Lymphedema Symptoms: Early Signs of Lymphatic Swelling

Early signs of lymphedema

Lymphedema often develops slowly, and early changes are easy to miss. Watch for:

• a feeling of heaviness, fullness or tightness in an arm, leg, breast, chest wall or genital area
• aching or discomfort
• jewelry, watch straps, sleeves, socks or shoes feeling tighter on one side
• less flexibility in the wrist, hand, ankle or fingers
• visible swelling that may come and go at first, often worse at the end of the day or in heat
• pitting: a dent that stays when you press the skin, in early stages

Breast cancer survivors should watch the arm, hand, breast and chest wall on the treated side. People treated for pelvic cancers (such as cervical, uterine, prostate or melanoma of the leg) should watch the legs and genitals. Lymphedema can start months or even years after treatment.

Later signs

If lymphedema is not treated, the fluid triggers inflammation and fat and fiber deposits, so the limb changes:

• swelling that no longer goes down with raising the limb
• skin that becomes thick, firm and less likely to pit
• deep skin folds, a "cobblestone" or warty surface
• small blisters that leak clear lymph fluid (lymphorrhea)
• repeated episodes of cellulitis

Lymphedema vs ordinary edema

Stemmer sign: try to pinch and lift the skin at the base of the second toe or middle finger. If you cannot lift a fold of skin, the sign is positive and suggests lymphedema. A negative sign does not rule it out.

Lipedema is often confused with lymphedema. It is a build-up of painful fat in both legs (and sometimes arms) of women, sparing the feet and hands, and bruises easily.

Causes of lymphedema swelling

• Cancer treatment: removal of lymph nodes and radiation, especially for breast cancer, melanoma, gynecological, prostate and head and neck cancers.
• Cancer itself blocking lymph nodes.
• Infection: repeated cellulitis damages lymph vessels. Worldwide, lymphatic filariasis, a parasitic infection spread by mosquitoes, is a major cause.
• Severe obesity, which can overwhelm and damage lymph drainage.
• Chronic venous insufficiency, which can overload the lymphatics.
• Inherited (primary) lymphedema: from birth, at puberty, or after age 35.
• Injury or surgery affecting lymph drainage.

For details of types, stages and treatment, see lymphedema as a condition.

What to do if you notice symptoms

1. Tell your doctor or cancer team early. Treatment is most effective before skin changes set in.
2. Ask for referral to a certified lymphedema therapist.
3. Get new swelling checked to rule out a blood clot, heart, kidney or liver disease, and cancer recurrence.
4. Protect your skin: moisturize daily, treat cuts promptly, use insect repellent and wear gloves for gardening.
5. Keep active: exercise does not cause or worsen lymphedema and often improves it.

Measurements of both limbs, or devices that detect fluid change (bioimpedance), can pick up lymphedema before it is visible. Some cancer centers offer this surveillance after lymph node surgery.

Frequently asked questions

What are the first signs of lymphedema?

The first signs are often a feeling of heaviness, tightness or aching in an arm or leg, and rings, watches, sleeves or shoes fitting more tightly on one side. Visible swelling may come and go at first. Report these to your doctor early, especially after cancer treatment.

How can I tell if swelling is lymphedema or edema?

Lymphedema usually affects one limb, includes the back of the hand or foot, does not go down overnight and causes the skin to thicken. Ordinary edema typically affects both ankles, pits easily and improves after a night's rest. A positive Stemmer sign suggests lymphedema.

Does lymphedema hurt?

Lymphedema is usually not very painful, but it often causes aching, heaviness and discomfort. Sudden pain, redness and warmth in a lymphedema limb suggest cellulitis, which is common in lymphedema and needs prompt antibiotic treatment.

Can lymphedema appear years after cancer surgery?

Yes. Lymphedema can develop months or many years after lymph node removal or radiation. The risk is lifelong, so watch for early signs, protect the skin of the affected limb and report changes promptly.

Does exercise make lymphedema worse?

No. Supervised, gradually progressive exercise, including weight training, is safe for people with or at risk of lymphedema and can improve symptoms. Wearing a compression garment during exercise may help if you already have lymphedema.