Lymphedema risk factors: who is more likely to get it

What lymphedema is

Lymphedema is swelling caused by a buildup of lymph fluid in the body between the skin and muscle. Lymph fluid is part of the lymph system, which helps your body fight infection and disease (NCI). It usually happens in the arms or legs (MedlinePlus), but it can occur anywhere in the body (NCI).

In people with cancer, the cancer or its treatment can disrupt the flow of lymph fluid and cause lymphedema (also called secondary lymphedema). It may start soon after treatment or years after treatment has ended, and most often it develops slowly over months or years (NCI). There is no score or calculator on this page; the lists below are the factors NCI and MedlinePlus name.

What causes lymphedema

Anything that blocks or changes the flow of lymph fluid can cause lymphedema. NCI says cancer and its treatment can cause it when (NCI):

• cancer or a tumor blocks the flow of lymph fluid;
• surgery for cancer disrupts the flow of lymph fluid;
• radiation therapy causes scar tissue that blocks the flow of lymph fluid.

MedlinePlus lists these causes of lymphedema: infection; cancer; scar tissue from radiation therapy or surgical removal of lymph nodes; and inherited conditions in which lymph nodes or vessels are absent or abnormal (MedlinePlus).

Who is more likely to get lymphedema

NCI says your risk depends on the type and location of your cancer and the treatments you have. Other risk factors it names are (NCI):

• having an infection;
• healing slowly after surgery;
• having lymph nodes removed;
• past surgeries or radiation;
• having advanced cancer;
• being overweight or having obesity.

Talk with your doctor to learn about your own risk (NCI). See also obesity risk factors.

Which cancers are linked to lymphedema

Some cancers and their treatments are more likely than others to cause lymphedema, especially those that form in the abdomen or genital area, because they sit near lymph nodes and vessels (NCI). NCI says the type of cancer can help predict where swelling may appear (NCI):

• Breast cancer: surgery often removes one or more lymph nodes in the underarm. After surgery or radiation, lymphedema may develop in the hand, arm or chest on the side where nodes were removed or damaged. See breast cancer risk factors.
• Vulvar, vaginal, ovarian, endometrial, cervical, prostate or colorectal cancer: lymphedema may develop in the leg, genitals or abdomen.
• Head and neck cancer: swelling may appear in the face, neck or under the chin, or inside the body, such as in the throat, where it may not be visible.
• Melanoma and sarcoma: lymphedema can develop after surgery.
• Lymphoma: white blood cells can build up and block lymph flow. See lymphoma risk factors.

NCI adds that sentinel lymph node biopsy lets doctors remove fewer lymph nodes when checking whether cancer has spread, which lowers the risk of lymphedema (NCI).

Signs to watch for

Signs may develop slowly, so NCI says to pay close attention to slight changes and contact your doctor if you notice any of these (NCI):

• a heavy, full or tight feeling where you had surgery or radiation therapy;
• swelling; pressing on it may leave a dent in the skin, though later it may not;
• numbness or tingling in the area;
• in an arm or leg: swelling that makes it look larger than the other one, trouble moving it, or weakness;
• in the head or neck: swelling or tightness in the face, neck or under the chin, trouble speaking, eating, swallowing or breathing, or voice, vision or hearing changes;
• in the genitals or abdomen: swelling there, difficult or painful urination, or pain during walking, sex and other movements.

Lymphedema is easier to control when treatment starts early, so NCI says to contact your doctor as soon as you notice heaviness, swelling or other signs (NCI).

Cellulitis

Cellulitis is a bacterial skin infection that is a common complication of lymphedema and can be life-threatening. Signs include pain, tenderness, redness and swelling, skin that feels warm in the swollen area, and fever. If you have a fever or other signs of cellulitis, NCI says to call your doctor right away (NCI).

How lymphedema is found

Your doctor will examine the swollen area and, for an arm or leg, compare its size with the other limb. Tests may include ultrasound, MRI or magnetic resonance lymphangiography, a CT scan, lymphoscintigraphy, limb volume measures (perometry or water displacement), and bioimpedance spectroscopy, which can help show early lymphedema in people without symptoms (NCI).

Steps that may lower your chances

NCI says there is no way to prevent lymphedema, but there are things you can do to lower your risk or keep it from getting worse. Your health care team may suggest (NCI):

• protecting your skin to prevent infection, such as wearing gloves for cooking and gardening and using lotion to prevent dry, cracked skin;
• exercise, which may help lower your risk; ask your doctor which program is safe for you;
• staying at or getting to a healthy weight;
• avoiding pressure on the area, such as tight jewelry, clothes with tight bands, or carrying bags with an affected arm, and having blood pressure and blood draws on the other arm;
• avoiding extreme heat and sun;
• staying hydrated and eating less salt.

Once lymphedema develops it is a chronic condition that cannot be cured, but it can be treated to relieve swelling (NCI). Treatment includes exercise, compression devices, skin care and massage (MedlinePlus).

Common questions

Can lymphedema start years after cancer treatment?

Yes. NCI says it may start soon after treatment or years after treatment has ended (NCI).

Can you get lymphedema without cancer?

Yes. MedlinePlus lists infection and inherited conditions in which lymph nodes or vessels are absent or abnormal among the causes (MedlinePlus).

Does having lymph nodes removed always cause lymphedema?

No. Having lymph nodes removed raises the risk, but your risk depends on the type and location of your cancer and your treatments (NCI). Ask your doctor about your own risk and which changes to report.