Overview
Lymphoedema is chronic swelling caused by a build-up of lymphatic fluid, usually in an arm or leg, resulting from damage to or absence of lymph nodes or lymphatic vessels. It most commonly follows cancer treatment (secondary lymphoedema). Primary lymphoedema results from congenital abnormalities of the lymphatic system. It cannot be cured but can be well managed.
How common is it?
Secondary lymphoedema affects approximately 20% of people who undergo lymph node removal or radiotherapy as part of breast cancer treatment. About 100,000 to 200,000 people in the UK live with lymphoedema of all causes.
Causes and risk factors
Damage to or absence of lymphatic vessels or nodes impairs drainage of interstitial fluid, causing it to accumulate in tissues.
Common risk factors
- Cancer-related lymph node removal (breast, pelvic, melanoma, penile cancers)
- Radiotherapy to lymph node regions
- Infection: filariasis (parasitic worm — most common global cause)
- Trauma or surgery to the affected limb
- Primary: Milroy disease, Meige disease, lymphoedema-distichiasis syndrome
- Chronic venous insufficiency (contributes to lower limb lymphoedema)
Symptoms
- Persistent swelling of an arm or leg (less commonly the trunk, genitals, or face)
- Feeling of heaviness or tightness in the limb
- Reduced range of movement
- Aching or discomfort
- Thickened, hardened skin (fibrosis in later stages)
- Recurrent skin infections (cellulitis) — can be severe
When to see a doctor
See a lymphoedema specialist promptly at first signs of swelling after cancer treatment. Report any rapid increase in swelling, redness, or fever (cellulitis) for urgent antibiotic treatment.
Diagnosis
Clinical assessment and history. Lymphoscintigraphy (isotope imaging of lymphatic flow) confirms diagnosis and maps lymphatic anatomy. Differentiation from venous oedema and lipoedema is important.
Treatments
Complete decongestive therapy (CDT)
CDT combines manual lymphatic drainage (MLD) massage, multilayer bandaging, prescribed compression garments, skin care, and exercise. It is the cornerstone of lymphoedema management.
Compression garments
Class II or III compression stockings or sleeves worn daily maintain volume reduction achieved by CDT. Custom garments are often needed. They must be replaced every 6 months.
Exercise
Swimming, walking, and specific lymphatic exercise programmes activate the lymphatic pump. Resistance exercise does not worsen breast cancer lymphoedema, contrary to older beliefs.
Surgical options
Lymphovenous anastomosis (LVA) and vascularised lymph node transfer (VLNT) are microsurgical procedures improving drainage in early-stage lymphoedema. Liposuction for chronic fibrotic lymphoedema reduces volume.
Self-care and lifestyle
- Maintain meticulous skin care to prevent entry portals for infection
- Avoid needle injections, blood pressure cuffs, and tight clothing on the affected limb
- Maintain a healthy BMI (obesity dramatically worsens lymphoedema)
- Never leave the house without compression garment on the affected limb
Prevention
Sentinel lymph node biopsy rather than full axillary clearance reduces breast cancer lymphoedema risk. Early intervention at first sign of swelling may prevent progression.