Lymphedema and the Cancer Connection

Compression garments have been around for some time.

At first glance, lymphoma and lymphedema are words that seem as if they might be related, but they refer to very different conditions. Lymphoma is a cancer of the lymphocyte white blood cells while lymphedema is an accumulation of fluid, or lymph, in the soft tissues with accompanying swelling. Often a person experiences lymphedema as a swollen arm or leg.

Lymphedema is most commonly caused by the removal of or damage to your lymph nodes as a part of cancer treatment.

Because breast cancer is so common relative to other cancers, scientists have more data about lymphedema in breast cancer; however, lymphedema can occur in survivors of cancers of all different types, including various types of lymphoma. The number of people with lymphedema is expected to increase significantly over the next decade or so because of improved survival rates following cancer treatment.

What Causes Lymphedema?

The lymphatic system is like the circulatory system in reverse: it collects fluid in the body’s tissues and circulates it back into your veins. The system of canals, joined together by lymph nodes, has different territories or “jurisdictions.” For instance, lymph nodes in the groin area are responsible for draining and filtering tissue fluid and lymph from the legs, while those lymph nodes in the armpits help drain and filter lymph coming from the arms.

When something obstructs the flow of lymph or prevents it from circulating properly, this can lead to lymphedema in a particular zone of the body.

In the case of the lymphatic structures in the groin, for instance, a blockage can result in swelling of one or both legs. In the armpits, after surgery and radiation for breast cancer, there may be scarring or bands of fibrous tissue that block the flow of lymph, or the lymphatics themselves may be poorly functioning following treatment.

There are other causes of arm and leg swelling not due to lymphedema, to be sure, and it's your doctor's job in these cases to pinpoint the underlying problem.

Symptoms and Complications of Lymphedema

If the accumulation of extra fluid and protein in the tissues persists, this can lead to an inflammatory reaction, with fat deposition and scarring, and permanent, mild-to-severe swelling of the affected body parts. Lymphedema can produce bothersome symptoms, such as:

  • Skin tightness
  • Reduced ability to move the joints
  • Heaviness in the affected limbs
  • Discomfort and pain
  • Recurrent infections.

Lymphedema and Lymphoma

Following cancer therapy, blockage or destruction of lymphatic structures by surgery and radiation can lead to lymphedema. Cancer treatments that involve lymph nodes can damage lymph drainage routes, causing lymph fluid to accumulate in related limbs and body areas.

While it's not commonly reported as a presenting symptom of lymphoma, lymphedema can result from the lymphoma, itself, or its recurrence.

Lymphedema affecting just one leg has been reported as a rare initial presentation of lymphoma, mostly in women, and often with swollen lymph nodes in the groin area or malignancy in the abdomen. Lymphedema due to lymphoma can occur in other areas as well, when the flow of lymph is blocked by a large mass, for instance.

Managing Lymphedema

Lymphedema is considered a chronic progressive condition. While it can be managed, it is not yet recognized as a condition that can be cured definitively. Researchers are working to improve the situation, however.

The standard treatment for lymphedema is what is known as decongestive treatment, which includes exercise, wearing a compression garment, skin care and manual massage and lymph drainage.

Surgery is sometimes needed in severe cases or in cases that are resistant to standard decongestive treatment.

Surgical Treatments

There are two basic categories of surgery for lymphedema: ablative/debulking surgery and functional /physiologic surgery.

Ablative or debulking procedures have been in use since the early to mid-20th century. These techniques reduce the volume of swollen limbs, but they can be disfiguring with extensive scarring and other complications. Liposuction removes adipose tissue to reduce the limb volume, however, you generally have to use lifelong compressive therapy to maintain.

Functional or physiologic surgeries include vascular lymph node transfer (VLNT) as well as lymphovenous bypass. These techniques have come into use more recently, so less is known about comparative outcomes and the particulars about optimal techniques to maximize results. Nonetheless, results have been promising thus far, which has created enthusiasm. Both techniques try to redirect some of the fluid that’s retained back into the venous system. Both are also relatively complicated surgeries in that they are considered microsurgeries, whereby tiny connections need to be made -- and lymphovenous bypass to a greater extent, which is why it's sometimes described as "super" micro surgery.

  • In lymphovenous bypass, working lymphatic vessels are connected to tiny venules – a complex microscopic surgery that essentially attempts to reconnect the plumbing.
  • In VLNT, the surgeons borrow lymph nodes from one area of the body and transplant them with a blood supply and some surrounding fat to the area affected by lymphedema. In this surgery, you are actually transplanting.

One of the distinguishing things about VLNT is that you are transferring a working "immunological center" into an area that has been damaged -- whether by surgery, radiation of something else. Interestingly, all clinical studies thus far with VLNT have shown an improvement in skin infections -- with clinical names like erysipelas, lymphangitis, and cellulitis -- after vascularized lymph node transfer.

Does Lymphedema Affect Cancer Risks?

There is no evidence to this effect, but it is an interesting question currently for researchers as they work to understand interactions between the immune system and cancer.

On the one hand, lymph nodes are often removed in various types of cancers. Most types of cancer initially metastasize or spread into draining lymph nodes via lymphatic channels before they spread to other sites in the body, so regional lymph nodes in cancer patients are often surgically removed.

On the other hand, some researchers point out that elective lymph node dissection in melanoma of the limbs is not recommended since it does not improve survival. In some cases and for some cancers, it may be that draining lymph nodes may act as gatekeepers of tumor immunity, meaning their unnecessary removal could potentially result in a poor prognosis.

Some findings in animal studies suggest that the flow of lymph plays an essential role in generating tumor-specific immune responses and that severe dysfunction of the lymphatics might actually promote the growth of primary tumors. Still, scientists are just beginning to study and understand things about the "tumor microenvironment" and tumor immunology, and this is a very active area of research, with many questions remaining .


Elgendy IY, Lo MC. Unilateral lower extremity swelling as a rare presentation of non-Hodgkin’s lymphoma. BMJ Case Reports. 2014;2014:bcr2013202424.

Kimura T, Sugaya M, Oka T, Blauvelt A, Okochi H, Sato S. Lymphatic dysfunction attenuates tumor immunity through impaired antigen presentation. Oncotarget. 2015;6(20):18081-18093.

Massini G, Hohaus S, D’Alò F, et al. Mantle Cell Lymphoma Relapsing at the Lymphedematous Arm. Mediterr J Hematol Infect Dis. 2013;5(1):e2013016.

Tourani SS, Taylor GI, Ashton MW. Vascularized Lymph Node Transfer: A Review of the Current Evidence. Plast Reconstr Surg. 2016 Mar;137(3):985-93.

Ito R, Suami H. Overview of lymph node transfer for lymphedema treatment. Plast Reconstr Surg. 2014 Sep;134(3):548-56.

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