Lymphedema is swelling that occurs as a result of accumulated lymph, a clear fluid made of white blood cells that is involved in the immune system. Lymphedema can occur anywhere in the body. In the treatment of head and neck cancers, lymph nodes are often removed during surgery, or may be damaged by radiation therapy. This causes a blockage in the lymphatic system (part of the immune system), which prevents lymphatic fluid from draining properly, leading to a buildup of fluid, which results in swelling of the affected area.
Understanding Lymphedema in Head & Neck Cancer Patients
Lymphedema generally occurs in the arms or legs. However, in head and neck cancer patients, lymphedema is most likely to occur in the submental region (under the chin) or in the neck or cheek. In select cases it may appear in the eyelids when treatment involves surgery and radiation of the cheek.
Lymphedema is chronic, irreversible, variable, and fluctuating. Swelling may come and go throughout the day or over time, and will be different for different patients. Lymphedema typically occurs 1-2 months after surgery and/or radiation therapy, but it is an indefinite risk that could develop at any point after treatment has been completed. The swelling from lymphedema generally feels soft and spongy. It may feel tight, heavy, or uncomfortable, and may restrict range of motion or increase the likelihood of developing infections.
Often, lymphedema is worse after sleeping or lying down, when the head and neck are in a dependent position, meaning that they are below or at the same level as the rest of the body. It typically improves during the day when the patient is upright.
Managing Lymphedema
Lymphedema has no definitive cure, and treatment involves the management, maintenance and alleviation of symptoms. In general, it is best to start treatment as soon as possible, as this allows for the highest chance of improving symptoms, slowing the progression of lymphedema, or even reversing it. If untreated, the swelling from lymphedema may become hard over time. The earlier treatment begins, the easier it is to soften the swelling and reduce the size of the affected region.
It is recommended that patients get evaluated by a certified lymphedema therapist 4–6 weeks after radiation therapy, or sooner, if they begin to experience symptoms of lymphedema. Many patients will only require 8–12 weeks of intensive therapy, after which they can continue with self-maintenance at home.
Compression Therapy
Patients can wear specialized garments to supply compression throughout the day or overnight to redistribute lymphatic fluid, facilitate lymphatic drainage, and prevent fluid collection. Some patients may have side effects of surgery or radiation that make sleeping difficult and may prevent the usage of a compression garment overnight. In these cases, a physician may recommend that the patient wear a compression garment during the day.
Manual Therapy
Manual lymphatic drainage therapy aims to manipulate the lymphatic fluid and disperse it throughout the surrounding tissues. This type of therapy consists of gentle massage following a specific direction of flow that is based on the location of a patient’s scar and the site of their lymphedema. This therapy must be administered by a certified lymphedema therapist who, in addition to performing the manual therapy, will teach patients to perform the therapy on their own. Lymphedema therapists may use compression, therapeutic taping, and/or wrapping along with massage to loosen, manipulate, and manually disperse the collected fluid. Therapists will also assess range of motion, perform stretches, and help patients manage their pain.
Devices
New devices such as compression pumps are also being used in lymphedema therapy for head and neck cancer. These devices include inflatable garments that fill up with air and intermittently inflate and deflate to provide variable compression that helps with lymphatic circulation and drainage. These devices can be used by patients in their homes, allowing them to self-manage their lymphedema.
Treatment Course
Because lymphedema is chronic, therapy must be administered regularly, whether through nightly use of compression garments or daily massage, among other treatments. Therapy will only provide temporary relief, so maintenance is necessary. Individual patients will likely respond differently to various treatments.
