© 2005-2012 American Society of Clinical Oncology (ASCO). All rights reserved worldwide.
Cancer and its treatment sometimes cause a type of swelling called lymphedema. Most often, lymphedema affects the arms and legs, particularly in patients treated for breast or genitourinary cancers, but it also occurs in other parts of the body, including the head and neck. The neck is the most common site of lymphedema in patients receiving cancer treatment to the head and neck area. However, lymphedema may also occur below the chin, in the face, and, less often, inside the mouth.
What is lymphedema?
Lymphedema is the abnormal buildup of fluid in soft tissue due to a blockage in the lymphatic drainage system. The lymphatic system helps fight infections and other diseases by carrying lymph (a colorless fluid containing white blood cells) throughout the body through a network of vessels (thin tubes). Small glands called lymph nodes filter bacteria and other harmful substances out of this fluid so they can be dealt with by the body’s natural defenses. However, when the lymph nodes are removed or damaged, lymphatic fluid collects in the surrounding tissues, causing them to swell, which can result in discomfort and tightness. Head and neck lymphedema can also affect vision, eating, speaking, and in some patients, breathing.
Symptoms of head and neck lymphedema include:
- Swelling of the eyes, face, lips, neck, or area below the chin
- Discomfort or tightness in any of the affected areas
- Difficulty moving the neck, jaw, or shoulders
- Fibrosis (scarring) of the neck and facial skin
- Decreased vision because of swollen eyelids
- Difficulty swallowing, speaking, or breathing
- Drooling or loss of food from the mouth while eating
- Nasal congestion or chronic middle ear pain if swelling is severe
Talk with your doctor or nurse if you have any of these symptoms after cancer treatment. Because swelling also may be a sign of cancer, it is important to see your doctor to be sure that the cancer has not recurred (come back).
Causes and risk factors
Causes of head and neck lymphedema in patients treated for cancer include:
- Surgery that removes or blocks the lymphatic structures (nodes and vessels) from transporting lymphatic fluid into the bloodstream
- Damage to lymph nodes and vessels from radiation therapy to the head and neck area
- Damage to the lymph nodes or vessels from the cancer itself
- Infection or injury that impairs lymphatic drainage
The risk of lymphedema rises with the number of lymph nodes and vessels that are removed or damaged during cancer treatment. Overall, approximately half of patients treated for head and neck cancer will develop lymphedema. The symptoms are usually most severe for patients who have been treated with a combination of surgery and radiation therapy.
Although swelling can develop days or weeks after cancer treatment, head and neck lymphedema typically occurs two to six months later.
Lymphedema often results in chronic (long-term) problems. However, most people show improvement with treatment known as complete decongestive therapy (CDT). This treatment is most often performed in an outpatient clinic but can also be done at home. CDT combines:
Skin care. Because chronic lymphedema increases the risk of infection, it is important to keep the affected area clean, moisturized, and healthy.
Manual lymph drainage. This technique involves a special type of gentle skin massage to help blocked lymphatic fluid drain properly into the bloodstream. A well-trained head and neck lymphedema therapist will determine the amount of therapy needed, generally 10 to 12 visits, depending on the stage of the lymphedema.
Exercise. Movement is important to help lymphatic drainage. A head and neck lymphedema therapist will show you specific exercises to improve your range of motion.
Compression. Non-elastic bandages or compression garments that are worn at home often place gentle pressure on the affected area to help drain the lymph fluid and prevent it from refilling and swelling. There are several options, depending on the location of the lymphedema, to improve comfort and avoid complications from pressure on the neck.
A clinician or therapist who is specially trained in head and neck lymphedema should perform CDT. The therapist will also teach you how to perform the necessary techniques yourself at home and will tell you how often to do them. Ask your doctor for a referral.
If functional problems result from lymphedema of the head and neck, you may need other types of therapy (such as therapy to address trouble swallowing). Additionally, your doctor will prescribe medications, such as antibiotics to treat infections or drugs to relieve pain, when necessary.
Prevention and managing lymphedema
The following tips can help reduce your chances of experiencing head and neck lymphedema or decrease the severity if it does occur.
Exercise. Exercise helps lymph drainage. However, in some people, strenuous exercise can cause or worsen swelling. Ask your doctor or therapist when you can start exercising, which exercises are right for you, and whether you should wear a compression garment during exercise.
Sleep sitting up. Prop yourself up with pillows in bed. An upright position improves lymph drainage.
Prevent skin infection. Avoid cuts, burns, needle sticks, or other injury to the affected area. If you shave, use an electric razor to reduce the chance of cutting the skin. When you are outside, wear sunscreen with a high sun protection factor (SPF). If you do cut or burn yourself, wash it with soap and water and use an antibiotic cream as directed by your doctor or nurse.
Wear loose fitting clothes. Don’t wear tops with a tight neckline.
Limit time in extreme heat or cold. Avoid hot tubs or saunas, and limit hot showers to less than 15 minutes. Also, don't apply a heating pad or ice to the swollen area.
Know when to seek medical care. Call your doctor or nurse if you have any signs of infection: a fever (temperature over 100ºF); skin that is hot to the touch; or skin redness, swelling, or pain.