What is lymphoedema?
This page tells you about lymphoedema and cancer. There is information about
What is lymphoedema?
Lymphoedema is pronounced lim-fo-dee-ma. It means a build up of lymph fluid that causes swelling in an area of the body.
Lymph fluid is in all body tissues. It carries fluid and waste products away from the body tissues. It comes from tiny blood vessels into the body tissues and then normally drains away in tubes or channels called lymph vessels. These are part of the lymphatic system. Through the lymph vessels, the fluid then drains back into the bloodstream.
If any part of this system gets blocked or damaged, or if there are a reduced number of nodes or vessels, the lymph fluid can build up in the area and cause swelling.
Cancer and lymphoedema
Lymphoedema may develop when a cancer blocks a lymph node or some lymph vessels. Or it can happen if you have treatment for cancer that removes or damages part of the lymphatic system. Surgery and radiotherapy to the lymph nodes can cause lymphoedema. Wherever possible, doctors plan treatment to try to avoid damage to the lymph nodes.
Not everyone who has treatment to the lymph nodes will develop lymphoedema. Other factors that may increase your risk include being overweight, not being active, varicose veins, and infection after treatment.
You can view and print the quick guides for all the pages in the About lymphoedema section.
Lymphoedema is pronounced lim-fo-dee-ma. It means a build up of lymph fluid that causes swelling in an area of the body. Lymph fluid is in all body tissues. It comes from the tiny blood vessels into the body tissues and normally drains away in tubes or channels called lymph vessels. These are part of the lymphatic system. Through the lymph vessels, the fluid then drains back into the bloodstream.
If the lymph drainage channels or lymph nodes in a part of the body are blocked or removed or damaged, lymph fluid can build up in that area and cause swelling. Some people with cancer develop lymphoedema due to changes in the lymphatic system caused by the cancer. Or they may have it due to treatments such as surgery or radiotherapy.
Lymphoedema most commonly affects the arms or legs. But it can develop in other body areas, such as the chest, abdomen, genitals, head and neck, face, back, breast or armpit and the pelvic area. It is a long term (chronic) condition which can’t be cured, but can usually be well controlled.
To understand how lymphoedema develops, it helps to know how the lymphatic system normally works.
The lymphatic system is a system of drainage tubes and lymph nodes (also called lymph glands) that run throughout the body. The tubes are called lymph vessels or lymphatic vessels. They start as tiny tubes in the body tissues and join up to form bigger lymph vessels in the chest and abdomen.
Along the lymph vessels are small bean shaped lymph nodes. The ones you are most likely to know about are under your arm, in your neck, and in your groin. You may be able to feel these. But there are also nodes in other areas including your chest, abdomen and pelvis.
The lymphatic system also includes body organs, such as the
The lymphatic system carries clear watery fluid called lymph, which drains out from the small blood vessels (capillaries) into the body tissues. Proteins can also move out of the capillaries and the lymph carries them back to the bloodstream. It also drains waste and harmful substances away from body tissues, including bacteria, viruses and bits of old cells.
The lymphatic vessels have valves so that the lymph can only flow one way. When muscles near the lymph vessels contract they press on the lymph vessels and help to push the fluid through the lymph system. Some of the larger lymph vessels have muscle tissue in their walls which contracts to help move the lymph along.
Lymph nodes filter the lymph. They also make and store white blood cells that circulate around the body and help fight infections.
The lymph vessels join up into 2 main lymphatic ducts. These are both in the chest. They are
The thoracic duct drains lymph fluid from
- Both legs
- The left half of the chest (thorax)
- The pelvis and abdomen
- The head and neck
- The left arm
The right lymphatic duct drains lymph from
- The right half of the chest (thorax)
- The head and neck
- The right arm
These main ducts then drain into the large blood vessels in the neck, carrying the waste products from the body into the blood. The kidneys filter the blood and get rid of the waste products in the urine.
Knowing how lymph drains helps us to understand how lymphoedema treatment works.
Lymphoedema develops when lymph isn’t able to drain in the normal way and collects in an area of the body, causing swelling. Lymphoedema related to cancer may develop when
- The cancer blocks a lymph node or some lymph vessels
- You have treatment for cancer that removes or damages part of the lymphatic system
Cancer treatments that can cause lymphoedema include
- Surgery, especially if the surgeon needs to remove lymph nodes during the operation
- Radiotherapy to treat cancer in the lymph nodes or an area of the body where there are lymph nodes
- Or a combination of the two treatments
Not everyone who has cancer or cancer treatment develops lymphoedema. We don’t know exactly how many people get lymphoedema due to cancer or its treatment. We need more research to find out. The number of people developing lymphoedema varies depending on the type of cancer and the treatment they have.
Any cancer that affects the lymph nodes may cause lymphoedema. Researchers are finding out more about this all the time. We know that some cancers are more likely to lead to lymphoedema than others. They include
- Breast cancer
- Prostate cancer
- Vulval (vulva) cancer
- Cervical (cervix) cancer
- Womb cancer
- Bladder cancer
- Penile (penis) cancer
- Melanoma skin cancer
- Head and neck cancer
We also know that
- About 2 out of 10 people (20%) with breast cancer develop lymphoedema
- The number of breast cancer patients with lymphoedema varies from around 1 in 10 (10%) to about 5 out of every 10 (50%), depending on the type of cancer treatment they have
- About 5 out of every 10 women (50%) who have treatment for cancer of the vulva get lymphoedema
- About 3 out of every 10 men (30%) with cancer of the penis get lymphoedema
- The number of people who get lymphoedema after treatment for melanoma in the lymph nodes in the groin varies – research shows lymphoedema in between 2 and 5 out of every 10 people (20 to 50%)
Your doctor or specialist nurse will tell you if your cancer or treatment is likely to increase your risk of lymphoedema. Wherever possible, doctors plan treatment to try to avoid damage to the lymph nodes. Your risk may be higher if you have
- Surgery to the lymph nodes
- Radiotherapy to the lymph nodes or to an area of the body where there are lymph nodes
- Complications after surgery to the lymph nodes, such as infection
- Advanced cancer
For many types of cancer, doctors remove the group of lymph nodes closest to the tumour to see if they contain cancer cells. This can help to show if the cancer has spread and whether you need further treatment. But removing the lymph nodes increases the risk of lymphoedema.
In some types of cancer, doctors now do a test called a sentinel node biopsy. This can reduce the need to remove all the lymph nodes, which helps to reduce the risk of lymphoedema. The sentinel node is the first lymph node (or first few nodes) that fluid drains to from the area of the tumour. Doctors can use a dye to show up the sentinel lymph nodes and remove them. If there are no cancer cells in these nodes, you may not need to have further treatment to the other lymph nodes in the area.
Removing the sentinel nodes can also damage the lymph system and so may still cause lymphoedema. But the risk is much lower than after removing most of the lymph nodes in the area.
Some other factors can increase your risk of lymphoedema, including
- Being very overweight
- Being born with a body structure that puts you at higher risk (congenital predisposition)
- Varicose veins or other blood vessel problems in the area of the body where you are having cancer treatment
- Getting a skin infection after surgery or radiotherapy
- Not being able to move around – this makes it more difficult for the lymph fluid to move through the lymphatic system
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