Key points
- Lymphoedema is swelling caused by lymph fluid building up under the skin when lymph node surgery, radiotherapy or the tumour itself disrupts the flow of lymph [1].
- After breast cancer treatment, more than 1 in 5 women develop arm lymphoedema; the risk after removal of all the lymph nodes under the arm is about 4 times that after sentinel node biopsy [3].
- After treatment for gynaecological cancers, melanoma, prostate cancer and sarcoma, the leg, arm or genital area may also swell [1, 4].
- Tell your doctor early if you notice heaviness, tightness or swelling; the sooner lymphoedema is treated, the easier it is to control [1].
- Exercise, even weight training, starting light and building up slowly under supervision, did not increase lymphoedema in studies and improved symptoms [5, 6, 7].
- Redness, warmth, pain and fever in a swollen limb may be a skin infection (cellulitis) and need treatment the same day [1].
What is lymphoedema and why does it happen?
The lymphatic system is a network of lymph nodes and lymph vessels that carries a fluid called lymph around the body and helps fight infection. If cancer or its treatment disrupts this flow, lymph fluid builds up between the skin and the muscle and causes swelling; this swelling is called lymphoedema [1]. It can happen when [1]:
- a tumour blocks the flow of lymph
- cancer surgery, especially removal of lymph nodes, cuts the lymph pathways
- radiotherapy causes scar tissue that blocks the flow of lymph
Lymphoedema can start soon after treatment or years later, and it usually develops slowly over months or years. Infection, slow healing after surgery, removal of lymph nodes, previous surgery or radiotherapy, advanced cancer and being overweight or having obesity increase the risk [1]. Once lymphoedema develops it is usually long-lasting and does not go away completely, but treatment can reduce the swelling and make daily activities easier [1].
After which treatments is it most common?
| Cancer and treatment | Where the swelling occurs | How common is it? |
|---|---|---|
| Breast cancer (surgery or radiotherapy to the armpit) | Hand, arm, breast or chest wall on the same side [1] | More than 1 in 5 people; much more common after removal of all the armpit lymph nodes than after sentinel node biopsy [3] |
| Gynaecological cancers (cervix, womb, ovary, vulva and vagina) | Leg, genital area or abdomen [1] | About 1 in 5 people [4] |
| Melanoma (surgery to lymph nodes in the groin or armpit) | Leg or arm [1] | About 1 in 6 people; far more common in the leg than the arm [4] |
| Prostate cancer and other urological and genital cancers | Leg, genital area or abdomen [1] | About 1 in 10 people [4] |
| Sarcoma (soft tissue tumour) of the arm or leg | The same arm or leg [1] | About 1 in 3 people in one study [4] |
| Head and neck cancer | Face, neck, under the chin or inside the throat [1] | Less studied [4] |
The risk is higher after removal of lymph nodes in the pelvis and after radiotherapy. These figures are approximate and depend on the type of surgery, how swelling is measured and how long people are followed up [4].
Know the early signs
Signs usually develop slowly, so pay attention to small changes in the area that had surgery or radiotherapy [1]:
- a heavy, full or tight feeling in the hand, arm, leg, fingers or treated area
- swelling that makes one arm or leg look bigger than the other; in the early stages, pressing on the swelling leaves a dent
- numbness or tingling, difficulty moving or weakness of the arm or leg
- in the head and neck: swelling and tightness of the face, neck or under the chin; pain or numbness; difficulty speaking, eating, swallowing or breathing
- in the genital area or abdomen: swelling, difficult or painful urination, or pain when walking or during sex
In the early stages, resting and raising the arm or leg reduces the swelling. Without treatment the swelling becomes firmer, no longer goes down when the limb is raised, and in the late stage the skin becomes hard and thick [1]. That is why you should tell your doctor at the first sign [1].
How can I lower the risk?
There is no sure way to prevent lymphoedema, but these steps lower the risk or keep it from getting worse [1].
Steps that lower the risk
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Movement and exercise
Exercise works like a natural pump that improves the flow of lymph [1]. In a study of women at risk of lymphoedema after breast cancer, a year of weight training that started light and increased slowly did not increase lymphoedema; in women who had 5 or more lymph nodes removed, there were even fewer cases of lymphoedema [6]. Exercise experts say that weight training supervised by a trainer, following the "start low, progress slowly" principle, is safe for these women [7]. (Can I exercise during cancer treatment?)
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Look after your skin
Skin infection is one of the clearest risk factors for lymphoedema [8, 9]. Wear gloves when cooking and gardening, use moisturiser to prevent dry, cracked skin, clean any cut or burn well and ask your doctor about an antibacterial ointment. Tell your doctor if you notice redness or other signs of infection [1].
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Blood pressure, injections, blood tests and air travel
You may have been told not to have blood pressure taken or injections given in the arm on the side of your surgery. Few studies have looked at this carefully, and most of the evidence is weak or conflicting [8]. In a large study that measured the arms of breast cancer patients many times, blood draws, injections, blood pressure readings and air travel were probably not linked to the arm getting bigger [9]. Use the other arm if you can, but do not put off a necessary test or injection because of this worry. If you already have lymphoedema, blood pressure and blood tests should be done on the arm without lymphoedema [1].
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If you have lymphoedema
Avoid great heat and strong sun, wear loose clothing and jewellery, do not carry bags with the swollen arm, drink plenty of water and cut down on salt [1].
Treating lymphoedema
Lymphoedema is usually treated by a physiotherapist or occupational therapist trained in lymphoedema care [1]. The main treatments:
- Complete decongestive therapy: a combination of gentle lymphatic massage, compression bandaging, exercise and skin care. In the first phase this is done every day, usually for about 2 weeks, to reduce the swelling; in the second phase the swelling is kept under control with compression stockings or sleeves, exercise and skin care [2].
- Compression garments: special sleeves, gloves or stockings; the therapist chooses the right size and shows you how to wear them [1].
- Lymphatic massage (manual lymphatic drainage): very gentle massage that moves lymph along; the therapist can also teach you to do it at home [1].
- Compression pump: a sleeve or stocking connected to a device that applies pressure on and off [1].
- Exercise: in women with arm lymphoedema, gradual weight training twice a week while wearing a compression sleeve did not increase swelling, reduced flare-ups of lymphoedema and improved symptoms and muscle strength [5].
- Surgery: for advanced lymphoedema, operations such as connecting lymph vessels to a vein, lymph node transfer or liposuction may be offered [1], usually after non-surgical treatments have been fully tried [2].
Lymphoedema can also affect how you feel: you may not be able to do some of the things you enjoy or find clothes that fit, or you may feel uncomfortable about how you look. Ask your care team for support; working with a lymphoedema therapist is often the best way to cope with it [1]. See also the guide Anxiety, depression and fear of cancer coming back.
When should I call my doctor?
Call your doctor the same day if:
- your swollen arm or leg becomes red, warm, painful or tender, or you have a fever; this may be a skin infection (cellulitis), which is treated with antibiotics and can become dangerous if left untreated [1]. If you have a high fever and chills or feel very unwell, go to an emergency department.
- an arm or leg suddenly swells and hurts; your doctor may check with an ultrasound scan that a blood clot is not causing the swelling [1]. If this comes with sudden shortness of breath or chest pain, call your local emergency number.
- your face or neck is swollen and breathing or swallowing has become difficult [1]; if breathing is difficult, call your local emergency number.
Tell your doctor as soon as you can if:
Frequently asked questions
Does lymphoedema go away?
Lymphoedema is usually long-lasting and does not go away completely, but treatment reduces the swelling and makes daily activities easier. The sooner treatment starts, the easier it is to control [1].
Can I lift weights after breast cancer surgery?
Yes, starting light and building up slowly, preferably supervised at first by a trainer or physiotherapist [7]. In studies, gradual weight training did not increase lymphoedema in women at risk of it, nor did it make swelling worse in women who had lymphoedema [5, 6]. If you have lymphoedema and have been prescribed a compression sleeve, wear it when you exercise; in that study, women wore a compression sleeve while weight training [5].
Should blood pressure and injections be avoided in the arm on the side of the surgery?
The evidence for this precaution is weak [8], and in a large study blood draws, injections and blood pressure readings were probably not linked to the arm getting bigger [9]. Use the other arm if you can, but do not put off a necessary test. If you already have lymphoedema, have these done on the arm without lymphoedema [1].
Does flying make lymphoedema worse?
Can lymphoedema start years later?
Is lymphatic massage different from ordinary massage?
Yes. Lymphatic massage is very gentle and is part of complete decongestive therapy, which a trained therapist carries out or teaches you to do [1]. Check with your therapist before having any other kind of massage on the swollen limb.
Notes for physicians (for doctors)
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- Incidence after breast cancer: meta-analysis of 72 studies: 16.6% (95% CI 13.6 to 20.2); 21.4% (14.9 to 29.8) in prospective cohorts; incidence rises for up to 2 years after diagnosis or surgery; ALND 19.9% versus SLNB 5.6%. Risk factors with strong evidence: extensive surgery (ALND, more nodes dissected, mastectomy) and being overweight or obese [3].
- Other cancers: meta-analysis of 47 studies (7,779 patients): overall incidence 15.5%; melanoma 16% (upper extremity 5%, lower extremity 28%), gynaecological 20%, genitourinary 10%, head and neck 4% and sarcoma 30%; pelvic dissection 22% and radiotherapy 31% [4].
- PAL trial, stable lymphoedema (141 women): twice-weekly progressive weight lifting with a compression garment: increase of 5% or more in limb swelling 11% versus 12% (cumulative incidence ratio 1.00; 95% CI 0.88 to 1.13); lymphoedema exacerbations 14% versus 29% (P=0.04); improved symptom severity (P=0.03) and strength (P<0.001); no serious intervention-related adverse events [5].
- PAL trial, at risk (154 women, at least 2 nodes removed): incident lymphoedema 11% versus 17% (P for equivalence=0.04); with 5 or more nodes removed, 7% versus 22% (P for equivalence=0.003) [6].
- ACSM 2019: supervised progressive resistance training is safe for women with or at risk of BCRL (60 to 70% 1RM, 1 to 3 sets of 8 to 15 repetitions, 2 to 3 sessions a week, 52 weeks); the data are limited to upper-limb lymphoedema after breast cancer and may not apply to lymphoedema after head and neck, bladder, melanoma or gynaecological cancers [7].
- Precautions: review of 31 studies: evidence on air travel, blood pressure measurement, skin puncture and extreme temperatures is mostly low-level (levels 3 to 5) or inconclusive; skin infection and previous infection or inflammation of the ipsilateral arm are the most clearly established risk factors; a risk-adjusted approach has been proposed [8]. Prospective cohort (3,041 perometer measurements): blood draws (P=0.62), injections (P=0.77) and the number or duration of flights were not associated with arm volume increase; BMI 25 or more, ALND, regional lymph node irradiation and cellulitis were [9].
- Staging and treatment: ISL staging (0 to III); CDT is the standard of care for stage II, although the optimal programme has not been established: phase 1 (decongestion): skin care, exercise, MLD and compression bandaging daily for an average of 15 days; phase 2 (maintenance): skin care, exercise, MLD as needed and compression garments. In a randomised trial after ALND, a compression sleeve worn from the first day after surgery until 3 months after adjuvant therapy reduced arm swelling (HR 0.61 by BIS). Non-surgical options should be tried before surgery (LVA, VLNT, liposuction) [2]. The ISL 2020 consensus notes that no treatment method has yet undergone a satisfactory meta-analysis or rigorous long-term randomised trials, and that its recommendations rest on various levels of evidence [10].
Scientific evidence
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Scientific evidence
1 itemExercise Guidelines for Cancer Survivors: Consensus Statement from International Multidisciplinary Roundtable
Related cancer types
References
10 referencesShow all references, 1 with a study cardClose the reference list
Numbers in the text, such as [1], refer to these sources. Sources with a “Study card” button are summarised in the site’s evidence library.
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- 10The diagnosis and treatment of peripheral lymphedema: 2020 Consensus Document of the International Society of Lymphology
This page is based on reputable scientific sources and was last updated on 28 October 2026. The content of this website is for educational and informational purposes only and does not replace consultation, diagnosis or treatment by a specialist physician. Consult your treating physician about any treatment decision.
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