Lymphedema

Overview

If you have been diagnosed with lymphedema, or if you may be at risk of developing it, the multidisciplinary lymphedema program specialists at City of Hope will provide you with the information and expertise you need. Our specialized team of doctors, surgeons, nurses and certified lymphedema therapists will guide you through each step of the journey, from diagnosis to treatment to long-term management.

Request a consultation

City of Hope’s multidisciplinary lymphedema program offers patients the latest surgery, technology, research and innovation while providing compassionate care. Please call 800-826-4673 for personalized assistance or request an appointment online. Visit Making Your First Appointment for additional information.

 

City of Hope is one of a small number of cancer centers in the U.S. that offers microsurgery treatment for lymphedema.

Located near Los Angeles, City of Hope is a nationally recognized leader in the research and treatment of cancer. We are one of the few facilities designated a comprehensive cancer center by the National Cancer Institute, For more than a decade, U.S. News & World Report has named City of Hope one of the top cancer hospitals in America.

NEWS & BREAKTHROUGHS

What is lymphedema?

Lymphedema is swelling that develops due to the abnormal collection of fluid beneath the skin, most commonly in an arm or leg. This can occur when lymph nodes are removed or damaged during cancer treatment. It can also be the result of other trauma, and can be an inherited condition in those born with a deficiency in their lymphatic system.

Was is the lymphatic system?

Your lymphatic system, which is part of your immune system, is a specialized network made up of lymphatic channels and lymph nodes. Much as the circulatory system carries blood throughout the body, the lymphatic system carries lymphatic fluid, a clear liquid that contains infection-fighting white blood cells. If you have ever scraped your knee and noticed the seepage of clear liquid through the wound, then you saw lymphatic fluid oozing from the tissues.
 
The lymph nodes are small structures that filter the fluid, which carries various debris and impurities collected from the tissues on its travels through the body. When damage occurs to the lymph nodes or lymphatic channels, the lymphatic fluid has nowhere to go and begins to collect like water behind a dam. Because lymphatic fluid is rich in proteins and contains salts, it attracts additional fluid and the localized swelling becomes more severe.

Are you at risk for lymphedema?

Lymphedema is common in the developed world and is most commonly caused by an injury or disruption of the lymphatic system. For example, surgery, chemotherapy and/or radiation therapy may injure the lymphatic system. Lymphedema often happens following surgery that involves removal of lymph nodes such as an axillary lymph node dissection or after radiation therapy. It can appear weeks, months or even years after the surgery. It is not always clear why some people develop swelling while others do not.

What are the signs and symptoms of lymphedema?

In its early stages, lymphedema may be a subtle change to the way your body looks or feels. An increase as small as three-fourths of an inch to the circumference of your upper arm may be an indicator of lymphedema. Since early detection gives you a better chance of successful treatment, it is important to remain vigilant.
 
Symptoms of lymphedema may include:
  • The limb or affected area feels heavy or full
  • Tightness or decreased flexibility in the nearby joints
  • Slight puffiness or swelling in the limb or nearby tissue
  • A lasting ‘dent’ in the skin when you press it with your finger
  • Veins, tendons or knuckles become harder to see
  • Skin that was wrinkled becomes smooth
  • Clothes or undergarments become too small
  • Swelling that makes removing watches and rings more difficult
  • Changes in skin texture, such as swelling, hardening or redness
 

Lymphedema evaluation and diagnosis

Prior to your cancer treatment our certified lymphedema therapists will meet with you to collect diagnostic baseline measurements, educate you about how to reduce your lymphedema risk, teach you what symptoms to look for, and answer any questions or concerns.

During this evaluation your lymphedema therapist will ask questions and perform tests.

These include:

  • Your cancer history and your complete medical history
  • Detailed information about any symptoms you may be experiencing
  • A personal history regarding lifestyle, work or school requirements, nutrition and exercise regimens
  • A physical examination of the skin and soft tissues of the affected area
  • Precise measurements of the circumference along multiple points of the affected limbs or area of the body
  • Bioimpedance scanning: This test detects the amount of fluid in the limb. The device passes a small and painless electrical current through the limb and measures the level of resistance to the current. The higher the fluid content, the lower the resistance reading. The test is particularly useful in cases where visible symptoms are slight or absent.
  • Additional imaging studies such as magnetic resonance imaging or computed tomography scans to rule out other problems that could be causing lymphedema

How is lympedema treated?

Complete decongestive therapy is the most common treatment for lymphedema. At City of Hope, this process begins with a certified lymphedema therapist evaluating you and creating a treatment plan that may include one or more of the following strategies:
  • Skin Care - It is very important to avoid injury and infection. Practice good hygiene and put on moisturizing lotion. We will teach you how to care for your skin.
  • Massage - Manual lymph draining is a precise and gentle form of massage that helps move the fluid to other parts of the body for clearance.
  • Exercise - Stretching, strengthening and range-of-motion exercises can help restore limb volume to a more normal functional level and improve the movement of fluid. Exercise may also be helpful with weight control, which is an integral part of lymphedema therapy. Exercises should be performed under the guidance of a certified lymphedema therapist.
  • Bandaging - Cotton, low stretch bandages apply constant pressure on the limb. Bandaging is usually combined with other methods of treatment.
  • Compression Garments - Elastic fabric garments similar to a girdle or support stocking put pressure on the arm or leg to help move fluid and keep new fluid from collecting.
  • Presurgery Evaluation Prior to surgery for lymphedema, the use of specialized imaging allows your surgeon to visualize the affected tissues more precisely using ICG fluorescent technology.

Surgery for lymphedema

At City of Hope’s multidisciplinary lymphedema program, certified lymphedema therapists work with our world-renowned surgeons, oncologists and nurses. They combine expertise with the latest in research and technology to provide you with the most effective treatment. 

We are one of a small number of cancer centers in the U.S. that offers microsurgery for lymphedema. Although the surgery is not a cure, it has been shown to improve the severity of the condition and to reduce the number of complications.

Thanks to rapid advances in technology that allow imaging of the extremely small lymphatic vessels, as well as microscopes and instruments that make it possible to see and operate on the structures of the lymphatic system, several microsurgery techniques are now available to patients who fall within certain specific criteria.

What should I expect from surgery?

While many patients see improvement, every patient’s treatment experience will be unique. Our multidisciplinary lymphedema care team is made up of plastic surgeons, certified lymphedema therapists and interventional radiologists. The team will provide a thorough evaluation prior and postprocedure to assess and document your improvement and provide follow-up care if necessary. The surgery may not help every patient or offer complete cure.

The skilled physicians at City of Hope use the following procedures to treat lymphedema:

  • Lymphaticovenous bypass - Also known as LVA, this procedure redirects the lymph fluid to small veins. This is essentially an outpatient procedure which takes between four to six hours and results in virtually no blood loss. Patients typically stay less than 24 hours for observation.
  • Vascularized lymph node transfers - A surgical procedure in which lymph nodes from elsewhere in your body are transplanted in order to replace those removed as part of cancer treatment

What care would I need after surgery?

There is usually limited pain, and you may have to limit some of your activities or movement after surgery.

What are the risks?

As with any surgery, there are risks such as infection. Your surgeon and your care team will review the risks and answer any questions you may have. The procedure will leave small, permanent scars in the treatment area.

Does lymphedema go away?

Although there are rare cases when lymphedema has improved and been eliminated, in many patients it requires long-term treatment and management.

What are the advantages of the procedure?

The procedure may help reduce the severity and progression of the lymphedema, reverse some of the changes seen within the affected limb, and diminish pain, heaviness and infection.

Would I still need lymphedema treatment postsurgery?

Although you may experience some improvement postsurgery, we recommend you continue your prescribed treatment to get the best possible results. For example, we would recommend continued use of your compression garments, consistent massage and exercise, and caring for your skin.
 

Lymphedema experts

City of Hope’s renowned physicians and staff utilize the latest in technology and innovation to treat lymphedema, coupled with our enduring belief in providing unparalleled compassionate care.

Lymphedema Surgeons

Mark C. Tan, M.D.

Clinical Specialties

  • Plastic Surgery
Sharon Clancy, M.D.

Clinical Specialties

  • Plastic Surgery
Wai-Yee Li, M.D., Ph.D.

Clinical Specialties

  • Plastic Surgery
James S. Andersen, M.D.

Clinical Specialties

  • Plastic Surgery
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