A potentially devastating result from surgery to treat cancer, acquired lymphedema is the progressive swelling of either an arm or leg following the removal of, and/or radiation therapy to, lymph nodes.
Lymphedema is most commonly associated with breast cancer treatment, but it also occurs in patients with gynecologic, genital, urinary, head and neck cancers as well as in patients treated for melanoma.
Lymphedema takes many people by surprise and can occur as many as 20 years after the surgery was performed.
Some are aware of the trigger; for example a bee sting, injury to the affected limb while gardening, sunburn, an airplane ride, a blood pressure cuff or needle stick to the extremity.
For others there is no known trigger. In fact, patients and even medical professionals may fail to look for, and recognize, early lymphedema.
It is important to diagnose lymphedema quickly and to take steps to prevent it from worsening. It can become a chronic progressive condition resulting in pain and limited range of motion. In later-stage lymphedema, the incidence of infection is twice that of a normal non-swollen extremity. In many cases these infections cannot be treated as an outpatient but require hospitalization.
Psychologically, lymphedema can be devastating to the individual, who may feel disfigured. In many cases patients are unable to wear their normal clothes and may feel that their battle with cancer is no longer private, but obvious for all to see.
To prevent lymphedema, it is important to protect the extremity from injury and infection. In a doctor's office this means not allowing anyone to take your blood pressure or get any injections to the affected extremity. It's also recommended to wear a compression garment when flying or climbing in high altitudes.
At the first signs of swelling, seek prompt treatment. Physical therapists trained in lymphedema management can teach patients manual lymph drainage, massage and therapeutic exercises.
Wearing compression garments may help control the progression of the swelling — and they don't have to be ugly or look like a bandage. For upper extremity swelling there is now a wide selection of high fashion, medically correct garments available.
The outlook is improving for chronic sufferers. In select academic centers, plastic surgeons trained in less invasive microvascular techniques are making progress toward correcting lymphedema.