How to Treat & Manage Lymphedema

A combination of preventive & treatment options to improve your quality of life.

“Lymphedema is often confused with other causes of extremity edema and enlargement. Understanding the risk factors and physical examination signs of lymphedema can accurately diagnose patients about 90% of the time. Correct diagnosis is imperative so patients can be managed appropriately.” -

Greene AK, Goss JA. Diagnosis and Staging of Lymphedema. Semin Plast Surg. 2018 Feb;32(1):12-16.

There is no sure way to prevent lymphedema related to cancer but there are ways to help lower your risk for it, and to reduce the chance of it worsening. The goal of treatment is to control the swelling, improve functioning, and prevent complications, such as infection. Being aware of the signs of lymphedema and talking to your oncologist/cancer care team right away if you notice any symptoms is important. You can refer to the checklist on the signs of lymphedema to help you note any changes on your skin and bring it to your cancer care team’s notice.

The chances of improving lymphedema are better if treatment begins early. Untreated lymphedema can lead to irreversible problems that can impact your day-to-day activities significantly. Here are some preventative measures that you can use to reduce your risk of lymphedema after surgery or radiation or its severity if you already have it:

  • Being obese can increase your risk of developing lymphedema. Talk to your cancer care team about what is a healthy weight for you.

  • Keep skin and nails clean and cared for to prevent infection.

  • Cut toenails and fingernails straight across to prevent ingrown nails and infections.

  • Use cream or lotion to keep the skin moist.

  • Watch out for small cuts such as paper cuts or breaks in the skin and carefully monitor them till they are healed. An antibacterial ointment can help.

  • Avoid needle sticks of any type into the arm with risk for lymphedema. This includes talking to your nurse or cancer care team about shots or taking blood for tests in the affected arm.

  • Use a thimble for sewing.

  • Avoid testing bath or cooking water using the limb with lymphedema as there can be altered sensation in the affected limb resulting in burns.

  • Wear gloves when gardening and cooking.

  • Use sunscreen when outdoors.

  • Wear only loose jewelry and clothes without tight bands or elastic.

  • Do not carry handbags on the arm that has had lymph node removal in the axilla.

  • Do not use a blood pressure cuff on the arm where you have had lymph node removal.

  • Do not use elastic bandages or stockings with tight bands.

  • If you have lymphedema, keep the arm with lymphedema raised higher than the heart when possible.

  • Do not swing the arm quickly in circles or let the arm hang down. This makes blood and fluid collect in the lower part of the arm.

  • Do not apply heat to the arm that is affected.

  • Exercise does not increase the chance that lymphedema will develop in patients who are at risk for lymphedema. Studies have now shown that a slow, low-intensity, carefully controlled exercise regime is safe and may even help keep lymphedema from developing. Studies have also shown that, in breast-cancer survivors, upper-body exercise does not increase the risk of lymphedema developing. However, talking to your cancer care team and especially to a certified lymphedema specialist before starting any exercise program is absolutely necessary.

  • If you’re planning airplane travel, talk to your lymphedema therapist. If a sleeve is recommended as a precaution, have it properly fitted by an expert. Be careful not to lift very heavy suitcases. Get out of your seat and move your arm from time to time. Keeping your arm and upper body in one position for too long could slow down the outflow of lymph.

Here is a handy checklist that can remind you of the ways to help yourself at home or at work to deal with the side effects of lymphedema.

“Health education, preventive exercise programs, and patient adherence to therapeutic recommendations all play an important role in preventing lymphedema.” |

Treatment options for lymphedema are based on primarily reducing the swelling and help with activities of daily living, lessening pain and improving mobility. A certified therapist who may be part of your cancer care team or is associated with a specialized separate lymphedema treatment center can help you with these treatment options, including:

  • Pressure Garments: Pressure garments are also called compression sleeves and lymphedema sleeves or stockings and can be bought over the counter or custom fitted. If you have mild lymphedema (stage 0 or stage 1), a compression sleeve or garment may be your initial treatment. All of the garments are made of a specialized fabric. Sleeves are tighter at the bottom than they are at the top. This helps create the graded (or ‘gradient’) pressure that keeps the lymph moving out of the arm. An improperly fitted sleeve can make lymphedema worse by placing too much or too little pressure on certain areas of the limb that can cause fluid backup to worsen. Ideally, a trained lymphedema therapist or a medical supply company’s fitter should measure you for the right sized pressure sleeve or garment. Typically these sleeves need to be replaced every 3 to 6 months because they lose the stretchiness over time. If you’re getting a compression sleeve, ask your lymphedema therapist if you should wear a glove or gauntlet on your hand, too. Avoid applying moisturizer to your arm and hand before putting on the sleeve as the ingredients in the lotion can break down the elastic fibers in the sleeve over time.

  • Bandages: Once the lymph fluid is moved out of a swollen limb, bandaging or wrapping can help prevent the area from refilling with fluid. Bandaging is a mainstay of treatment for stage 2 and stage 3 lymphedema (moderate to severe lymphedema). Compression bandaging is a specialized form of compression used in the treatment of lymphedema. They can be easily adjusted to fit changing limb size and compression needs. The bandages that are applied by your therapist during treatment are called ‘short-stretch’ bandages. They look like ACE bandages, but they are different. You should not use over-the-counter ACE wraps as they can cut off blood supply and are not the bandages used for lymphedema treatment. They are much less stretchy. A stocking or a liner is used as a base before bandages are applied. For the arm, there are typically more layers further down on the limb and fewer layers higher up. This creates a pressure gradient that helps fluid move up and out of the arm. The bandages should feel snug but not tight. The non-elastic bandage sheath also counters refilling of fluid and reduces tissue fibrosis, further reducing fluid build up. Lymphedema that has not improved with other treatments is sometimes helped with bandaging. Multiple layers of short-stretch bandages are applied to the affected area. Pressure within the short-stretch bandages is low when the patient is inactive (resting pressure) and higher when there is activity. Bandages work differently than compression sleeves, which support the flow of lymph in the right direction but don’t decongest (move fluid out of) the limb. Sleeves apply what is known as resting pressure, meaning that the pressure is higher when the arm is at rest. When you move your arm, the elastic fabric moves right along with it, which actually reduces the amount of pressure. A compression sleeve may be enough for mild lymphedema, but more advanced cases need the help of bandaging before a compression sleeve can be used. Bandaging works by reducing limb volume.

  • Combined Therapy: Combined therapy is a program of massage, bandaging, exercises, and skin care managed by a trained lymphedema therapist or physical therapist. 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. Combined therapy is also called complex decongestive therapy.

  • Compression Device: These are pneumatic pumps connected to a sleeve that wrap around the arm or leg and apply pressure on and off. The sleeve is inflated and deflated on a timed cycle. This pumping action may help move fluid through lymph vessels and veins and keep fluid from building up in the arm or leg. They are generally not recommended as stand-alone treatment. There is wide discrepancy about the safety and effectiveness of pneumatic pumps, so you should check with your lymphedema therapist first. A pump might be used during the active phase I of treatment or as part of the phase II home-care plan intended to maintain those results. Compression devices may be helpful when added to combined therapy. The use of these devices should be supervised by a trained professional because too much pressure can damage lymph vessels near the surface of the skin.

  • Laser Therapy: Laser therapy has some effectiveness in reducing the volume of the arm, breaking down scar tissue, and increasing range of motion while reducing tightness for some women. A hand-held, battery-powered laser device is used to aim low-level laser beams at the area with lymphedema.

  • Massage Therapy: Massage therapy for lymphedema should be performed only by trained therapists who know how to massage areas that have lymphedema. In this type of massage, the body is lightly rubbed, tapped, and stroked. It is a very light touch, almost like a brushing. This specialized form of massage therapy improves lymph flow and reabsorption without increasing capillary filtration. It can also help reduce tissue swelling and softening fibrosis in the trunk and arm. Massage may help move lymph out of the swollen area into an area with working lymph vessels. Patients can be taught to do this type of massage therapy themselves. When done correctly, massage therapy does not cause medical problems. Massage should not be done on open wounds, bruises, or areas of broken skin.

Exercise: Exercise can help with moving lymph out of the affected limb and decrease swelling. Consult with a certified lymphedema therapist before beginning exercise. Research shows that if women start exercising slowly under the supervision of a lymphedema therapist, taking care not to overstress the arm, exercise is not likely to make lymphedema worse. Some studies suggest that it can play a role in reducing lymphedema flare-ups. Strength training has been shown to be safe for most women at risk for, or already diagnosed with lymphedema and that it could even reduce the number of symptom flare-ups for some people. Most women with lymphedema can exercise the affected arm or other body part safely as long as they wear compression garments, do not exercise the arm or other affected body part to the point of fatigue and make appropriate modifications to prevent trauma and overuse.

As always, being open and forthcoming with your cancer care team about your concerns and symptoms goes a long way in helping you deal with the side effects of treatment.

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Reason to Hope

There is new research from Brigham and Women’s Hospital that indicates a Western-style diet that is rich in red and processed meat, sugar and refined grains/carbohydrates is tied to higher risk of colorectal cancer through the intestinal microbiota.  Gastroenterology, 2022;DOI:10.1053/j.gastro.2022.06.054