Causes of lymphoedema related to cancer and how it’s treated
Posted on 29 September 2017
Lymphoedema is an incurable but manageable condition that causes swelling, usually in the arms or legs. It develops when the lymphatic system – the network of channels and glands in the body that helps fight infection and remove excess fluid – is disrupted.
‘Lymphoedema usually only affects a single lymph draining the area where the disruption took place,’ says Dr Lizanne Langenhoven, a Cape Town clinical and radiation oncologist.
What are the signs and symptoms?
The main sign of lymphoedema is swelling in the limbs. This may come and go initially, but without treatment it will become more severe and persistent. It can cause other problems, such as difficulty moving and skin infections such as cellulitis. Other symptoms in affected body parts include an aching, heavy feeling; hard, tight skin; and fluid leaking through the skin.
Water retention as a result of heart failure may be mistaken for lymphoedema – you need to see a doctor for the right diagnosis.
What causes lymphoedema in cancer patients?
Common causes include surgical removal of the glands, radiotherapy to the glands and involvement of the glands by cancer.
‘Lymphoedema in the arm is commonly seen in breast-cancer survivors who required an axillary dissection – removal of lymph nodes in the armpit – as part of their surgical management. These patients often require radiotherapy, and the combination of these two procedures increases the risk of developing lymphoedema to about 30%,’ says Dr Langenhoven.
An axillary dissection without radiotherapy carries a lymphoedema risk of 20%.
There’s a smaller procedure available to patients whose breast cancer is caught early. Called a sentinel lymph node biopsy, only 1-3 nodes are usually removed, and although radiotherapy often follows, the risk of developing lymphoedema for this combination drops to 10%. ‘Unfortunately, not all women are candidates for the smaller procedure, as their cancer might warrant a more aggressive approach to removing the lymphatics in the axilla,’ says Dr Langenhoven.
Lymphoedema in the lower limbs may occur in patients who’ve had pelvic lymph nodes removed for gynaecological malignancies, followed by radiotherapy.
‘Start management early, before any signs are apparent, if you’ve had a procedure putting you at risk,’ says Dr Langenhoven. ‘Early rehabilitation by a specialist decreases your risk of developing a more severe form of the condition.’
A practitioner with formal training in lymphoedema rehabilitation should be able to help. ‘It’s important to ensure that your therapist is trained and registered by the Lymphoedema Association of South Africa (Laosa),’ says Dr Langenhoven.
Techniques to minimise fluid build-up and stimulate the flow of fluid through the lymphatic system can help control the symptoms. These include wearing compression garments, moving and exercising regularly, and using specialised massage techniques.
‘Where all conservative measures have failed, surgery aimed at forming new lymphatic pathways may offer some symptomatic relief,’ says Dr Langenhoven.