Secondary lymphedema: what is it? 

Secondary lymphedema is an acquired impairment of the lymphatic system. It can occur following a surgical procedure or cancer treatment, an accident or an infection.  
Secondary lymphedema effects 10 to 50%⁽¹⁾ of patients (men and women) having undergone lymph node dissection or radiotherapy. This risk can double after certain surgical procedures, chemotherapy or mastectomy. Some types of cancer can also cause lymphedema. It can affect the upper and lower limbs. An infection, inflammation, venous disease, obesity, a sedentary lifestyle, trauma or injury are other possible causes.

What causes secondary lymphedema?

“Swollen arm” syndrome

Surgical removal of lymph nodes in the armpit (or axillary lymph node dissection) can be part of the initial surgical treatment for women with breast cancer. If the cancer cells have invaded the lymph nodes in the armpit, these lymph nodes are surgically removed. The sentinel lymph node dissection method can be used to determine whether or not the lymph node located closest to the tumor is affected⁽²⁾. But this procedure can have significant side effects: the lymph no longer circulates correctly and builds up in the skin of the arm on the side of the breast that was operated on, causing swelling: lymphedema develops. This is sometimes called “swollen arm syndrome”. The risk of developing lymphedema is increased when surgery is combined with radiotherapy, when the patient is obese or if a large number of lymph nodes have been removed. Lymphedema can develop a few weeks after surgery, or a few months or, more rarely, even a few years later. It is obviously not systematic but is thought to affect 15 to 28% of women having undergone conventional axillary lymph node dissection and 2.5 to 6.9% after the sentinel lymph node dissection method⁽³⁾.

Accidents, diseases and therapies as a cause of lymphedema

Lymphedema can develop in the legs following treatment for various types of cancer, such as lymphoma, melanoma, sarcoma, gynaecological cancers (cervical, endometrial, ovarian, vaginal, vulvar), or cancer of the prostate, bladder, testicle, penis or rectum. More generally, lymphedema follows the destruction or blockage of lymphatic vessels due to the spread of metastases to the lymph nodes, the surgical destruction of these lymph nodes in order to treat cancer, or tissue trauma (burns, scars), infection or inflammation. For gynaecological cancers, lymphedema often develops at an early stage: 75% during the first year, with an incidence of 20 to 40% for uterine and ovarian cancers and 36% after cancer of the vulva. Prostate and testicular cancers are complicated by lymphedema in 8 to 39% of cases and the figure is 50% for cancers of the penis⁽⁴⁾.

What are the symptoms of secondary lymphedema?

The first symptoms of lymphedema are a feeling of tightness (“stretched skin”) or heaviness. In the case of edema of the lower limb, it usually starts in the thigh and can spread to the calf and foot. In the upper limb, it starts in the armpit and can extend to the arm and hand. Initially, the edema is soft. Without any treatment and over time, lymphatic fluid builds up in the tissues, causing swelling and thickening of the skin. Bulky edema will restrict joint mobility and impair function.  Infections called “erysipelas” are the most common complication. They concern 20 to 40% of cases of lymphedema⁽³⁾. They are caused when Streptococcal bacteria develop in the affected limb. Signs include the sudden development of a fever, chills, pain and redness of the limb and an increase in volume. It is important to consult a doctor in this case, because it can become a medical emergency. 

If you have any questions, ask your doctor for advice.