Introduction 

If you’re wondering how to detect lymphedema before it advances, you’re in the right place. In this article, I will provide detailed information on the signs and symptoms of both early and advanced lymphedema so you can act with confidence. Understanding these symptoms is key to preventing progression so you can live better and confidently. 

Lymphedema is a chronic condition, causing swelling in the tissues, usually due to failure or obstruction of the lymphatic system, caused by cancer treatments or surgery.¹ This is part of the immune system and is involved in fighting infection and removing excess fluid. Increased fluid can cause persistent swelling, discomfort and an increased risk of infections (NHS). Thus, early detection is crucial for treating this condition as soon as possible, as knowing the signs and symptoms is essential, as without sufficient treatment, it can become permanent.² 

What are the main types of lymphedema? 

There are two main types of lymphedema:

• Primary: Developmental abnormalities occur in the lymphatic system due to a rare genetic condition. This can occur at any time in life and often affects the legs, yet it can occur in other parts of the body³
• Secondary: This can arise as a result of damage or blockage of the lymphatic system, which is often caused by surgery, cancer treatments, or infections. It is much more common and can frequently be seen after breast cancer when lymph nodes are removed, leading to swelling³

What are the early signs and symptoms of lymphedema? 

Detection of the early signs is crucial in preventing the progression of lymphedema.  Some of the earliest symptoms you may notice include mild swelling, heaviness and a sense of tightness in the skin. This can develop gradually and come and go, but can progress after physical activity. For mild, early lymphedema, these symptoms may not always be obvious. Many do notice some changes, such as their clothes feeling tighter than usual or subtle swelling around the ankle or foot, while in the arms, there may be slight puffiness in the fingers. If left untreated, this will progress and worsen, leading to skin changes.⁴

Early warning signs include:⁵ 

• Tightness and swelling are present in the chest, shoulder, arm, hand, leg, and foot
• Aching in the area
• Inability to move the affected limb
• Pitting of the skin, leaving an indent when pressure is placed upon it 

It is important to seek medical help by seeing your GP as soon as these symptoms are noticed, to start treatment as soon as possible. 

What are the symptoms of advanced lymphedema? 

Without treatment, the condition will worsen. The swelling will become worse and harder, and the skin of the affected area can become rough and thick. This is known as fibrosis, and it makes the area feel less flexible. Thus, causing problems in usual daily activities. Skin can also tend to break and leak fluid, so you will need urgent medical attention. Aching and discomfort can also occur in the late stages due to the fluid buildup as well as the increased pressure surrounding the affected area.⁴

A skin infection called cellulitis is also likely to develop, which is a bacterial infection that occurs in inflamed skin due to swelling. This will require antibiotic treatment for at least two weeks. Signs include fever, redness and swelling.⁴

Although rare, angiosarcoma - a type of soft tissue cancer can also arise. 

How is lymphedema different from general swelling? 

Most people may not understand the difference between general swelling and lymphedema-related swelling. General swelling is thought to be temporary, with overnight rest being enough to reduce it, along with other treatments.  Lymphedema, however, is chronic and gradual and can worsen without long-term treatment. 

What are the stages of progression? 

Lymphedema can range from four main stages:⁶ 

• Stage 0: Reversible. Slight symptoms of the area feeling tight
• Stage 1: Mild. Visible swelling. Usually reversible. The area may feel tight and heavy 
• Stage 2: Moderate. More swelling occurs and is worse. It can be reversible if treated early
• Stage 3: Severe. Extreme swelling. This is irreversible. Skin can be thickened and discoloured. Blisters or fluid leaking can occur

Treatment

A combination of therapies is used to help reduce these symptoms and to prevent further complications. The most common type of treatment is compression therapy, such as wearing compression socks or sleeves to encourage fluid movement and prevent fluid accumulation. 

Manual lymphatic drainage can also be used to promote the movement of fluid away from affected areas.  Additionally, physiotherapy can be used to improve circulation and reduce swelling by strengthening muscles.⁷

However, in severe cases, this may not be sufficient, and so advanced interventions are needed. Drainage procedures, such as aspiration, can remove excess fluid to help with discomfort. Surgical techniques can also be used by reconnecting damaged lymphatic pathways, such as the use of liposuction to remove fibrotic tissue buildup, which can help with mobility and aid those living with advanced lymphedema.⁸

Summary

Lymphedema can have detrimental effects on everyday life due to how important the lymphatic system is in fighting infections and removing excess fluid.  This is why it is important to understand the early signs and symptoms to prevent further complications and reduce disease progression. From swelling and skin changes to discomfort and loss of movement, it is important to seek medical attention when these symptoms are noticed to prevent advanced lymphedema. Although treatment is lifelong, there are solutions in place to aid with these symptoms, including lymphatic drainage as well as compression garments. 

Comparison table to show the differences between early and advanced lymphedema 

FAQs

What are the tips for preventing and managing lymphedema? 

• Promote fluid circulation by raising the affected arm or leg to reduce swelling. Avoid wearing tight clothing or jewellery that may   restrict circulation to the affected area
• Stay well-hydrated by drinking plenty of water to help eliminate excess fluid and waste

When should I talk to my doctor? 

• There’s a worse pain/injury in the affected area
• The affected area feels hot, swollen
• There are other symptoms of an infection, such as sweats and muscle pains