Lymphedema after head & neck cancer

What is lymphedema?

Lymphedema is a condition where there is swelling in the soft tissues of the face and neck due to the accumulation of lymph. Lymph is a fluid that contains water, some protein and white cells. Normally this fluid is circulated through a network of lymphatic channels and lymph nodes (also called lymph glands), and it passes back into the bloodstream. Cancers of the head and neck or treatments for them (surgery and radiotherapy) can distort these lymphatic channels resulting in collection of fluid in the tissues. 

How common is it?

It is seen in up to three-fourths of head and neck cancer patients at some point in their treatment or recovery process. It is more common in those who have had extensive or bilateral neck dissections (removal of neck lymph nodes), those who have had high dose radiotherapy (alone or after surgery), those who received chemoradiotherapy, and those have had cancer recurrences. 

What are the signs and symptoms?

It initially feels like a stiffness or tightness in the face and neck. It can also feel like a doughy or diffuse swelling, particularly around surgical scars, under the chin and the jawline. It is often more in the morning and reduces as the day progresses. There can also be redness, pain and fever if this fluid gets infected, known as lymphangitis. Finally, as a result of scarring, there can be significant and permanent swelling in the region, leaving tissues stiff or woody in texture. Internal lymphedema can cause swelling in the voicebox and throat, leading to difficulty in swallowing, hoarseness of voice, a sense of something being stuck in the throat, and rarely breathing difficulty.

How is it diagnosed?

Your surgeon can usually diagnose lymphedema clinically, and there are several scoring systems to determine how severe it is. Standardized face and neck measurements with photography is used to track progress. Ultrasound can quantify the amount of fluid deposition in the soft tissue. Videolaryngoscopy can assess the amount of internal lymphedema that you have.

How is it treated?

Prevention is better than cure. Patients who are on head and neck cancer therapy need to learn and practice regular massage therapy to prevent the lymphatic channels from being obstructed and open parallel channels for the lymph fluid to traverse. After you are diagnosed with lymphedema, the most effective treatment method is called complete decongestive therapy (CDT). It includes techniques like manual lymphatic drainage or massage, compression bandages to the affected area, exercise to improve lymphatic flow and skin care of the affected areas. Two-thirds of patients who are compliant with their CDT report improvements.