If you have been diagnosed with and treated for gynecological cancer, you are at risk of developing lymphedema. Lymphedema, chronic swelling, can develop when there has been damage to the lymphatic vessels and/or lymph nodes from surgery and/or radiation therapy. Lymphedema develops when the lymph fluid is not able to move out of an area that has damage to the lymphatic system. It is an accumulation of protein rich fluid (lymph) in the soft tissues. Lymphedema is not painful, although it can be uncomfortable, and it is not life threatening.
Signs and Symptoms
People who have been treated for gynecological cancer can develop lymphedema in the abdomen, genitals, buttocks and/or the legs. Symptoms of the development of lymphedema are:
- Skin feels too tight
- Clothing feels too tight
- An increase of numbness or tingling in the area
- New aching or heaviness in the area
Reducing the Risk of Lymphedema
There are some things that you can do to reduce the risk of developing lymphedema:
- Keep the skin clean and well moisturized with non-perfumed skin lotion
- Avoid pedicures
- Cut toenails carefully
- Wash cuts with soap and water as soon as possible
- Don't walk in bare feet
- Wear shoes that fit well and cover the feet
- Wear clothing that doesn't bind in the waist
- Avoid extremes of hot and cold – no saunas, hot tubs, hot packs or ice packs
- Avoid deep tissue massages to the area at risk
- Use insect repellant to avoid bug bites
- Use sunscreen when planning to be out in the sun
Who Do I Call if I Suspect Lymphedema?
If you suspect that you are developing lymphedema, call your health care team to make an appointment to be evaluated. Your health care team will refer you to a physical therapist or an occupational therapist, which specializes in treating people with lymphedema. There is a team of physical therapists at Penn Therapy and Fitness/Good Shepherd Penn Partners who specialize in treating people with lymphedema.
Although lymphedema is not life threatening, it is important to look out for signs of infection. If you notice the area feels warm or hot to touch, increased redness or rash, quick change of swelling, fever or new pain, please contact your physician.
What is Lymphedema Treatment?
Lymphedema treatment is provided by certified lymphedema, physical/occupational therapists. The treatment is referred to as Complete Decongestive Therapy (CDT). CDT includes:
- Manual lymphatic drainage – a precise, gentle stretching technique of the skin to direct fluid to flow away from the swollen area
- Compression bandaging
- Therapeutic exercise
- Measurement for and fitting of compression garments
- Careful skin care
- Patient education
Additional Treatment as Needed
Often people who have been treated for gynecological cancers have physical therapy needs in addition to treatment for lymphedema. Your health care team and/or lymphedema therapist may recommend treatment for:
- Range of motion and strength deficits
- Cancer fatigue
- Soft tissue and/or scar adhesions from surgery and/or radiation therapy
- Pelvic floor dysfunctions – incontinence, constipation, diarrhea, sexual dysfunctions, etc.
- Pelvic pain
Physical, Occupational and Speech therapy services are provided by Good Shepherd Penn Partners; a partnership between Penn Medicine and the Good Shepherd Rehabilitation Network. Good Shepherd Penn Partners provides specialized long-term acute care and inpatient and outpatient physical rehabilitation throughout the Philadelphia region.
Lymph Node Transfer at Penn Medicine
Lymph node transfer is a relatively new microsurgical, reconstructive procedure used for the treatment of lymphedema. Typically, it involves surgically removing lymph nodes from one region of the body to the region affected by lymphedema.
The goal of the surgery is to incorporate the new lymph nodes so that they begin to function on their own and drain fluid naturally.
Some ovarian cancer survivors are at high risk for a small bowel obstruction. This may be due to surgical adhesions or the tumor itself. First it is important to know what the signs and symptoms are of a partial small bowel obstruction.
Some symptoms may be cramping, gas, bowel changes, nausea and vomiting. Vomiting and increasing abdominal girth and pain may indicate a total obstruction. Keep in mind that symptoms may vary by individual and severity of the obstruction. It is important to notify your doctor immediately.
With a partial small bowel obstruction, there may be dietary changes to prevent a complete obstruction. These include:
- Eat smaller meals, more frequently throughout the day.
- Follow a low fiber diet. Avoid fruits and vegetables with skins and seeds; avoid whole grains, nuts and seeds. White bread, white flour based pasta and peeled potatoes may be tolerated. Low fiber cereals include: puffed rice, Cheerios, cream of rice, cornflakes.
- Avoid fatty and greasy foods. These are much more difficult to digest and may stay in the stomach longer causing greater discomfort.
- Drink plenty of fluids: water, broth, tea, gelatin and juice may help you stay well hydrated. Some people find that full liquids: hot cereals, puddings, milkshakes and nutritional drinks are tolerated. If nausea is persistent, switching to nutritionally concentrated liquids is worth trying.
- Avoid lactose containing drinks if gas or milk intolerance is noted.
- Avoid gas-forming foods such as gassy vegetables (ex: broccoli, cauliflower), soft drinks, beans and chewing gum.
For more individualized assistance contact our registered dietitian at 215-829-6560.