Lymphedema causes part of your body to swell with fluid. Anyone can develop lymphedema, but cancer patients are at higher risk. Lymphedema is usually a lifelong condition, but early treatment can keep it from getting worse.

OHSU’s Lymphedema Program provides care that is made just for you. We work closely with your cancer team and other specialists to support you before, during and after treatment. 

Our program is a Lymphatic Education & Research Network (LE&RN) Comprehensive Center of Excellence in Lymphatic Diseases, which means we meet high standards for lymphedema care. The program is led by Dr. Laura K. Tom, director of the OHSU Lymphedema Program and the Traci Parker Endowed Professor for Lymphedema.

You’ll find:

• A team of experts who work together to improve your symptoms and long-term quality of life
• Care based on the latest research and technology
• Help navigating and coordinating your care
• A full range of treatments
• Physical and occupational therapists who focus on lymphedema
• Surgeons with experience and advanced training in lymphedema surgery

Lymph is a fluid that contains white blood cells and immune cells. It is part of your immune system. Lymph flows through a network of vessels, nodes and organs called the lymphatic system. If this system is damaged or blocked, lymph can build up, causing lymphedema.

Your care team may describe lymphedema in stages:

• Stage 0: At risk for lymphedema, with damage to the lymphatic system. No visible swelling.
• Stage 1: Mild swelling that comes and goes. It may improve with rest or when the affected body part is raised.
• Stage 2: Swelling persists and tissues thicken.
• Stage 3: Significant swelling, along with skin changes.

Lymphedema may be:

• Related to cancer, often after treatment that damages or removes lymph nodes
• Not related to cancer

Cancer-related lymphedema

The most common type of lymphedema in the U.S. happens after cancer treatment, especially when surgery is combined with radiation or chemotherapy.

Lymphedema is most common in patients treated for:

• Breast cancer, with about 1 in 5 patients affected
• Pelvic cancers, such as colon, prostate or ovarian cancer
• Head and neck cancer
• Melanoma

Lymphedema can happen any time after cancer treatment, with the highest risk in the first three years.

Lymphedema signs and symptoms

Common early symptoms of lymphedema include:

• Swelling, especially in an arm, leg, hand or foot
• A feeling of heaviness or fullness
• Skin that feels tight
• Clothing, shoes or jewelry that feel tight
• Indents in the skin (pitting) when pressed

Later symptoms include:

• Firm or thicker skin
• Less flexibility or range of motion
• Discomfort or pain
• Frequent infections or redness

These symptoms can also be caused by other conditions. It’s best to talk with your doctor about them so you can get proper care.

What to expect at your first visit

When you seek lymphedema care at OHSU, your first visit is with a lymphedema specialist. You’ll discuss your medical history, symptoms and any swelling. The specialist may recommend imaging to better understand your condition.

You may get referrals to experts in:

• Lymphedema therapy, for compression therapy and other nonsurgical treatments
• Plastic and reconstructive surgery, to discuss whether surgery is right for you
• Vascular and venous medicine, to care for your circulatory system
• Bariatrics and weight management, to support weight loss if needed
• Wound care and hyperbaric medicine, to help with healing
• Support services, for you and your family
• Other services as needed

Lymphedema diagnosis and testing

Your care team may use several tests to diagnose or better understand your condition:

• ICG lymphangiography: Indocyanine green lymphangiography uses a special dye and camera to show where lymph may be blocked.
• Bioimpedance spectroscopy: This uses a sensor to measure fluid levels in your body.
• MRI: Magnetic resonance imaging uses a magnetic field to create detailed images of your organs and systems.
• Lymphoscintigraphy: This uses a special dye and camera to map how lymph is flowing in your body.

Lymphedema treatment

Lymphedema can often be managed without surgery, especially in early stages. Whether surgery is right for you depends on your stage, symptoms and how well other treatments are working. You and your care team will work together on a treatment plan.

Treatments that don’t use surgery

• Manual lymph drainage (MLD): This is like a gentle massage. It helps fluid move out of swollen areas and drain more easily.
• Compression therapy: This uses wraps or special clothes to move fluid and reduce swelling.

Your care team can work with you on:

• Exercise and movement, to improve lymph flow and reduce swelling
• Skin care, to reduce infection risk
• Managing your symptoms and knowing when to seek treatment

Types of surgery

Lymphatic bypass: This connects blocked or damaged lymph vessels to nearby small veins to create a new path for lymph to drain. This can prevent or reduce swelling. Bypass types include:

• Immediate lymphatic reconstruction (LYMPHA): This is done at the same time as cancer surgery to remove lymph nodes. The goal is to lower the risk of developing lymphedema.
• Lymphovenous bypass (LVB): This is done when someone already has lymphedema.

Lymphatic tissue transfer or vascularized lymph node transfer (VLNT): This moves healthy lymph nodes to a part of the body affected by lymphedema. The goal is to help the lymphatic system work better.

Debulking: This removes extra tissue to reduce volume. It’s usually for more advanced lymphedema after swelling has been managed. Liposuction is the most common type of debulking. In extreme cases the tissue can be surgically cut off.

Resources

• Lymphatic Education & Research Network, including a patient registry to help speed research and improve care
• Lymphedema, Breastcancer.org