General Information About Lymphedema
Lymphedema is the build-up of fluid in soft body tissues when the lymph system is damaged or blocked.
Lymphedema occurs when the lymph system is damaged or blocked. Fluid builds up in soft body tissues and causes swelling. It is a common problem that may be caused by cancer and cancer treatment. Lymphedema usually affects an arm or leg, but it can also affect other parts of the body. Lymphedema can cause long-term physical, psychological, and social problems for patients.
The lymph system is a network of lymph vessels, tissues, and organs that carry lymph throughout the body.
The parts of the lymph system that play a direct part in lymphedema include the following:
- Lymph: Colorless, watery fluid that travels through the lymph vessels and carries T and B lymphocytes. Lymphocytes are a type of white blood cell.
- Lymph vessels: A network of thin tubes that collect lymph from different parts of the body and return it to the bloodstream.
- Lymph nodes: Small, bean-shaped structures that filter lymph and store white blood cells that help fight infection and disease. Lymph nodes are found along a network of lymph vessels throughout the body. Groups of lymph nodes are found in the neck, underarm, mediastinum, abdomen, pelvis, and groin.
The spleen, thymus, tonsils, and bone marrow are also part of the lymph system but do not play a direct part in lymphedema.
Anatomy of the lymph system showing the lymph vessels and lymph organs, including the lymph nodes, tonsils, thymus, spleen, and bone marrow. Lymph (clear fluid) and lymphocytes travel through the lymph vessels and into the lymph nodes where the lymphocytes destroy harmful substances. The lymph enters the blood through a large vein near the heart.
Lymphedema occurs when lymph is not able to flow through the body the way that it should.
When the lymph system is working as it should, lymph flows through the body and is returned to the bloodstream.
- Fluid and plasma leak out of the capillaries (smallest blood vessels) and flow around body tissues so the cells can take up nutrients and oxygen.
- Some of this fluid goes back into the bloodstream. The rest of the fluid enters the lymph system through tiny lymph vessels. These lymph vessels pick up the lymph and move it toward the heart. The lymph is slowly moved through larger and larger lymph vessels and passes through lymph nodes where waste is filtered from the lymph.
- The lymph keeps moving through the lymph system and collects near the neck, then flows into one of two large ducts:
- The right lymph duct collects lymph from the right arm and the right side of the head and chest.
- The left lymph duct collects lymph from both legs, the left arm, and the left side of the head and chest.
- These large ducts empty into veins under the collarbones, which carry the lymph to the heart, where it is returned to the bloodstream.
When part of the lymph system is damaged or blocked by infection, injury, cancer, removal of lymph nodes, or radiation to the affected area, fluid cannot drain from nearby body tissues. Fluid builds up in the tissues and causes swelling.
Possible signs of lymphedema include swelling of the arms or legs.
Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems occur:
- Swelling of an arm or leg, which may include fingers and toes.
- Swelling in the head or neck.
- A full or heavy feeling in an arm or leg.
- A tight feeling in the skin.
- Voice changes.
- Difficulty swallowing.
- Difficulty breathing.
- Pain in the arm or leg.
Cancer and its treatment are risk factors for lymphedema.
Lymphedema is a side effect of cancer and its treatment. The condition may develop months or years after treatment. Risk factors for lymphedema include the following:
- Removal and/or radiation of lymph nodes, especially of those in the underarm, groin, pelvis, or neck.
- Infection or slow healing after surgery.
- A tumor that affects or blocks the lymph ducts, nodes, or vessels in the neck, chest, underarm, pelvis, or abdomen.
- Having a higher disease stage.
- Being overweight or having obesity.
Lymphedema often occurs in breast cancer patients who had all or part of their breast removed and axillary (underarm) lymph nodes removed. Lymphedema in the legs may occur with vulvar cancer, ovarian cancer, endometrial cancer, cervical cancer, or colorectal cancer. Lymphedema may occur in patients with cancers of the head and neck due to radiation after surgery. Internal lymphedema (swelling inside the body) may result from chemotherapy for head and neck cancer. Lymphedema also may occur after surgery for melanoma, prostate cancer, and sarcoma.
Tests that examine the lymph system are used to diagnose lymphedema.
It is important to make sure there are no other causes of swelling, such as infection, cancer, or blood clots. The following tests and procedures may be used to diagnose lymphedema:
- Physical exam and health history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient's health habits and past illnesses and treatments will also be taken.
- Limb measurements: A doctor uses tools to measure the fluid inside arms, legs, fingers, and toes. The doctor will also measure the size of the limbs and will compare their sizes to the other arm or leg. Measurements are taken over time to see if swelling arises, gets worse, or does not go away.
- MRL (magnetic resonance lymphography): A procedure that uses magnetic dye and a computer to make a series of detailed pictures of the lymph system.
A grading system is also used to diagnose and describe lymphedema. Grades 1, 2, and 3 are based on size of the affected limb and how severe the signs and symptoms are.
Stages may be used to describe lymphedema.
- Stage 0: The flow of lymph in the body is not moving as it should.
- Stage I: The limb (arm or leg) is swollen and feels heavy. Pressing on the swollen area leaves a pit (dent). This stage of lymphedema may go away without treatment.
- Stage II: The limb is swollen and feels spongy. A condition called tissue fibrosis may develop and cause the limb to feel hard. Pressing on the swollen area does not leave a pit.
- Stage III: This is the most advanced stage. The swollen limb may be very large. .
Prevention and Treatment of Lymphedema
There are ways to reduce the risk of lymphedema and help lessen the problems it causes. Many methods that help prevent lymphedema can also be used to treat it. Surgery may be a treatment option for lymphedema when other treatments do not work.
Treatment of lymphedema may include the following:
Compression garments
Compression garments are made of fabric that puts a controlled amount of pressure on different parts of the arm or leg to help move fluid and keep it from building up. The fabric may be either elastic or inelastic (also called flat knit and circular knit). The type of fabric that is best depends on the stage of lymphedema and other therapies.
Compression device
Compression devices are pumps connected to a sleeve that wraps around the arm or leg and applies pressure on and off. This pumping action may help move fluid through lymph vessels and veins and keep fluid from building up in the arm or leg. Compression devices should be used with compression garments. They may be helpful when added to combined therapy. Most of these devices should be used under supervision by a trained professional.
Complete decongestive therapy (CDT)
CDT is managed by an occupational or physical therapist with special training. CDT consists of manual lymph drainage, bandaging, exercises, and skin care. At the beginning of the program, the therapist gives many treatments over a short time to decrease most of the swelling in the limb with lymphedema. Then the patient continues the program at home to keep the swelling down.
Exercise
The muscle movement from exercise improves the flow of lymph and the functioning of the heart, which may help treat lymphedema. Resistance exercise may be helpful when added to combined therapy.
The American College of Sports Medicine advises that a supervised exercise program is safe for patients with or at risk for lymphedema after breast cancer. The safety of unsupervised exercise and exercise in other cancers is unknown.
Drug therapy
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ketoprofen, are being studied in the treatment of lymphedema.
Surgery
There may be surgery options for some people with lymphedema:
- Lymphatico-venous anastomosis (LVA) surgery connects lymphatic vessels to a vein. This creates a new way for lymph fluid to travel in the body.
- Vascularized lymph node transfer (VLNT) replaces damaged lymph nodes with healthy lymph nodes from elsewhere in the person's body. It may help new lymphatic vessels grow and create new pathways for lymph to flow in the body.
- Liposuction to remove extra fat in the affected part of the body may improve lymphedema. Compression garments are needed after liposuction.
Laser therapy
Low-level laser therapy uses light to stimulate new growth of lymphatic vessels, improve the flow of lymph fluid, and help repair skin affected by lymphedema.
Current Clinical Trials
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.
To Learn More About Lymphedema
For more information from the National Cancer Institute about lymphedema, see the following:
- Lymphedema and Breast Cancer Surgery
- Lymphedema and Cancer Treatment
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Last Revised: 2023-08-23
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