Management
Prevention
Treatment
Compression garments
Drug therapy
Dietary Management
Pain Management
Complications
Psychosocial considerations
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:
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
- 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.
- Clean the skin of the arm or leg daily and moisten with lotion.
- 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.
- 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.
- Watch for signs of infection, such as redness, pain, heat, swelling, and fever. Call the doctor immediately if any of these signs appear.
- Do prescribed exercises regularly as instructed by the doctor or therapist.
- Keep regular follow-up appointments with the doctor.
- 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.
- 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.
Treatment
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.
Compression garments
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.
Drug therapy
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.
Dietary Management
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.
Pain Management
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.
Complications
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.
Psychosocial considerations
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 and Sexuality and Reproductive Issues for more information.
Back to Top
< Previous Section | Next Section > |