A short story: what would you do?
Follow Grace to learn the warning signs and what to do. Turn on your sound for the narration.
What happens in lymphedema
Besides arteries and veins, your body has a third set of vessels: the lymph vessels. They carry extra fluid, protein and cells out of the tissues and back into the blood, passing through lymph nodes along the way. [Ref: ISL 2023 Lymphedema]
In lymphedema, the lymph vessels cannot carry away as much fluid as the tissues make. This can happen because the lymph vessels did not form normally (primary lymphedema), or because they were damaged by surgery, radiation, cancer or an infection such as filariasis (secondary lymphedema). [Ref: ISL 2023 Lymphedema] [Ref: Lee 2024 Lymphedema]
How lymphedema gets worse, step by step
- Drainage slows down. The lymph vessels cannot clear fluid as fast as it leaks out of the tiny blood vessels.
- Protein-rich fluid collects. The fluid left behind is rich in protein. It sits in the tissue and causes soft swelling that leaves a dent when pressed. The trapped fluid also makes it harder for germ-fighting cells to move through the area.
- Inflammation starts. Immune cells gather in the swollen tissue. They release chemical signals (such as IL-4, IL-13 and TGF-beta) that keep the tissue irritated and slow the repair of the lymph vessels.
- Scar-like tissue and fat build up. These signals switch on cells that make scar-like tissue (fibrosis) and make fat cells grow. The limb becomes firmer and heavier, and pressing it leaves less of a dent.
- The lymph vessels work even worse. Scar-like tissue and fat press on the lymph vessels and weaken the tiny muscles and valves that push lymph forward. Even less fluid drains, and the cycle starts again.
[Ref: Lee 2024 Lymphedema] [Ref: StatPearls 2025 Lymphedema] [Ref: ISL 2023 Lymphedema]
Why this matters to you
- Start treatment early. Early swelling is mostly fluid and can go down. Once scar-like tissue and fat build up, the changes are much harder to reverse. [Ref: StatPearls 2025 Lymphedema] [Ref: ISL 2023 Lymphedema]
- Protect your skin from infection. Skin infections such as cellulitis are common in lymphedema, and each one can damage the lymph vessels further and make the swelling worse. [Ref: StatPearls 2025 Lymphedema]
- Vein problems can add to the swelling. Weak leg veins push more fluid into the tissues, while weak lymph vessels clear less of it. Many people have both, so your doctor may check and treat both. [Ref: StatPearls 2025 Lymphedema]
It most often affects an arm or a leg, but it can also affect the chest, breast, face or genitals. [Ref: ISL 2023 Lymphedema] [Data: DOH Filariasis 2023]
Causes
Secondary lymphedema (most cases)
Damage to lymph vessels or nodes from cancer surgery that removes lymph nodes, radiation, injury, repeated infections, or filariasis, a parasitic infection spread by mosquitoes. About 85% of lymphedema worldwide is secondary. [Ref: ISL 2023 Lymphedema]
Primary lymphedema
The lymph vessels did not develop normally from birth. Swelling may appear in childhood, the teens or later in adult life. Some forms run in families. [Ref: ISL 2023 Lymphedema]
How common is it?
About 1 in 5 women (21%) develop arm lymphedema in the years after breast cancer treatment. The risk is about 4 times higher after removal of the armpit lymph nodes than after a sentinel node biopsy, which removes only a few nodes. [Data: DiSipio 2013]
In the Philippines, filariasis was once found in 46 provinces. By 2023, the Department of Health had declared 44 of them free of the infection, but people infected in the past can still live with swelling. [Data: DOH Filariasis 2023]
Not all swelling is lymphedema. Swelling can also come from vein disease, heart failure, kidney or liver disease, thyroid problems, some medicines, or lipedema (a painful build-up of fat in the legs). A careful check finds the real cause. [Ref: ISL 2023 Lymphedema]
Signs and stages
Early signs include a feeling of heaviness or tightness, clothes, rings or watches feeling tighter on one side, and swelling that leaves a dent when pressed. [Ref: ISL 2023 Lymphedema]
| Stage | What you may notice |
|---|---|
| Stage 0 | No visible swelling yet, but drainage is already reduced. You may feel heaviness. This stage can last months or years. |
| Stage I | Soft swelling that often goes down when you raise the limb. Pressing may leave a dent. |
| Stage II | Swelling that rarely goes down with raising the limb. The tissue becomes firmer as fat and scar-like tissue build up. |
| Stage III | Severe swelling with thick, hardened skin and skin changes such as warty growths. This is sometimes called elephantiasis. |
Starting treatment early, at stage 0 or I, gives the best results. [Ref: ISL 2023 Lymphedema]
What happens at your check-up
Lymphedema is often diagnosed from your history and an examination. Your doctor will also check for other causes of swelling. [Ref: ISL 2023 Lymphedema]
Limb measurements
Measuring around the limb at set points, compared with the other side, tracks swelling over time. [Ref: ISL 2023 Lymphedema]
Duplex ultrasound
Often the first test, to check the veins for clots or valve problems that also cause swelling. [Ref: ISL 2023 Lymphedema]
Lymph imaging
Lymphoscintigraphy, or ICG lymphography with a special dye and camera, shows how well the lymph vessels drain. [Ref: ISL 2023 Lymphedema]
Bioimpedance
A painless test that can pick up extra fluid before swelling is visible, useful after cancer treatment. [Ref: ISL 2023 Lymphedema]
Your doctor decides which tests you need and explains what the results mean for you.
Swelling that will not go away? Get it checked.
Only an examination can tell whether your swelling is lymphedema or something else, and which treatment is right for you. Dr. Aaron Christopher P. Novales is a Certified Lymphedema Therapist and sees patients with lymphedema.
Sudden swelling with breathlessness or chest pain? Do not wait for a clinic visit. Go to the emergency room now →
How lymphedema is treated
About the medicines on this page
Medicines are described here only to help you understand your doctor's plan. Do not buy or take any medicine because you read about it here. Take only what your doctor prescribes for you, and never start, stop or change a dose on your own.
The main treatment is complete decongestive therapy (CDT), given by trained therapists. It has two phases. [Ref: ISL 2023 Lymphedema]
Phase 1: Reduce the swelling
- Skin care
- Manual lymphatic drainage, a gentle massage that moves fluid
- Exercises
- Multilayer compression bandaging, applied by trained staff
Phase 2: Keep it down
- A fitted compression garment or sleeve, worn daily
- Daily skin care
- Regular exercise
- Manual lymphatic drainage as needed
[Ref: ISL 2023 Lymphedema]
Compression garments
A well-fitted, custom-measured garment is the key to keeping swelling down long term. It should be prescribed by a doctor, especially if you have artery disease, because compression is not safe for everyone. Wrapping done wrongly can cause harm, so bandaging should be done or taught by trained staff. [Ref: ISL 2023 Lymphedema]
Pneumatic compression pumps
A sleeve that inflates in sequence can help some people. It is used together with compression garments. [Ref: ISL 2023 Lymphedema]
Surgery for selected people
Microsurgery can connect lymph vessels to veins or transfer healthy lymph nodes. In later stages, when the swelling is mostly extra fat, a special kind of liposuction can remove it. Surgery works best when done by experienced surgeons and combined with compression, which is still needed afterwards. [Ref: ISL 2023 Lymphedema]
Medicines
Water pills (diuretics) do not treat lymphedema and are not recommended for long-term use. Infections need prompt treatment by a doctor. People who get infections often may be given preventive treatment. Filariasis is treated with medicines prescribed by a doctor. [Ref: ISL 2023 Lymphedema]
Living with lymphedema
Care for your skinWash gently, dry well, especially between toes and in skin folds, and moisturize daily. Treat cuts and fungal infections early.
Keep movingWalk and use the stairs daily. Aim for at least 150 minutes a week of mixed aerobic and strength exercise.
Wear your garmentEvery day, as prescribed. Replace it when it loses its stretch.
Raise the limbRaising it when resting can help, especially in early stages.
Keep a healthy weightExtra weight adds to the load on the lymph vessels. No special diet is needed, and cutting back on water does not help.
Ask for supportLiving with swelling can be hard. Emotional and social support are part of good care.
[Ref: ISL 2023 Lymphedema]
If you are at risk after cancer treatment
Exercise, a healthy weight and less extensive lymph node surgery are linked to a lower risk. Avoid extreme heat on the at-risk limb and try to prevent infections. You do not need to stop normal activities out of fear. Staying active helps. [Ref: ISL 2023 Lymphedema]
Talk to your doctor about
Bring these questions to your visit.
- Is my swelling lymphedema, or something else?
- What stage is it, and how will we measure it over time?
- Where can I get decongestive therapy from a trained therapist?
- What compression garment and pressure are right for me?
- What should I do if my limb becomes red, hot or painful?
This practice provides lymphedema care led by a Certified Lymphedema Therapist.
Related conditions
Sources for this page
- ISL 2023 Lymphedema: Executive Committee of the International Society of Lymphology. The diagnosis and treatment of peripheral lymphedema: 2023 consensus document of the International Society of Lymphology. Lymphology 2023;56:133–151.
- Lee 2024 Lymphedema: Lee S-O, Kim I-K. Molecular pathophysiology of secondary lymphedema. Front Cell Dev Biol 2024;12:1363811.
- StatPearls 2025 Lymphedema: Nimmana BK, Kimyaghalam A, Manna B. Lymphedema. StatPearls. Treasure Island (FL): StatPearls Publishing; updated 18 October 2025.
- AHA VTE Symptoms: American Heart Association. Symptoms and diagnosis of venous thromboembolism.
- DiSipio 2013: DiSipio T, Rye S, Newman B, Hayes S. Incidence of unilateral arm lymphoedema after breast cancer: a systematic review and meta-analysis. Lancet Oncol 2013;14(6):500–15. Summary.
- DOH Filariasis 2023: Philippine News Agency. DOH: 44 of 46 identified provinces in PH already filariasis-free. 14 July 2023.