Cancer Treatment And The Risk For Lymphedema
What Is Lymphedema And How Can Cancer Treatment Increase Your Risk
Having and treating cancer can increase the risk for developing lymphedema, which could be generally categorized as a side effect of the cancer. In this article, we take a look at lymphedema, what lymphedema is and how it develops as a result of having and/or treating cancer.
The Lymphatic System And Lymphedema
The lymphatic (or lymph) system is an integral part of your body's detoxification and immune system. The lymphatic system helps maintain the right balance of fluids in your body, transports immune cells and nutrients, and filters out germs, toxins and waste.
The lymphatic system is comprised of lymphatic vessels that contain lymph fluid which travels throughout the body and ultimately flows into the lymph nodes, that are the organs which filter and clean the system. The small, bean-sized lymph node glands are found in many parts of the body, including the neck, armpit, chest, abdomen (belly), and groin.
Click here to see the human lymphatic system.
The lymph fluid contains proteins, salts, water, and white blood cells (infection-fighting cells) and as it moves through the lymphatic vessels, it picks up fluid, nutrients and waste products, such as bacteria, damaged cells and other debris. Once filtered in the lymph nodes, the lymph fluid re-enters the bloodstream where the waste products are ultimately excreted by the kidneys, liver and other organs.
The lymphatic system works closely with the cardiovascular system, transporting (blood or lymph) through vessels throughout the body, helping to maintain fluid balance, supporting immunity and playing a role is waste removal. However, unlike the cardiovascular system which has a powerful pump (the heart) to move blood through the body, the lymphatic system doesn’t have a pump. Instead, the lymphatic system relies on lymph nodes and the movement of muscles to keep the lymph fluid moving. Therefore, if the lymph nodes are damaged or removed, the lymphatic system’s ability to move lymphatic fluid (lymph flow) through the system may become disrupted or compromised.
What Is Lymphedema?
Lymphedema can occur when the lymphatic system is damaged or compromised, resulting in the disruption of the lymphatic flow (of lymph fluid) moving through the body within the lymphatic system. When this disruption occurs, there is a build-up of the lymph fluid in the fatty tissues just under your skin that causes swelling (edema), which is referred to as lymphedema.
In addition to swelling, the accumulated excess lymph fluid can cause your skin to become thickened or hardened, and creates a breeding ground for bacteria that makes the affected area susceptible to skin infections (cellulitis). If left untreated, the cellulitis can spread to the bloodstream and create potentially life-threatening conditions. The skin in the affected area may also become compromised, resulting in leakage of the lymph fluid, especially in cases where the skin is extremely swollen.
Cancer Treatment As A Cause Of Lymphedema
Some of the surgical procedures used to treat cancer include removing one or more of the lymph nodes within the lymphatic system. When a lymph node is removed, it is like closing a lane on a highway. If that occurs, vehicles can’t get through as easily, traffic slows down and a major back up of traffic can develop on that section of the highway. In the case of the lymphatic system, the lymph fluid, like the vehicles in our example, begins to slow down and back up. As the backed up lymphatic fluid accumulates it causes swelling (edema) in the regions of the body where the removed lymph nodes would have otherwise drained the lymphatic fluid. In this situation, lymphedema will have developed.
Even if the lymph nodes are not removed with surgery, radiation therapy can also result in lymphedema developing, as the radiation can damage or scar nearby lymph nodes that are not directly removed. These damaged lymph nodes become compromised and don’t work well, similarly causing the back up of lymphatic fluid.
Lymphedema is most common in the arms and legs, but since there are lymph nodes throughout the body, it can develop anywhere. Any cancer or cancer treatment that affects the lymphatic system can cause lymphedema, but due to the particular methods (surgery and radiation) used to treat a specific cancer, the occurrence of lymphedema is more common with certain types of cancer.
- Breast cancer
- facial lymphedema (lymphedema in the face)
- head and neck lymphedema
- lymphedema in the neck (neck lymphedema)
Most breast cancer surgeries and treatments, including breast removal surgery (mastectomy and double mastectomy surgery), involve removing lymph nodes from the area of the armpit. The more lymph nodes that are removed, the higher your risk for developing lymphedema becomes. With the removal of lymph nodes in the armpit region, the risk for developing lymphedema in the hand or arm is greatest after breast surgery.
Compression bras and post-op bras, compression vests, compression shirts and tops and compression camisoles are generally used to help you look and feel good during and after post-surgical recovery, and are ideally suited to help manage truncal lymphedema (swelling in the trunk of the body, specifically affecting the breast, chest and underarm areas) should it develop. A variety of specialty swell spots and pads are also available for use to provide targeted compression for treating and managing fibrotic tissue and lymphedema in the chest. Compression arm sleeves and compression gloves and gauntlets are used if lymphedema in the arm or lymphedema in the hand should develop.
Prostate cancer
Prostate cancer is the most common cancer among men (after skin cancer), but it can often be treated successfully. In addition to prostrate cancer, there are also other pelvic area cancers (such as bladder, penile, testicular, endometrial, vulvar, or cervical cancer). When treating for prostrate cancer, lymph nodes near the prostrate gland (pelvic area) are oftentimes removed to determine whether the cancer has spread. When these lymph nodes are removed or damaged, the risk for developing lymphedema in the abdomen, legs or groin (genital lymphedema) increases.
If lymphedema in the legs should develop, knee high compression stockings or thigh high compression stockings can be worn, depending on the extent of the lymphedema. If abdominal lymphedema develops compression shorts or compression pantyhose can be used to provide needed compression to the legs and abdominal areas.
Head and neck cancers
Head and neck cancer can be generally categorized into 5 main types: oral (mouth) cancer , pharyngeal (throat) cancer, laryngeal (voice box) cancer, nasal cavity cancer and salivary gland cancer. There are lymphatic vessels in the head and neck, which drain lymph fluid from the scalp, face and neck. If the lymph nodes located in this region (back of head, behind the ears, under the jaw, along the sides and the front of the neck) are damaged as a result of treating the various forms of head and neck cancers, lymphedema can develop. In terms of lymphedema, the following broad categories are often used to describe the extent and affected areas when speaking of head and neck lymphedema:
There are a variety of uniquely designed lymphedema head and neck compression garments and specialty padding that can be used to help treat and manage lymphedema of the head and neck.
Lymphedema Not Caused By Cancer Treatment
Absent cancer and cancer treatment, tumors and enlarged or otherwise compromised lymph nodes themselves can also cause lymphedema if they are pressing on and blocking the flow of lymph fluid. Other "non-cancer" causes of lymphedema includes:
- Primary lymphedema which is a congenital condition where the lymphatic system develops abnormally
- Infections that damage tissue or cause scarring that affects the lymphatic system
- Other health conditions, such as heart or vascular disease, arthritis, and eczema
- Gene changes or mutations that involve the lymph system
- Injury or trauma to a certain part of the body that affects the lymphatic system
What Are Symptoms Of Lymphedema?
If you believe that you may have lymphedema, it is important to consult your healthcare provider as soon as possible. With a positive diagnosis of lymphedema it is critical that you start lymphedema treatment right away to ensure the best outcome. Lymphedema that isn’t treated can get worse and can lead to a variety of other health issues. Common signs and symptoms of lymphedema can include:
- swelling, fullness, or heaviness in the breast, chest, shoulder, arm, hand, leg, or foot
- skin changes such as dryness, discoloration, thickening, or dimpling
- aching, tingling, numbness, pain, or discomfort
- less movement or flexibility in your joints
- trouble putting clothes on, feeling clothes are tighter, or leaving indents on your skin
- your shirt collar, ring, watch, or bracelet feels tight, even though you haven’t gained weight