Lymphoedema is a chronic condition caused by the accumulation of protein-rich fluid in the tissues due to damage or dysfunction of the lymphatic system. It results in swelling, inflammation and progressive changes to the skin and underlying tissues. It can occur anywhere in the body but most commonly affects the arms, legs, breast, chest wall, genital area, head or neck.

Cancer-related lymphoedema may develop during treatment or months, even years, afterwards. Although there is generally no definitive cure, early diagnosis and appropriate treatment can help control symptoms, slow progression and improve quality of life.

What Is the Lymphatic System?

The lymphatic system is part of both the circulatory and immune systems. Its main functions are to:

  • Drain excess fluid from body tissues.
  • Transport proteins, fats and other substances.
  • Help protect the body against infections and disease.
  • Support the immune response.

The lymphatic system consists of:

  • Lymphatic fluid (lymph).
  • Lymphatic vessels.
  • Lymph nodes.
  • Lymphatic organs such as the spleen, tonsils and thymus.

Lymph nodes act as biological filters, helping to remove microorganisms, damaged cells and cancer cells.

Causes of Cancer-Related Lymphoedema

Lymphoedema may occur as a result of:

  • Surgery involving the removal of lymph nodes.
  • Radiotherapy to lymph node regions.
  • Tumour compression or infiltration of lymphatic vessels or lymph nodes.
  • Infections, fibrosis or scarring caused by treatment.
  • A combination of surgery and radiotherapy, which increases the risk.

Not everyone who undergoes these treatments will develop lymphoedema.

How to Reduce the Risk

Current recommendations focus on prevention, early detection and patient education.

Keep Your Skin Healthy

  • Keep the skin clean and well moisturised.
  • Treat cuts, burns and insect bites promptly.
  • Protect your skin from the sun.
  • Wear gloves for gardening and household tasks when appropriate.

Maintain a Healthy Weight

Obesity is one of the most important risk factors for both the development and worsening of lymphoedema.

Stay Physically Active

Current evidence shows that progressive, supervised exercise is safe and beneficial for people at risk of lymphoedema and for those already living with the condition.

Prevent Infections

Skin infections can trigger or worsen lymphoedema. Seek medical advice promptly if signs of infection develop.

Symptoms and Warning Signs

Early symptoms may be subtle:

  • A feeling of heaviness.
  • Tightness in the affected limb or area.
  • Intermittent or persistent swelling.
  • Reduced flexibility.
  • A sensation of skin thickening or hardening.
  • Pain or discomfort.
  • Changes in skin texture.
  • Difficulty wearing usual clothing, jewellery or footwear.

In more advanced stages, symptoms may include:

  • Fibrosis (hardening of tissues).
  • Persistent skin changes.
  • Recurrent infections.
  • Greater functional limitation.

If you notice swelling, heaviness or changes in a limb or an area affected by cancer treatment, inform your healthcare team as soon as possible. Early treatment generally provides better outcomes.

Treatment of Lymphoedema

The standard international approach to treatment is known as Complete Decongestive Therapy (CDT). This consists of several combined measures.

Main Components

  • Skin care.
  • Compression garments.
  • Therapeutic exercise.
  • Manual lymphatic drainage in selected patients.
  • Education and self-management strategies.

Exercise and Physical Activity

It is now well established that avoiding exercise does not prevent lymphoedema. On the contrary, regular physical activity can improve physical function and support lymphatic drainage.

Recommended Activities

  • Walking.
  • Swimming.
  • Cycling.
  • Adapted yoga.
  • Adapted Pilates.
  • Progressive, supervised strength training.
  • Joint mobility and stretching exercises.

Recommendations

  • Increase intensity gradually.
  • Stop exercising if significant pain or worsening swelling occurs.
  • Follow the specific advice of your physiotherapist or lymphoedema specialist.

Skin Care

Good skin care helps reduce the risk of infection.

Recommendations include:

  • Cleaning the skin daily.
  • Applying moisturiser regularly to prevent cracking.
  • Keeping nails and cuticles healthy.
  • Treating cuts and skin irritation promptly.
  • Using sun protection.
  • Using insect repellent when necessary.

Signs of Infection (Cellulitis)

Contact a healthcare professional immediately if you develop:

  • Redness.
  • Warmth in the affected area.
  • Pain.
  • Rapidly increasing swelling.
  • Fever or chills.

Cellulitis requires urgent medical assessment and usually early antibiotic treatment.

Compression Garments

Compression garments are one of the cornerstones of lymphoedema treatment.

Their purpose is to:

  • Limit fluid accumulation.
  • Promote lymphatic drainage.
  • Maintain the benefits achieved through other therapies.

Important Considerations

  • They should be prescribed and fitted by experienced healthcare professionals.
  • The degree of compression and type of garment should be individualised.
  • They require periodic review and replacement.
  • Not everyone requires the same level of compression.

In some cases, multilayer compression bandaging may be used before progressing to a long-term compression garment.

Positioning and Movement

Regular movement helps encourage lymphatic drainage.

If You Have Lymphoedema in the Legs

  • Avoid sitting or standing for prolonged periods.
  • Walk regularly.
  • Perform repeated ankle and calf movements.
  • Elevate your legs when comfortable and appropriate.

If You Have Lymphoedema in the Arms

  • Maintain normal shoulder and arm movement.
  • Avoid prolonged uncomfortable positions.
  • Perform exercises recommended by your physiotherapist.

Manual Lymphatic Drainage

Manual Lymphatic Drainage (MLD) is a specialised technique performed by trained professionals to stimulate lymphatic flow. It may be included as part of comprehensive treatment in selected patients.

It is important to note that:

  • It does not replace compression therapy.
  • It is most effective when combined with exercise, skin care and self-management strategies.
  • It should be recommended on an individual basis.

Surgery and Specialised Treatments

In selected patients, surgical procedures may be considered, including:

  • Lymphaticovenous anastomosis (LVA).
  • Vascularised lymph node transfer (VLNT).
  • Procedures to reduce fatty tissue or fibrosis.

These options are generally considered when conservative treatments have not achieved adequate symptom control.

Lymphoedema in Other Areas of the Body

In addition to the arms and legs, lymphoedema can affect:

  • The breast or chest wall.
  • The head and neck.
  • The genital region.
  • The trunk.

Management follows the same principles:

  • Early diagnosis.
  • Good skin care.
  • Adapted exercise.
  • Compression therapy where appropriate.
  • Specialist treatment from healthcare teams experienced in lymphoedema management.