After radiotherapy to treat a head and neck cancer, you are at risk of getting swelling called lymphoedema in your neck or face.
Lymphoedema is pronounced lim-fo-dee-ma.
Lymph fluid is in all body tissues. It comes from the tiny blood vessels into the body tissues. Usually, it drains back into the bloodstream through channels called lymph vessels. These are part of the lymphatic system.
A build up of lymph fluid in an area of the body can happen if lymph drainage channels or lymph nodes are blocked, removed or damaged. This causes swelling called lymphoedema.
Radiotherapy can cause changes in the lymphatic system in the head and neck area. It's a long-term (chronic) condition. It can’t be cured, but it can usually be well controlled.
Sometimes the cancer itself can affect your lymphatic system and cause lymphoedema.
What are the symptoms of lymphoedema?
Lymphoedema in the head or neck can also cause symptoms inside your mouth and throat. This may include swelling of your tongue and other parts of your mouth.
Tell your doctor if you:
- have any swelling or a feeling of fullness or pressure
- find it difficult to swallow
- have changes in your voice
Symptoms can take many months or a few years to appear after radiotherapy.
What to do if you have symptoms
The Lymphoedema Support Network can tell you how to get lymphoedema care within the NHS.
The British Lymphology Society has a directory of lymphoedema services.
Types of treatment for lymphoedema
The main treatments for lymphoedema are
- skin care – keeping skin in the swollen area clean, dry and moisturised and preventing injury and infection
- exercise – to keep lymph flowing through the lymphatic system and help you to maintain a healthy weight
- reducing swelling – specialised skin massage called manual lymphatic drainage (MLD) is the main treatment. It's not usually possible to do bandaging in the head and neck area. There are light compression garments for the head.
Manual lymphatic drainage (MLD) is a specialised massage that encourages the flow of lymph.
You shouldn't wear anything around your neck.
Exercises for lymphoedema
Using your head, neck and shoulder muscles may help to reduce swelling. Your physiotherapist or specialist nurse will usually go through these exercises with you.
These exercises shouldn't be painful. You might have a feeling of stretching as you do them, this is normal. Stop doing the exercises if you have any pain and, if it doesn't get better contact your doctor.
Try to do some exercises every day once or twice a day. It is better to do some every day even if you need to reduce how many you do. Aim to do between 5 and 10 of each exercise.
Do the exercises slowly and gently, don't rush them. You can rest between exercises. It might help to do them in front of the mirror so you can check that your shoulders are back and relaxed.
- Head turns - turn your head to look over your shoulder as far as you can, hold for 2 seconds. Slowly go back to the start position. Repeat on the other side. Keep your shoulders still while doing this exercise.
- Head tilt - tilt your head towards one shoulder until you feel a stretch on the opposite side. Hold for 2 seconds then straighten up. Repeat on the other side. Keep your shoulders still while you're doing this exercise.
- Chin to chest - bend your neck down as far as you comfortably can so your chin is on your chest, hold for 2 seconds and then slowly bring your head back up so you are looking forward again.
- Shoulders up and down - relax your shoulders, bring them up to your ears, relax then drop them back down. Repeat.
- Shoulder rotation - rotate your shoulder forward, then rotate them backwards.
- Open and close your mouth.
- Blow kisses, blow out imaginary candles.
- Smile - an exaggerated one
- Say the vowels in an exaggerated way - a, e, i, o, u.
- Chew sugar free gum but only if you don't have any swallowing problems.
- Side to side - slide your lower jaw one way and then the other.
- Jaw forward - push your lower jaw forward then relax and repeat it.
Exercises for head and neck lymphoedema
Hi, I’m Carla. I’m going to show you how to do head and neck exercises. Remember to do your deep abdominal breathing exercises before and after. Each exercise you will do 5 to 10 times and very important , pain free.
We’ll start with the head and neck. We’ll do looking to the side, back to the middle and to the other side. It’s normal to feel a bit of stretch sensation.
Next one will be ear to the shoulder, not shoulder to the ear. Go back to the middle and to the other side. If you’re not sure you’re doing it right, sometimes it’s helpful to do it in front of a mirror.
Next one will be chin to the chest and back to start position.
Next one will be shoulders. We’ll go up, relax and down and relax.
Next one will be circles. And we go backwards and then forward.
We’ll do as well mouth exercises. We’ll start with open and close. Blowing kisses, blowing candles, exaggerated smile. And then you say the vowels in an exaggerate way
And we’ll do as well the jaw exercises. We’ll do side to side first.
And then moving the jaw forward and the back to normal.
Remember to do the deep abdominal breathing at the end, repeat them once a day minimum and if you have any concerns just call your doctor or lymphoedema specialist.
Find out more about lymphoedema on the Cancer Research UK website.