(Primary Lymphedema; Secondary Lymphedema)
by Patricia Griffin Kellicker, BSN
The lymph system is a series of organs, vessels, nodes, and fluids. This system creates and carries fluids that play an important role in the immune system and maintaining the balance of fluids in the tissue. Lymphedema is a build up of fluid normally transported by the lymph system. The fluid build up leads to swelling in the affected area. While lymphedema occurs most often in the arms and legs, it can eventually spread to the core of the body and head. Lymphedema can range from mild swelling to swelling that dramatically increases the size of the limb and causes skin discoloration.
Lymphedema is caused by defect, damage, or infection of an area in the lymph system.
Primary lymphedema is caused by defects of the lymph nodes or lymph vessels. The structures may be missing or may not work properly. Though the defects are present from birth, lymphedema may not develop until later in life. Conditions associated with primary lymphedema include:
Secondary lymphedema develops when there is injury, infection, or nearby growth that blocks the flow of fluids in the lymph nodes or lymph vessels. It may be caused by medical conditions, medical treatments, or trauma.
Risk Factors TOP
Lymphedema is more common in older adults.
Medical treatments or conditions that may increase your risk of lymphedema include:
Symptoms of lymphedema include:
Lymphedema can also lead to complications like a breakdown of the skin, infections of the skin, or massive changes in the size and shape of the limb.
The doctor will ask about any symptoms and medical history. A physical exam will be done. The degree of swelling can be tested by pressing a finger into the swollen area. The indent in the skin will indicate the severity of swelling. Measurements will also be taken around the affected limb and compared to the healthy limb. The doctor may diagnose lymphedema based on the swelling and appearance of the skin and medical history.
If the cause of swelling is unclear, the doctor may want to do further testing. Image tests may help to determine the cause of the lymphedema. Tests may include:
Lymphangiography is a test that uses a radioactive dye to create images of the lymph system but it is rarely used.
Treatment will depend on the severity and cause of lymphedema. Some causes may respond to treatment and stop causing lymphedema, but most will have a continued risk of lymphedema. Initial treatment may require more intensive treatment over a few weeks. A long-term plan will be developed once initial goals are reached. Long-term plans will include understanding factors that may worsen swelling . Managing lymphedema flare up early may prevent complications.
Options to treat lymphedema itself and prevent complications include the following:
Reduction of Swelling
Fluid is moved through the lymph vessels when nearby muscles and tissue contract or squeeze during normal movement. Mimicking this compression may help move excess fluid out of the affected area. Some methods that may help include:
A combination of treatment may provide the best results. A method called complete decongestive therapy combines the methods above plus the lifestyle habits and education below. Different methods will be tried until the best method or combination for each individual is found.
Certain lifestyle changes or habits may also help reduce the risk of increasing fluid in the affected area:
Surgery may be needed for severe lymphedema. The goal of surgery is to remove extra tissue from the arm or leg to unblock the lymphatic system and help reduce swelling.
Doctors or physical therapists will work with you if you are at risk for developing lymphedema because of medical treatments or conditions. Certain lifestyle changes and monitoring may prevent the development of lymphedema. If you had lymph nodes in your armpit removed during cancer surgery, a strength and physical activity program in recovery may help prevent lymphedema.
National Cancer Institute
National Lymphedema Network
Canadian Cancer Society
Lymphedema Association of Quebec
Lymphedema. Society for Vascular Surgery website. Available at: https://vascular.org/patient-resources/vascular-conditions/lymphedema. Updated December 2011. Accessed February 17, 2015.
Lymphedema—approach to the patient. EBSCO DynaMed website. Available at:
...(Click grey area to select URL)
Updated November 10, 2014. Accessed February 18, 2015.
Poage E, Singer M, Armer J, Poundall M, Shellabarger MJ. Demystifying lymphedema: development of the lymphedema putting evidence into practice card. Clin J Oncol Nurs. 2008;12(6):951-964.
Trayes KP, Studdiford JS, Pickle S, Tully AS. Edema: diagnosis and management. Am Fam Physician. 2013;88(2):102-110.
1/22/2010 DynaMed's Systematic Literature Surveillance
...(Click grey area to select URL)
Torres Lacomba M, Yuste Sánchez MJ, Zapico Goñi A, et al. Effectiveness of early physiotherapy to prevent lymphoedema after surgery for breast cancer: randomised, single blinded, clinical trial. BMJ. 2010;340:b5396.
Last reviewed March 2016 by Marcin Chwistek, MD
Last Updated: 2/20/2015