Lymphoedema as a result of cancer

Posted by Jeanne Everett on 11th Sep 2020

What causes Lymphoedema to develop?

Lymphoedema can be an unwelcome side effect of cancer and cancer treatment. It develops when the lymphatic system is damaged and is no longer able to effectively drain fluid from the tissues (1). Fluid then accumulates in the tissue spaces, causing swelling (2).


How common is Lymphoedema following treatment for cancer?

Lymphoedema related to cancer is not uncommon, affecting one in five women with breast cancer, 50% of women with vulval cancer, a third of men with penile cancer, and between 20%–50% of melanoma patients who have had treatment to inguinal lymph nodes (nodes in the groin), or axillary lymph nodes (in the armpit) (5). Some other cancers and their related treatments can also cause lymphoedema: cancers of the head and neck; renal cancers, including cancer of the prostate; bowel cancer; and spread of a primary cancer to another part of the body where it affects lymph nodes.


How cancer treatments can affect normal lymphatic drainage.

Surgery

Surgery for cancer can damage the lymphatic system if lymph nodes are removed. The lymphatic system is then no longer able to effectively drain away tissue fluid, resulting in a reduction in its ability to function normally, and causing lymphoedema to develop.

Radiotherapy

Radiotherapy causes further damage to the lymphatic system, depleting the number of tiny drainage vessels, as well as forming scar tissue. This scar tissue presses on or narrows the remaining lymph vessels and nodes (3).

In breast cancer, it is commonly known that radiation to the axilla (under-arm) increases the risk of lymphoedema, but radiation to the breast or chest wall area also carries an increased risk of lymphoedema.

In addition, radiotherapy can cause skin discoloration of the affected area, and although this may disappear quite soon after treatment, in some cases the effects of radiotherapy can last much longer, sometimes up to couple of years.

Having radiotherapy as well as surgery increases the risk of lymphoedema.

Chemotherapy

Although chemotherapy does not cause lymphedema, it can contribute to swelling, causing water retention throughout the whole body. It has, however, been suggested that some chemotherapy drugs do increase the risk of developing lymphoedema. The main one being Taxol, which is commonly used in the treatment of breast cancer (4) & (5).


Other causes of Lymphoedema

Cording

Cording, also known as axillary web syndrome, can develop as a result of breast cancer treatment and is known to increase the risk of lymphoedema. A “cord” is a tight lymphatic band, stretching from the axilla (armpit), often down as far as the forearm and wrist. Occasionally the band may stretch onto the breast or the front of the abdomen. It is thought that up to a third of those undergoing treatment for breast cancer may develop cording, and although it is most common within the first 3 – 6 months following treatment, in some cases it has been found to develop as long as 2 years afterwards. It can cause considerable pain and problems with movement and can lead to the development of lymphoedema (6).

Breast Seroma

A breast seroma is a collection (pocket) of serous fluid that can develop following surgery or radiotherapy. Most seromas are reabsorbed by the body over a period of several weeks, but sometimes fine needle drainage is needed to remove the fluid. Seromas are known to increase the risk of lymphoedema (7).

Infection

The lymphatic system is part of the body’s immune system, helping to protect us from infection and disease. Due to the damage which occurs during treatment for cancer the ability of the lymphatic system to fight infection becomes less effective, increasing the risk of infection, or cellulitis, for those with, or at risk of, lymphoedema.


Preventing cellulitis

Looking after your skin

Hygiene – daily washing the affected limb, avoiding soaps which dry the skin, and careful drying, especially between digits.

Moisturising - it is important to ensure that your skin is well hydrated to prevent it from becoming dry and cracking. Daily application of a non-perfumed moisturiser - applying this with gentle upward strokes will encourage fluid to drain upwards towards the top of the limb.

Protection - preventing damage to stretched, fragile, delicate skin is important in order to reduce the risk of cellulitis. If your skin becomes broken, applying a mild antiseptic and covering the area will help to prevent cellulitis.

However, if your skin becomes red, hot and painful, or you become feverish, you will need prompt treatment, usually with antibiotics.

If you think you may have cellulitis, you should see your GP immediately, or contact 111 if a GP appointment is not available.


Other management priorities

Exercise and Activity

Continue to be as active as you comfortably can, as reduced mobility can worsen the lymphoedema. You may feel tired following your cancer treatment, but even a relatively small amount of exercise can help to keep the swelling under control by making the muscles work harder.

Simple (Self) Lymphatic Drainage (SLD) (massage)

If you have been shown how to carry out SLD you should continue with this as advised.

Your Lymphoedema garment

If you normally wear a lymphoedema garment, either a sleeve, stocking, or lymphoedema Wrap, this will have been carefully measured for you, and you should continue to wear it.

If, following cancer treatment, you have found that your garment is no longer suitable, then please contact your Lymphoedema Practitioner, as an alternative can usually be found.

Haddenham HC have a wide range of compression to treat lymphoedema of any part of the body, and provide innovative and responsive solutions, helping to solve problems within their clientele who have cancer related lymphoedema.

The Haddenham Team of Clinical Advisors are available to support you Lymphoedema Practitioner and help them find the correct garment to best suit your needs.


About the author

Jeanne started her lymphoedema career in the early 1990s, setting up the lymphoedema clinic in Durham. She then moved into a specialist clinical role across South Durham, Teesside and North Yorkshire, and in 2013 set up the Lymphoedema Service based in Imperial Healthcare Trust at Charing Cross Hospital. Jeanne is now the Lymphoedema Nurse at St Teresa’s Hospice in Darlington, where her passion for education continues.


REFERENCES

(1) Sheer R (2017) Compression garments for managing lymphoedema. Journal of Lymphoedema. 12(1):39–45

(2) International Lymphoedema Framework (ILF), (2006) International Lymphoedema Framework. Best Practice for the Management of Lymphoedema. 2006. (accessed 20 April 2020)
(3) Avraham T, Yan A, Zampell J, Daluvoy S, Haimovitz-Friedman A, Cordeiro A, & Mehrara B (2010) Radiation therapy causes loss of dermal lymphatic vessels and interferes with lymphatic function by TGF-β1-mediated tissue fibrosis. American Journal of Physiology, 299:3; C589-C605

(4) Jung SY, Shin KH, Kim M, Chung SH, Lee S, Kang HS, Lee ES, Kwon Y, Lee KS, Park IH, Ro J (2014) Treatment factors affecting breast cancer-related lymphedema after systemic chemotherapy and radiotherapy in stage II/III breast cancer patients. Breast Cancer Research and Treatment, 148:1; 91-8.

(5) Kim M, Shin KH, Jung SY, Lee S, Kang HS, Lee ES, Chung SH, Kim YJ, Kim TH, Cho KH1 (2016) Identification of Prognostic Risk Factors for Transient and Persistent Lymphedema after Multimodal Treatment for Breast Cancer. Cancer Research and Treatment, 48:4; 1330-7.
(6) O’Toole J, Miller C, Specht M, Skolny M, Jammallo L, Horick N, Elliott K, Niemierko K, & Taghian A (2013) . Cording Following Treatment for Breast Cancer. Breast Cancer Research and Treatment Journal, 140(1) 105-111.

(7) Toyserkani N, Jørgensen M, Haugaard K, Sørensen J (2017) Seroma indicates increased risk of lymphedema following breast cancer treatment: A retrospective cohort study. The Breast, 32; 102-4.