Five years ago, Ngoc was diagnosed with cervical cancer and underwent a hysterectomy, lymph node dissection, and chemotherapy. Over the past two years, her left leg gradually swelled, accompanied by occasional pain. Doctors diagnosed her with lower extremity venous insufficiency and treated her with various methods, including vein-relaxing medication and compression stockings. Recently, with her left leg almost twice the size of her right, she visited Tam Anh General Hospital in TP HCM. Dr. Le Chi Hieu, from the Thoracic-Vascular Surgery Department, determined that in addition to venous insufficiency, Ngoc also suffered from lymphedema, a common complication for cancer patients post-treatment.

The patient's swollen left leg (image A) and after two weeks of compression bandaging (image B). Photo: Ha Vu

The patient's swollen left leg (image A) and after two weeks of compression bandaging (image B). Photo: Ha Vu

The lymphatic system comprises organs like the bone marrow, thymus, spleen, lymph nodes, and lymphatic vessels, along with lymph fluid. Lymph fluid, located between the skin and muscles, plays a vital role in protecting the body against infection and disease. The lymphatic network, distributed throughout the body, forms a circulatory system that transports nutrients and immune cells while eliminating foreign bodies such as bacteria and viruses.

Lymphedema occurs when the lymphatic system's flow is locally obstructed, leading to swelling and pressure in the affected area. This condition is common after treatment for cancers such as breast cancer, gynecological cancers, genitourinary cancers, soft tissue sarcomas of the extremities, and head and neck cancers. Other risk factors for lymphedema include infections, slow-healing surgical wounds, lymph node removal, previous surgery or radiation therapy, obesity, and parasitic elephantiasis (caused by filarial worms).

"Any disruption or alteration to the flow of lymph fluid can lead to lymphedema," Dr. Hieu explained. In cancer patients like Ngoc, tumors often metastasize through the local lymphatic system. While surgery and post-operative chemo-radiation address the cancer, they can damage the local lymphatic system, causing lymph fluid to stagnate in the lower (or upper) extremities. Without prompt treatment, this can lead to complications like swelling, numbness, pain, and reduced mobility.

Ngoc received medical treatment through full-leg compression bandaging on her left leg to maintain pressure and support lymphatic circulation. The pressure from the bandaging redirects lymph flow back towards the heart and prevents blockage. Dr. Hieu also instructed Ngoc on appropriate massage techniques and exercises to aid in her recovery. After two weeks, the swelling in her leg reduced significantly. Dr. Hieu assessed her positive response to the compression therapy and expects her left leg to return to its normal size within the next 3 months.

Lymphedema can occur anywhere in the body, most commonly in the arms or legs. Individuals with vulvar, vaginal, ovarian, endometrial, cervical, prostate, or colorectal cancer often experience lymphedema in the legs, genitals, or abdomen. Those with head and neck cancers are prone to swelling in the face, neck, or under the chin and throat.

Dr. Hieu advises current and former cancer patients to protect their arms and legs, minimize injuries, and diligently care for wounds to prevent infection. Daily exercise is recommended, but strenuous activity should be avoided. Elevating the affected area is also crucial. For instance, if lymphedema affects the arm, keeping it elevated above the heart while sitting or resting is advised. Similarly, for leg lymphedema, elevating the legs with pillows or blankets while lying down is beneficial. Maintaining a healthy weight (BMI under 23), wearing loose-fitting jewelry and clothing, avoiding carrying bags or other items with the affected arm, staying hydrated to promote lymph flow, and reducing salt intake are also recommended.

Thu Ha

*The patient's name has been changed.