Limb Swelling (Lymphedema)

The lymphatic system is part of the body’s circulation and immune system. Lymphedema occurs when there is damage or blockage in the lymphatic system, causing swelling (edema) in the affected area. Lymphedema usually affects an arm or leg, but it can also affect other parts of the body, such as the head and neck. Swelling usually develops slowly, over time. It may develop during treatment or it may start years after treatment.

Causes of Lymphedema

Tumours or growths that block lymph vessels
Removal or damage to lymph nodes or vessels from surgery, and / or radiation therapy

What you need to look out for

Lymphedema can be treated but results are best if done early. It is important to look out for the following symptoms and if present, to see your doctor or nurse to be assessed.

Swelling that is soft to touch
Heavy or achy feeling around the area
Difficulty with movement
Itch, redness, warmth, thickening or hardening of the skin
Recurring skin infections

How it can be treated

Your doctor or nurse will first need to assess your condition and arrange for tests if necessary. They may then refer you to see a Physical or Occupational therapist, who will teach you exercises and self-massages, or recommend special compressive garments (e.g. stockings, arm sleeves) to help you manage the lymphedema.

Depending on your condition, your doctor may also refer you to a plastic surgeon, who will carry out further assessments to determine if you are a suitable candidate for surgical treatment. Surgical options include lympho-venous bypass, lymph node transfer and debulking surgery, depending on the severity of your lymphedema.

What you can do

The following are some of the do’s and don’ts to help you manage lymphedema and prevent further complications:

Ensure good skin care

Keep nails and skin clean, dry and moisturized to prevent infection
Be careful during activities such as sewing, food preparation, and gardening to avoid cuts and wounds. Use an electric shaver instead of manual razor when removing hair over the affected area
Use insect repellent to prevent insect bites where necessary
Clean all wounds or broken skin over the swollen area properly, using saline or antiseptic solution. Please seek medical attention immediately if the wound appears red, or feels warm or painful

Avoid blood pressure measurements and any form of invasive treatments (e.g. blood withdrawals, injections, acupuncture) to the area

Avoid exposure to strong sunlight and use sunblock with SPF of at least 30 to protect your skin whenever possible

Other measures

Elevate affected limb when resting, where possible
Maintain a healthy body weight to reduce the strain on your lymphatic system
Continue your daily activities with exercises (e.g. yoga, walking) as tolerated. However, if the affected area is painful or sore at any point during these activities, stop them immediately
Take more frequent rest breaks when doing repetitive activities like scrubbing, mopping or cleaning
Wear special garments according to your therapist’s recommendations
Consult your therapist if you are going on flights ≥4 hours or altitudes ≥1500m, as high altitudes and low air pressure may lead to lymphedema. Your therapist will be able to advise you on the use of a customized gradient compression garment to be worn at all times during the flight

Avoid intense or strenuous activities using the affected limb or area
Avoid heat (including hot oil, hot water or any heat-producing products) to the affected area, as high temperatures will increase the production of lymphatic fluid and worsen swelling
Avoid exposure to extreme cold
Avoid constricting the affected area (e.g. hanging heavy shopping bags over the forearm, wearing tight clothing or accessories like watches, bracelets, or rings)

When to call your cancer care team

Please inform your doctor or nurse as soon as you notice symptoms of lymphedema or if you develop the following symptoms that may indicate worsening or complications of the condition.

Redness, warmth or pain over the area of lymphedema which may indicate infection
Worsening swelling or pain on movement of the affected area

If you have any questions regarding the above, please call the Cancer Helpline at +65 6225 5655 or approach your doctor or nurse for further details.

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The above contents are made available as part of TEMASEK FOUNDATION-ACCESS (Accessible Cancer Care to Enable Support for Survivors) PROGRAMME, a holistic care programme to support cancer patients during their care and recovery journey.

The contents have been approved by the Cancer Education Information Service, National Cancer Centre Singapore (NCCS), for people with cancer and their families and caregivers. However, this information serves only as a guide and should not be used as a substitute for medical diagnosis, treatment or advice. For specific medical conditions, please seek expert medical advice from your healthcare team.

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