Lymphedema can occur to anyone undergoing a surgical lymph node biopsy or radiation therapy. Lymphedema is a swelling (edema) that can occur anywhere in the body including the breast, trunk, arms, legs, as well as head and neck. For patients undergoing breast cancer treatment, the areas affected are generally the arm, breast or chest wall. There are two types of lymphedema: primary lymphedema and secondary lymphedema. Primary lymphedema results from congenital or genetic abnormalities. Secondary lymphedema results from damage to the lymphatic system and can develop as a side effect from cancer treatment. Fred Hutchinson Cancer Center’s physical therapists help cancer patients manage secondary lymphedema—Fred Hutch does not treat primary lymphedema.
The lymphatic system works in parallel with the body’s circulatory system. But instead of blood, the lymphatic system collects and circulates lymph—about three liters per day—through a complex series of vessels and lymph organs, including lymph nodes, tonsils, thymus, spleen, and bone marrow.
One function of the lymphatic system is to clean up and remove waste—it’s a central component of your body’s immune system. As lymph circulates, it gets filtered by the lymph nodes. Your body contains several hundred of these pear-shaped nodes that work to trap and kill harmful substances such as bacteria and viruses.
Many types of cancer use the lymph system as a way to spread (or metastasize) to other parts of the body. Along the way these cancer cells—like other foreign substances—are trapped in the lymph nodes. This is why surgeons remove lymph nodes (biopsy) so that a pathologist can examine and determine whether and how much cancer has spread. If nodes are removed or damaged, the flow of the lymph can be blocked. Lymph flows inward from the extremities and is returned to the blood system. When the lymphatic system gets blocked, swelling occurs in the head, neck, trunk, arms and legs. In addition to lymph node biopsies, radiation therapy can also affect the lymphatic system. Radiation therapy can cause the formation of scar tissue that makes it harder for the lymphatic system to move fluid and increases the risk of lymphedema. Patients with late-stage cancer who have a heavy tumor burden are also susceptible to developing lymphedema.
Patients who have been treated at Fred Hutch can be seen in the Physical Therapy department by one of our Certified Lymphedema Therapists, who are trained in teaching patients how to manage lymphedema.
Swelling is a common side effect of surgery, but not every instance of swelling is the result of lymphedema. Sometimes lymphedema does not occur until sometime after surgery, or until something occurs — such as an insect bite or burn — that causes an extra burden on the lymphatic system. Lymphedema usually develops slowly over time. Some of the first signs of lymphedema can be a feeling of fullness or heaviness in the affected area, tightness of skin and/or decreased movement or flexibility. The swelling can range from mild to severe and can develop soon after surgery, or months and even years later.
There is no cure for lymphedema. Early detection and treatment of lymphedema is critical — the later symptoms are addressed, the harder they can be to treat.