Does chemotherapy cause lymphedema?

Cancer, or cancer treatments, can cause damage to the lymphatic system. Cancer itself can get in the way of fluid draining out of the extremity. The treatments for cancer, particularly surgery and radiation, can damage lymphatic vessels and lymph nodes. While lymphatic vessels will grow again given time and a good healing environment, lymph nodes are not able to regrow.

Chemotherapy does not cause lymphedema, but can contribute to the swelling as it causes some water retention throughout the whole body. I would like to stress that while the treatments for cancer can cause lymphedema, those treatments were chosen to increase your chances of survival. Lymphedema is not a life-threatening disease, but cancer is. Those providing your cancer treatments have and/or will provide it in such a way to reduce your chance of getting lymphedema and still maximize your chance of survival.

Lymphedema can affect people soon after surgery and/or radiation, or 20 years down the road. With surgery, it is expected that people will have swelling as part of post-surgical healing. It is a good rule of thumb to wait until 3 months after surgery before deciding if swelling is truly lymphedema or is just post-surgical swelling. However, it is never too early to learn what you can do to prevent lymphedema.

You might also like:

• Lymphedema prevention strategies
• What is lymphedema and where can I get help?

What happens if I ignore my lymphedema?

Unfortunately, ignoring lymphedema won’t make it go away. Once you have it, your only options are to manage it to the best of your abilities or allow it to get out of control. The biggest risk to not treating lymphedema is an increased risk of infection. Because fluid and waste products are slow to leave your involved extremity, your body may not be aware of bacteria and viruses until they have had a chance to multiply. By the time your body is aware of the “invaders,” your infection may require oral or IV antibiotics. These infections cause further damage to the lymphatic system and repeated infections can progress lymphedema quickly or lead to sepsis (whole body infection).

The other risks to non-treatment are heaviness or the involved extremity, leading to joint pain, limited motion, reduced strength, and nerve damage. Because of the reduced immune system, there is also an increased risk, although minimal, of certain types of cancers.

Do I have to deal with lymphedema for the rest of my life?
Lymphedema is a progressive disease. Once you have had lymph nodes removed via surgery or damaged via radiation, you are at risk for lymphedema. Because lymph nodes do not regrow, you will remain at risk for developing lymphedema for the rest of your life and need to follow precautions from that point on. If swelling has started, you will need to use some type of management for the rest of your life. If treated early on, your chances of easily keeping it under control down the road are better. Treatment options in the earlier phases may only require occasional use of a compression garment, exercise or a self-massage. Without treatment, this condition will progress at a faster rate. Management in later phases requires consistent use of a compression garment as well as self-bandaging on some or all nights.

Lymphedema prevention strategies

Prevention strategies are the most important whether or not you already have swelling. Following these strategies will help prevent lymphedema altogether, delay its onset, or slow its progression. The strategies are designed to prevent injury or overuse of the involved extremity. The precautions apply to the involved extremity and include:

• Applying lotion/moisturizer to prevent dry skin and cracking
• Good nail care – to include trimming of calluses and avoidance of cutting cuticles
• Use of gloves while gardening, landscaping, or using chemicals to prevent cuts, scrapes, and burns
• Protection of the skin via sunscreen and bug repellant
• Use of an electric razor to prevent nicks and scrapes
• Thorough cleansing of scratches/punctures with soap and water followed by application of an antibiotic/first aid ointment to prevent infections
• Slowly increase the length of time and intensity of daily activities, including gym routines
       *Avoid long periods of repetitive activity if you have not been doing that activity much before (i.e. painting your house all day)
       *Take breaks during periods of intense activity
       *There are no limits to what you can do; you just need to get there slowly!
• Avoid blood pressure or blood draws (In the case of emergencies, do not limit access to this extremity)
• Wear loose fitting clothing and jewelry
• Participate in aerobic activities (something that gets your heart pounding and makes you sweat) if cleared by your physician
• Inform you physician immediately if you develop signs/symptoms of infection, which include fever, chills, fatigue, nausea/vomiting and/or a red, swollen extremity, which may be painful and warm/hot to touch. Treatment should be sought within 12 hours of onset of these symptoms.

If swelling has already started
In the early stages, when swelling comes and goes, the best treatment typically includes use of a compression sleeve, and potentially the use of a self-massage and an exercise program. The sleeve is worn during activities that induce swelling and the self-massage can be used to help reduce swelling or prepare the body for activity. Compression sleeves are not recommended for nighttime use.

When swelling becomes constant, treatment is geared towards reducing the limb down to its smallest size prior to being placed in a compression garment. Treatment of this kind is called complete decongestive therapy, or CDT. It includes compressive bandaging, manual lymphatic drainage (massage), skin care, patient education, and therapeutic exercise. Treatments vary between patients, but are typically performed 3-4x/week for 60-90 minutes. Treatment may take as little as 2 weeks, but may last more than 2 months depending on the severity of the swelling. These treatments propel the trapped fluid into the working portions of the lymphatic system, where it will be put into the blood, leaving the body as urine. After size reduction is complete, a compression sleeve is used for long-term maintenance.

What is lymphedema and where can I get help?

Lymphedema is the collection of excess fluid in an arm or leg (or surrounding areas) that results from damage to the lymphatic system.

The lymphatic system has two jobs:

1. Fighting off infections, viruses and cancer cells
2. Transportation of proteins and waste products, which are used cells (muscle, blood, bone, etc.) that your body will recycle and reuse

When this system is damaged from cancer or its treatments, fluid, protein and used cells back up into the involved extremity, causing it to swell.

What is the lymphatic system?
Up until now, you have probably heard all sorts of information about your immune system, white blood cell counts, and infections. These make up half of your lymphatic system’s daily duties, one if which is to recognize and take care of bacteria, viruses and cancer cells. The other half of its job is to filter and transport all of the by-products made by the body during the course of the day, such as the old red blood cells, muscle cells, bone cells, etc. Along with recycling these cells, it hauls around protein to provide energy and even absorbs many of the nutrients from our food!

These fluids travel along small vessels that are just below the skin from the tips of our fingers and toes up towards the center of our body. Along the way, fluid is processed in lymph nodes to make sure it is safe to be put back into circulation. The main stopping points are the groin, for the legs, and the armpits, for the arms. Once it passes a checkpoint, the cleansed fluid joins your blood in your heart. It is then free to be filtered by your kidneys and liver.

Where do I go for more information about lymphedema?
Your best bet is to see a lymphedema therapist who can assess your specific situation and provide the most appropriate education. Lymphedema therapists are available at local Providence facilities, including Providence Centralia Hospital (PCH), Providence St. Peter’s Hospital (PSPH) and Providence Sound Home Care and Hospice in Olympia (PSHCH).

These services are provided by physical therapists (PT) at PCH and occupational therapists (OT) at PSPH and PSHCH. You must have a referral from your physician for a “PT Evaluation” or “OT evaluation” depending on the requested facility along with a diagnosis of lymphedema.

Contact information is as follows:

• Providence Centralia Hospital
  914 S. Scheuber Road
  Centralia, WA 98531
  360.330.8720
• Providence St. Peters Hospital 
  410 Providence Lane NE
  Emilie Gamelin Pavilion 3rd Floor 
  Olympia, WA 98506-5166
  360.493.4159
• Providence Sound Home Care and Hospice
  3432 South Bay Road NE
  Olympia, WA 98506
  800.869.7062

You can also find some basic information on the National Lymphedema Network’s website at www.lymphnet.org. The areas of most beneficial information are under the Lymphedema FAQs tab at the top left. All of the options under this tab will provide additional useful information. The information on this website is all based on research and scientific findings.