Managing Lymphedema as a Side Effect of Ovarian Cancer Treatment

Lymphedema is a relatively common side effect for women with ovarian cancer. It occurs when the lymphatic system, which helps drain fluid from tissues, becomes blocked or damaged. This can cause fluid to build up in the tissues, leading to swelling and pain.^1,2

Lymphedema can occur in any part of the body. But, for those with ovarian cancer, it most commonly affects the lower legs. The number of women impacted with lower limb lymphedema (LLL) after ovarian cancer ranges between 2 and 4 in 10.^1,2

The lymphatic system

The lymphatic system is a group of tissues and organs that helps rid your body of toxins, waste, and other unwanted material. Your lymphatic system has 4 key functions:³

• Maintains your body's fluid levels
• Absorbs fats from the gut
• Protects your body from germs and other things that can make you sick
• Transports and clears waste products and abnormal cells from the lymphatic fluid (lymph)

What is lymphedema?

If your lymph system becomes blocked or does not work properly, lymph fluid can build up in the fatty tissues just under your skin. Lymphedema can happen anywhere in the body but is most common in the arms and legs. LLL is most common in those with ovarian cancer. ¹

What is the link between ovarian cancer and lymphedema?

There are several reasons why women with ovarian cancer may develop lymphedema. Cancer itself can damage the lymphatic system. Surgery to remove your ovaries can cause damage too. Radiation therapy can cause lymphedema by damaging your lymphatic vessels. Also, some chemotherapy (chemo) drugs can increase the risk of lymphedema. ^1,4

Lymphedema symptoms

Recognizing lymphedema is important to get timely treatment. Some symptoms include:¹

• Swelling in 1 or both of your legs
• Skin changes, such as your skin feeling tight, red, hot, or hard; or it has a change in texture
• New pain in the area, such as feeling tingly, numb, or heavy discomfort
• Reduced movement in the nearby joints of your ankle, knee, or toes
• Trouble fitting into your pant legs
• Socks or shoes not fitting well even though you have not gained weight

How is lymphedema described?

Your doctor will describe the severity of your swelling using a scale from 0 to 3:1.

• Stage 0 – There is no swelling that can be seen or felt. You may feel like the area is heavy or full.
• Stage 1 – Your affected leg is swollen. Your leg is bigger than usual, and it is easier to move when your leg is raised.
• Stage 2 – Your leg is larger and harder than stage 1. The swelling does not improve when your leg is elevated.
• Stage 3 – The swelling might be so severe that you cannot lift or move your leg on your own. Your skin can become very dry and thick. The swelling can cause fluid to leak from your skin or blisters to form.

Early stages (0 and 1) are often reversible, while stages 2 and 3 are harder to treat. Prompt and proper treatment is important as soon as you notice any concerning symptoms. ¹

How can I manage lymphedema?

There are steps you can take to help prevent lymphedema or keep it from getting worse: ⁴

• Keep moving – Exercise and staying active can be hard when you have LLL. But staying active keeps your body fluids moving. Start slow and do gentle movements. Ask your doctor, nurse, or physical therapist about which exercises might be best.
• Protect your skin – Wear sunscreen outside and gloves to prevent cuts or burns when working. Gentle, perfume-free lotions help to moisturize your skin and prevent dry skin. Wear properly fitted shoes and keep your feet clean and dry. Clip your toenails short and clean to prevent infections and ingrown nails. Avoid tight shoes and jewelry.
• Therapeutic massage – Try a special massage called manual lymph drainage. This therapeutic massage is performed by a certified lymphedema specialist. It works best when done early, before your symptoms progress.
• Compression garments – Your doctor might suggest stockings or other garments to help provide gentle squeezing of your legs. This keeps gentle pressure on your legs and keeps fluid where it belongs, reducing swelling. Talk to your doctor about the types that might be best.
• Other devices or procedures – There are other pumps and laser device procedures that might help with lymphedema. Like all devices and procedures, there are risks and benefits. You and your doctor will be able to decide if any of these are good for you and your specific condition.

Living with lymphedema after surviving ovarian cancer can be difficult. The symptoms, treatments, and management of the condition can be overwhelming. But, with help from your doctor and team of experts, you can manage this side effect and live an active life.