Lymphoedema after cancer treatment

Lymphoedema is swelling caused by damage to the lymphatic system, which normally drains fluid from tissue. When nodes are removed or irradiated, that drainage is reduced, and fluid can accumulate in an arm, a leg, the chest wall, the breast, the head and neck, or the genital area depending on where you were treated. It is usually controllable rather than curable — which is exactly why acting on the first signs matters so much.

• Heaviness, tightness or aching in the limb or area, often before anything looks swollen.
• A ring, watch, sleeve, bra or shoe that has become tight on one side.
• Skin that feels firmer, or an indentation that stays after pressing.
• Reduced flexibility in the wrist, hand, ankle or shoulder.
• Swelling that is worse at the end of the day or in hot weather.
• After head and neck treatment: puffiness under the chin, in the face, or inside the mouth and throat.

People were once told to avoid using an at-risk arm entirely — no lifting, no exertion, no blood pressure cuffs, no injections, ever. Evidence since has been more nuanced, and blanket avoidance carried its own cost in weakness and lost function.

• Exercise: slowly progressive resistance training has been shown to be safe and beneficial, including for people with or at risk of lymphoedema. Build up gradually, ideally with supervision at first.
• Blood pressure cuffs and needles: the evidence for a strict prohibition is weaker than the advice implied. Many services now advise using the other side where it is practical, rather than treating it as an absolute rule. Ask your own service what they recommend for you.
• Flying: often raised as a risk. Evidence is limited; many services suggest wearing a compression garment if you already have one, and not worrying beyond that.
• Weight: a higher body weight is one of the more consistently identified risk factors, which makes activity doubly worth doing.

An affected area is more prone to infection, and infection makes swelling worse — sometimes permanently. Cellulitis usually shows as a spreading area of redness, heat and pain, often with a temperature, feeling shivery or flu-like.

This needs antibiotics the same day, not at the next available appointment. People with recurrent episodes are sometimes given standby antibiotics to keep at home, or preventive antibiotics — ask if it has happened more than once.