Lymphoedema after cancer treatment

Overview

Lymphoedema is a long-term condition that causes swelling, usually in an arm or leg, when lymph fluid builds up. Lymph fluid is a clear liquid that travels through tubes called lymphatic vessels and helps your body fight infection. Cancer treatment can damage these tubes, so the fluid cannot drain properly and collects in the tissue.

Yes, lymphoedema is a common side effect of some cancer treatments. It affects about 1 in 5 people treated for breast cancer, and it can also happen after treatment for prostate, gynaecological, bladder, or melanoma cancers.

It affects people who have had lymph nodes removed or damaged by radiation therapy, especially during cancer treatment. Not everyone who has these treatments develops lymphoedema, and the risk varies from person to person.

Symptoms

Common symptoms

• Aching or discomfort in the affected arm or leg
• A feeling of heaviness or tightness in the limb
• Swelling that may come and go, or stay
• Clothing, rings, or shoes feeling tighter than usual
• Skin that feels tight, hard, or thicker than normal
• Reduced flexibility in the nearby joints

Symptoms in children

• Swelling of an arm, leg, hand, or foot
• Shoes or clothing suddenly feeling tight
• Pain or restricted movement in the swollen area
• Skin changes like a shiny or hardened look

Symptoms in older adults

• Swelling that may be mistaken for age-related fluid retention
• Fragile skin that is slow to heal
• Difficulty moving the limb, and a higher risk of falls due to heaviness
• Trouble with everyday tasks like dressing or climbing stairs

Causes

Main causes

• Surgery that removes or damages lymph nodes – for example, during breast, prostate, gynaecological, or melanoma surgery
• Radiation therapy aimed at areas that contain lymph nodes
• Scarring or inflammation in the lymphatic system after treatment

Risk factors

• Having several lymph nodes removed
• Radiation therapy to the lymph node area
• Carrying excess body weight
• Slow wound healing after surgery
• Infection or injury in the affected limb

When to see a doctor

See a doctor urgently if:

• Sudden increase in swelling or pain
• Redness, warmth, or red streaks on the skin – these can be signs of infection
• Fever with chills

Book a routine appointment if:

• New swelling that has lasted for more than a few days
• A feeling of heaviness or tightness that does not go away
• Difficulty using your arm or leg as you normally would

Diagnosis

Your doctor will ask about your cancer treatment, examine the area, and measure both limbs to compare sizes. If needed, they may refer you to a specialist who can confirm the diagnosis.

Tests that may be done

• Physical examination and limb measurement
• Ultrasound to rule out a blood clot (DVT)
• Lymphoscintigraphy – a scan that uses a small amount of contrast to show how lymph fluid flows

What to expect at your appointment

At your appointment, you will talk about your symptoms and your past cancer treatments. You may need to have your limb measured again over a few visits. A diagnosis can usually be made from the examination, and scans are only used when the picture is not clear.

Treatment

Lymphoedema cannot be cured, but it can be managed very well. Treatment aims to reduce swelling, improve movement, and prevent infections. The best results come from a plan that combines skin care, compression, exercise, and other therapies.

Self-care at home

• Keep the skin on the affected limb clean and moisturised – this helps prevent cracks and infections.
• Wear your compression garment (sleeve, sock, or wrap) as advised by your healthcare team.
• Raise the limb when resting to help fluid drain.
• Avoid cuts, burns, and insect bites on the affected limb, and treat any small injuries right away.
• Stay active with gentle exercises that move the limb and help pump lymph fluid.

Medical treatments

Your healthcare team may recommend a combination of manual lymphatic drainage – a type of gentle massage performed by a trained therapist – compression bandaging, intermittent pneumatic compression devices, and tailored exercise. These treatments are provided by lymphoedema specialists, and your plan will be based on your individual needs. Always follow the advice of your team; never try new treatments without their guidance.

When is surgery considered?

In a small number of cases, surgery – such as lymph node transfer or liposuction – may be considered. These are specialised procedures discussed with your specialist and are not suitable for everyone.

Living with this condition

Living with lymphoedema means adding a few simple habits to your day: wear your compression garment as advised, protect your skin, and keep an eye on your limb. Most people can still work, travel, exercise, and enjoy daily activities.

Lifestyle tips

• Keep your weight within a healthy range – extra weight can make swelling worse.
• Stay physically active with gentle activities like walking, swimming, or yoga.
• Avoid tight clothing, blood pressure cuffs, injections, or needles in the affected limb.
• Use an insect repellent when outdoors to prevent bites.
• Wash and moisturise the skin daily to keep it healthy.

Diet and exercise

A balanced diet rich in vegetables, fruits, and lean protein helps you keep a healthy weight. Some people feel better when they reduce salt, as too much salt can hold fluid in the body. Mild, regular exercise – like walking or gentle stretching – is very beneficial. Talk to your healthcare team before starting any new exercise plan.

Mental health and emotional wellbeing

Lymphoedema changes how your body looks and feels, and it can bring up feelings of frustration, sadness, or anxiety. These feelings are common and understandable. Please speak to your doctor or nurse if you are struggling. They can connect you with counselling or other mental health support. If you ever have thoughts of harming yourself, contact a mental health crisis team or your local emergency number right away.

Prevention

It may not always be possible to prevent lymphoedema because surgery and radiation can damage the lymphatic system. However, you can lower your risk by protecting the affected limb from injury, keeping a healthy weight, and paying attention to any early signs.

Vaccines

There is no vaccine that prevents lymphoedema. However, you may be offered vaccines – such as the flu vaccine – because an infection can make lymphoedema worse. Ask your pharmacist or doctor which vaccines are recommended for you.

Screening programmes

There is no routine screening test for lymphoedema, but if you are at risk after cancer treatment, your healthcare team may check your arms or legs regularly. Report any new swelling as soon as you notice it.

Complications

If left untreated

• Serious skin infections (cellulitis) that may need hospital treatment
• Increasingly hard, heavy limbs that become difficult to move
• Slow-healing wounds that are prone to infection
• Long-term discomfort and reduced quality of life
• Psychological distress, low mood, and reduced confidence

Long-term outlook

With good care, most people with lymphoedema can live active and full lives. Swelling often improves, and symptoms can be kept well controlled. Treatments continue to advance, and staying in close contact with your healthcare team gives you the best chance of a positive outcome.

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