustment and the Adjustment Disorders ¹ and Sexuality and Reproductive Issues ² for more information.

Complications

In addition to the complications associated with chronic lymphedema noted in previous sections, a rare but fatal complication of lymphedema is lymphangiosarcoma, a tumor of the lymphatic vessels. The average time between mastectomy and the appearance of lymphangiosarcoma is about 10 years. After a patient develops lymphangiosarcoma, the average survival time is a little more than 1 year.

The cause of lymphangiosarcoma is not known. It appears as one or more bluish-red bumps on the affected arm or leg. First, one purple-red, slightly raised area in the skin of the arm or leg appears. The patient usually describes it as a bruise. Later, more tumors appear, and the bumps grow. Death usually results from metastases to the lungs.

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Changes to This Summary (07/01/2008)

The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

Editorial changes were made to this summary.

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PDQ is a comprehensive cancer database available on NCI's Web site.

PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at NCI's Web site ⁴. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.

PDQ contains cancer information summaries.

The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.

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Glossary Terms

The area of the body that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs.

Not normal. An abnormal lesion or growth may be cancerous, premalignant (likely to become cancer), or benign.

In biology, to stimulate a cell in a resting state to become active. This causes biochemical and functional changes in the activated cell.

The tasks of everyday life. These activities include eating, dressing, getting into or out of a bed or chair, taking a bath or shower, and using the toilet. Instrumental activities of daily living are activities related to independent living and include preparing meals, managing money, shopping, doing housework, and using a telephone. Also called ADL.

Symptoms or signs that begin and worsen quickly; not chronic.

Having to do with reducing inflammation.

A substance that kills bacteria or stops them from growing and causing disease.

A drug used to treat infections caused by bacteria and other microorganisms.

A drug that helps prevent blood clots from forming. Also called blood thinner.

A blood vessel that carries blood from the heart to tissues and organs in the body.

The organ that stores urine.

A tissue with red blood cells, white blood cells, platelets, and other substances suspended in fluid called plasma. Blood takes oxygen and nutrients to the tissues, and carries away wastes.

A mass of blood that forms when blood platelets, proteins, and cells stick together. When a blood clot is attached to the wall of a blood vessel, it is called a thrombus. When it moves through the bloodstream and blocks the flow of blood in another part of the body, it is called an embolus.

The force of circulating blood on the walls of the arteries. Blood pressure is taken using two measurements: systolic (measured when the heart beats, when blood pressure is at its highest) and diastolic (measured between heart beats, when blood pressure is at its lowest). Blood pressure is written with the systolic blood pressure first, followed by the diastolic blood pressure (for example 120/80).

The long, tube-shaped organ in the abdomen that completes the process of digestion. The bowel has two parts, the small bowel and the large bowel. Also called intestine.

Cancer that forms in tissues of the breast, usually the ducts (tubes that carry milk to the nipple) and lobules (glands that make milk). It occurs in both men and women, although male breast cancer is rare.

A term for diseases in which abnormal cells divide without control. Cancer cells can invade nearby tissues and can spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord.

The smallest type of blood vessel. A capillary connects an arteriole (small artery) to a venule (small vein) to form a network of blood vessels in almost all parts of the body. The wall of a capillary is thin and leaky, and capillaries are involved in the exchange of fluids and gases between tissues and the blood.

The individual unit that makes up the tissues of the body. All living things are made up of one or more cells.

A disease or condition that persists or progresses over a long period of time.

In the body, the flow of blood through the heart and blood vessels, and the flow of lymph through the lymph vessels.

A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis, or treatment of a disease. Also called clinical study.

In medicine, a medical problem that occurs during a disease, or after a procedure or treatment. The complication may be caused by the disease, procedure, or treatment or may be unrelated to them.

A machine used to keep blood and lymph flowing by pushing air through bands or sleeves that are placed on the arms or legs.

A condition in which stool becomes hard, dry, and difficult to pass, and bowel movements don’t happen very often. Other symptoms may include painful bowel movements, and feeling bloated, uncomfortable, and sluggish.

A substance used to make drugs that prevent and treat blood clots in blood vessels and treat certain heart conditions. Coumarin is taken from certain plants and can also be made in the laboratory. It is a type of anticoagulant.

The process by which a professional counselor helps a person cope with mental or emotional distress, and understand and solve personal problems.

Any of several diseases in which the kidneys make a large amount of urine. Diabetes usually refers to diabetes mellitus in which there is also a high level of glucose (a type of sugar) in the blood because the body does not make enough insulin or use it the way it should.

The process of identifying a disease, such as cancer, from its signs and symptoms.

The things a person eats and drinks.

A product that is added to the diet. A dietary supplement is taken by mouth, and usually contains one or more dietary ingredient (such as vitamin, mineral, herb, amino acid, and enzyme). Also called nutritional supplement.

A drug that increases the production of urine.

The amount of medicine taken, or radiation given, at one time.

In medicine, to remove fluid as it collects; or, a tube or wick-like device used to remove fluid from a body cavity, wound, or infected area.

Any substance, other than food, that is used to prevent, diagnose, treat or relieve symptoms of a disease or abnormal condition. Also refers to a substance that alters mood or body function, or that can be habit-forming or addictive, especially a narcotic.

In medicine, a tube or vessel of the body through which fluids pass.

Swelling caused by excess fluid in body tissues.

An increase in body temperature above normal (98.6 degrees F), usually caused by disease.

Liquid.

Monitoring a person's health over time after treatment. This includes keeping track of the health of people who participate in a clinical study or clinical trial for a period of time, both during the study and after the study ends.

An agency in the U.S. federal government whose mission is to protect public health by making sure that food, cosmetics, and nutritional supplements are safe to use and truthfully labeled. The Food and Drug Administration also makes sure that drugs, medical devices, and equipment are safe and effective, and that blood for transfusions and transplant tissue are safe. Also called FDA.

The area where the thigh meets the abdomen.

A blood pressure of 140/90 or higher. High blood pressure usually has no symptoms. It can harm the arteries and cause an increase in the risk of stroke, heart attack, kidney failure, and blindness. Also called hypertension.

The complex group of organs and cells that defends the body against infections and other diseases.

Invasion and multiplication of germs in the body. Infections can occur in any part of the body and can spread throughout the body. The germs may be bacteria, viruses, yeast, or fungi. They can cause a fever and other problems, depending on where the infection occurs. When the body’s natural defense system is strong, it can often fight the germs and prevent infection. Some cancer treatments can weaken the natural defense system.

Redness, swelling, pain, and/or a feeling of heat in an area of the body. This is a protective reaction to injury, disease, or irritation of the tissues.

Transmitted through genes that have been passed from parents to their offspring (children).

One of a pair of organs in the abdomen. Kidneys remove waste from the blood (as urine), produce erythropoietin (a substance that stimulates red blood cell production), and play a role in blood pressure regulation.

A large organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile.

One of a pair of organs in the chest that supplies the body with oxygen, and removes carbon dioxide from the body.

The clear fluid that travels through the lymphatic system and carries cells that help fight infections and other diseases. Also called lymphatic fluid.

A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Lymph nodes filter lymph (lymphatic fluid), and they store lymphocytes (white blood cells). They are located along lymphatic vessels. Also called lymph gland.

The flow of lymph from an area of tissue into a particular lymph node.

A type of cancer that begins in the cells that line lymph vessels.

The tissues and organs that produce, store, and carry white blood cells that fight infections and other diseases. This system includes the bone marrow, spleen, thymus, lymph nodes, and lymphatic vessels (a network of thin tubes that carry lymph and white blood cells). Lymphatic vessels branch, like blood vessels, into all the tissues of the body.

A thin tube that carries lymph (lymphatic fluid) and white blood cells through the lymphatic system. Also called lymph vessel.

A condition in which excess fluid collects in tissue and causes swelling. It may occur in the arm or leg after lymph vessels or lymph nodes in the underarm or groin are removed or treated with radiation.

A type of white blood cell. Lymphocytes have a number of roles in the immune system, including the production of antibodies and other substances that fight infections and other diseases.

Surgery to remove the breast (or as much of the breast tissue as possible).

Refers to the practices and procedures used for the prevention, treatment, or relief of symptoms of a diseases or abnormal conditions. This term may also refer to a legal drug used for the same purpose.

The spread of cancer from one part of the body to another. A tumor formed by cells that have spread is called a “metastatic tumor” or a “metastasis.” The metastatic tumor contains cells that are like those in the original (primary) tumor. The plural form of metastasis is metastases (meh-TAS-tuh-SEEZ).

The National Cancer Institute, part of the National Institutes of Health of the United States Department of Health and Human Services, is the Federal Government's principal agency for cancer research. The National Cancer Institute conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the National Cancer Institute Web site at http://www.cancer.gov. Also called NCI.

A bundle of fibers that receives and sends messages between the body and the brain. The messages are sent by chemical and electrical changes in the cells that make up the nerves.

A chemical compound (such as protein, fat, carbohydrate, vitamin, or mineral) contained in foods. These compounds are used by the body to function and grow.

The taking in and use of food and other nourishing material by the body. Nutrition is a 3-part process. First, food or drink is consumed. Second, the body breaks down the food or drink into nutrients. Third, the nutrients travel through the bloodstream to different parts of the body where they are used as "fuel" and for many other purposes. To give the body proper nutrition, a person has to eat and drink enough of the foods that contain key nutrients.

A substance used on the skin to soothe or heal wounds, burns, rashes, scrapes, or other skin problems. Also called unguent.

A drug used to treat moderate to severe pain. Opioids are similar to opiates such as morphine and codeine, but they do not contain and are not made from opium.

A part of the body that performs a specific function. For example, the heart is an organ.

Being too heavy for one’s height. Excess body weight can come from fat, muscle, bone, and/or water retention. Being overweight does not always mean being obese.

PDQ is an online database developed and maintained by the National Cancer Institute. Designed to make the most current, credible, and accurate cancer information available to health professionals and the public, PDQ contains peer-reviewed summaries on cancer treatment, screening, prevention, genetics, complementary and alternative medicine, and supportive care; a registry of cancer clinical trials from around the world; and directories of physicians, professionals who provide genetics services, and organizations that provide cancer care. Most of this information, and more specific information about PDQ, can be found on the NCI's Web site at http://www.cancer.gov/cancertopics/pdq. Also called Physician Data Query.

Having to do with the pelvis (the lower part of the abdomen located between the hip bones).

The lower part of the abdomen, located between the hip bones.

Inflammation (redness, swelling, pain, and heat) of a vein, usually in the legs. Phlebitis may be caused by infection, injury, or irritation.

An exam of the body to check for general signs of disease.

A health professional who teaches exercises and physical activities that help condition muscles and restore strength and movement.

The use of exercises and physical activities to help condition muscles and restore strength and movement. For example, physical therapy can be used to restore arm and shoulder movement and build back strength after breast cancer surgery.

Medical doctor.

A doctor who specializes in the care of the foot and ankle.

In medicine, action taken to decrease the chance of getting a disease or condition. For example, cancer prevention includes avoiding risk factors (such as smoking, obesity, lack of exercise, and radiation exposure) and increasing protective factors (such as getting regular physical activity, staying at a healthy weight, and having a healthy diet).

A molecule made up of amino acids that are needed for the body to function properly. Proteins are the basis of body structures such as skin and hair and of substances such as enzymes, cytokines, and antibodies.

Having to do with how the mind works and how thoughts and feelings affect behavior.

The use of high-energy radiation from x-rays, gamma rays, neutrons, protons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Also called irradiation and radiotherapy.

To come back or to return.

Cancer that has recurred (come back), usually after a period of time during which the cancer could not be detected. The cancer may come back to the same place as the original (primary) tumor or to another place in the body. Also called recurrent cancer.

In medicine, a process to restore mental and/or physical abilities lost to injury or disease, in order to function in a normal or near-normal way.

A method used to reduce tension and anxiety, and control pain.

Something that may increase the chance of developing a disease. Some examples of risk factors for cancer include age, a family history of certain cancers, use of tobacco products, certain eating habits, obesity, lack of exercise, exposure to radiation or other cancer-causing agents, and certain genetic changes.

Checking for disease when there are no symptoms. Since screening may find diseases at an early stage, there may be a better chance of curing the disease. Examples of cancer screening tests are the mammogram (breast), colonoscopy (colon), Pap smear (cervix), and PSA blood level and digital rectal exam (prostate). Screening can also include checking for a person’s risk of developing an inherited disease by doing a genetic test.

A network of family, friends, neighbors, and community members that is available in times of need to give psychological, physical, and financial help.

Refers to muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body.

The bones, muscles, tendons, and other tissues that reach from the base of the skull to the tailbone. The spine encloses the spinal cord and the fluid surrounding the spinal cord. Also called backbone, spinal column, and vertebral column.

The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer, and whether the cancer has spread from the original site to other parts of the body.

A substance that helps protect the skin from the sun's harmful rays. Sunscreens reflect, absorb, and scatter both ultraviolet A and B radiation to provide protection against both types of radiation. Using lotions, creams, or gels that contain sunscreens can help protect the skin from premature aging and damage that may lead to skin cancer.

Care given to improve the quality of life of patients who have a serious or life-threatening disease. The goal of supportive care is to prevent or treat as early as possible the symptoms of a disease, side effects caused by treatment of a disease, and psychological, social, and spiritual problems related to a disease or its treatment. Also called comfort care, palliative care, and symptom management.

A procedure to remove or repair a part of the body or to find out whether disease is present. An operation.

An indication that a person has a condition or disease. Some examples of symptoms are headache, fever, fatigue, nausea, vomiting, and pain.

Treatment.

Having to do with the chest.

A group or layer of cells that work together to perform a specific function.

A procedure in which mild electric currents are applied to some areas of the skin. Also called TENS.

An abnormal mass of tissue that results when cells divide more than they should or do not die when they should. Tumors may be benign (not cancerous), or malignant (cancerous). Also called neoplasm.

Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra.

A blood vessel that carries blood to the heart from tissues and organs in the body.

Cancer of the vulva (the external female genital organs, including the clitoris, vaginal lips, and the opening to the vagina).

Refers to a blood cell that does not contain hemoglobin. White blood cells include lymphocytes, neutrophils, eosinophils, macrophages, and mast cells. These cells are made by bone marrow and help the body fight infections and other diseases. Also called WBC.