Lymphoedema and cancer

Lymphoedema means a build up of lymph fluid that causes swelling in a part of the body. It can sometimes develop due to cancer or cancer treatment. It's pronounced lim-fo-dee-ma.

Cancer and cancer treatment

Lymphoedema develops when lymph fluid isn’t able to drain in the normal way. Lymph collects in an area of the body, causing swelling.

Lymphoedema related to cancer might develop when:

• the cancer blocks a lymph node or some lymph vessels
• you have treatment for cancer to remove lymph nodes or treatment that 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
• a combination of surgery and radiotherapy
• chemotherapy
• targeted cancer drugs
• immunotherapy

Lymphoedema is a long-term condition. It can’t be cured, but it can usually be well controlled.

Not everyone who has cancer or cancer treatment develops lymphoedema. We don’t know exactly how many people will get lymphoedema, so we need more research to find out. 

Who gets lymphoedema?

Any cancer that affects the lymph nodes might cause lymphoedema. But more often it is caused by cancer treatments. Researchers are finding out more about what causes lymphoedema all the time.

We know that treatment for some types of cancer is more likely to lead to lymphoedema than other types. They include:

• breast cancer in women and men
• some women's cancers - including vulval, cervical, womb cancer
• some men's cancers - including penile and prostate cancer
• bladder cancer
• lymphoma
• melanoma skin cancer
• head and neck cancer

Lymphoedema is easier to control if treated early. It is important that you are referred to a lymphoedema specialist if you have signs of swelling. This is usually a nurse or physiotherapist.

How likely is lymphoedema?

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 of lymphoedema may be higher if you have:

• surgery to remove 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
• a seroma (a build up of fluid near a wound) after surgery
• scar tissue in the armpit after surgery to the area (cording)
• advanced cancer

For many types of cancer, doctors remove the 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.

Sentinel lymph node biopsy

For some types of cancer, doctors can do a test called a sentinel lymph node biopsy (SLNB). This is a test to find the first lymph node or nodes that fluid drains to from the area of the cancer. 

The doctor checks to see if the sentinel node or nodes contains cancer cells. They use a dye to show up the sentinel lymph nodes and remove them. This is usually under general anaesthetic. You might not need treatment to other lymph nodes in the area if there are no cancer cells in the sentinel nodes. This can reduce the need to remove all the lymph nodes and lowers the risk of lymphoedema. your nurse or doctor will explain more about this if a sentinel lymph node biopsy is suitable for you. 

Removing the sentinel node or nodes can damage the lymph system and this can still cause lymphoedema. But the risk is lower compared to removing most of the lymph nodes in the area.

Other risk factors

Some other factors can increase your risk of lymphoedema, including:

• being overweight or weight regularly going up and down
• being born with a condition that affects your lymphatic system that puts you at higher risk (known as congenital predisposition)
• varicose veins or other blood vessel problems in the area of the body where you have cancer treatment
• getting a skin infection (cellulitis) in a limb at risk of getting lymphoedema
• not being able to move around, because that makes it harder for lymph fluid to move through the lymphatic system
• an injury to the lymphatic system, for example, a deep burn
• blood clots and deep vein thrombosis (DVT)