What is lymphedema?

Lymphedema is swelling caused by a buildup of lymph fluid in the body between the skin and muscle. Lymph fluid is part of the lymph system, which plays a role in your body’s ability to fight infection and disease. If you have cancer, the cancer or cancer treatment can disrupt the flow of lymph fluid and cause lymphedema (also known as secondary lymphedema). Lymphedema may arise soon after cancer treatment, or it may develop years after treatment has ended. Most often, it develops slowly over months or years. 

Although lymphedema cannot be prevented, there are ways to lower your risk or keep lymphedema from getting worse.

Once lymphedema develops, it is a chronic condition that cannot be cured but can be treated to relieve swelling and improve your ability to function day to day. Lymphedema is easier to control when treatment starts early, so contact your doctor as soon as you notice heaviness, swelling, or other signs of lymphedema.

What causes lymphedema?

Anything that blocks or changes the flow of lymph fluid in the body can cause lymphedema. Cancer and cancer treatments can cause lymphedema when:

• cancer or a tumor blocks the flow of lymph fluid 
• surgery for cancer disrupts the flow of lymph fluid
• radiation therapy causes scar tissue that blocks the flow of lymph fluid

Your risk for lymphedema depends on the type and location of your cancer and the treatments you have. Other risk factors for lymphedema include having an infection, healing slowly after surgery, having lymph nodes removed, past surgeries or radiation, having advanced cancer, and being overweight or having obesity. Talk with your doctor to learn about your risk of lymphedema.

Lymphedema and breast cancer

Treatment for breast cancer often involves surgery that removes one or more lymph nodes in the underarm area, increasing the risk of lymphedema. If you have been treated for breast cancer with radiation therapy or surgery, you may develop lymphedema in your hand, arm, or chest on the side of the body where lymph nodes were removed or damaged.

Lymphedema and other cancers

Lymphedema can occur anywhere in the body, but it most commonly affects an arm or leg. Some cancers—especially those that form in the abdomen or genital area—and their treatments are more likely than others to cause lymphedema because they are located near lymph nodes and vessels. Lymphoma, a cancer that affects white blood cells (part of the lymph system), can also cause lymphedema as white blood cells build up and block lymph flow. 

The type of cancer you have can help predict where you may develop lymphedema.

• People with vulvar, vaginal, ovarian, endometrial, cervical, prostate, or colorectal cancer may develop lymphedema in the leg, genitals, or abdomen.
• People with head and neck cancer may develop swelling in the face, neck, or under the chin. You may also develop lymphedema inside your body, such as in your throat, in which case the lymphedema may not be visible.

Lymphedema can also develop after surgery for melanoma and sarcoma. 

What are symptoms of lymphedema?

You may notice symptoms of lymphedema in an arm or leg or near where you had surgery or received radiation therapy. Signs and symptoms may develop slowly over time, so pay close attention to any slight changes. Contact your doctor if you notice any of these signs of lymphedema.

Signs and symptoms of lymphedema anywhere in the body

• A heavy, full, or tight feeling in the area where you had surgery or radiation therapy.
• Swelling. When you press on the swollen area, a dent may remain in the skin. However, as lymphedema gets worse, pressing on the swollen area may no longer leave a dent.
• Numbness or tingling in the affected area. Discomfort will worsen as lymphedema progresses.  
• Discoloration and hardening of the skin in people with long-term, untreated lymphedema.

Signs and symptoms of lymphedema in the arms or legs

Lymphedema in your arm or leg may cause these additional signs and symptoms:

• a heavy, full, or tight feeling in your arm, leg, fingers, or toes
• swelling in an arm or leg that makes it appear larger than the other arm or leg
• difficulty moving your arm or leg
• weakness in your arm or leg

Signs and symptoms of lymphedema in the head or neck

Lymphedema in your head or neck may cause these additional signs and symptoms:

• swelling and a tight, uncomfortable feeling in your face, neck, or under your chin
• aching, tingling, pain, or numbness in your face, head, neck, shoulders, or ears
• difficulty moving your head or neck
• difficulty speaking, eating, swallowing, or breathing
• voice, vision, or hearing changes

Signs and symptoms of lymphedema in the genitals or abdomen

Lymphedema in your genitals or abdomen may cause these additional signs and symptoms:

• swelling in the genital area or abdomen
• difficult or painful urination
• pain during walking, sex, and other movements

Lymphedema and cellulitis

Cellulitis is a potentially life-threatening bacterial infection of the skin that is a common complication of lymphedema. People with lymphedema are at greater risk of cellulitis because skin in swollen areas is stretched thin, allowing easier entry of bacteria that thrive in fluid-rich areas of the body. 

Some signs and symptoms of cellulitis are similar to those of lymphedema. Always check with your doctor about any skin changes or other symptoms you experience. Symptoms of cellulitis include:

• pain, tenderness, redness, and swelling in the affected area 
• skin that feels warm to the touch in the swollen area
• fever

If you have a fever or other signs of cellulitis, call your doctor right away. If left untreated, cellulitis can become life-threatening. Your doctor can prescribe antibiotics to treat cellulitis. 

How is lymphedema diagnosed?

You should watch for lymphedema signs and symptoms, such as tightness or swelling in an arm or leg, during and after cancer treatment. If you alert your doctor to swelling or other changes you have noticed, your doctor will examine the swollen part of your body. If swelling is affecting an arm or leg, they will compare the size of your swollen arm or leg with that of the other limb. 

You may also have one or more of the following tests to help your doctor better understand the cause of swelling and what is disrupting the flow of lymph fluid:

• Ultrasound uses high-energy sound waves to examine how fluid, such as blood and lymph, is moving through the body. Doctors can use ultrasound to find a blood clot that might be the cause of swelling.
• Magnetic resonance imaging (MRI) uses a dye, magnet, radio waves, and computer to make a series of detailed pictures of areas inside the body. Magnetic resonance lymphangiography (MRL) is like an MRI, but it makes pictures of the lymph system. Doctors can use MRI and MRL to identify what might be blocking the flow of lymph.
• CT scan uses a computer linked to an x-ray machine to make a series of detailed pictures of areas inside the body from different angles. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
• Lymphoscintigraphy uses a small amount of radioactive glucose to allow doctors to trace the flow of lymph fluid and identify blockages. 
• Perometry and water displacement are noninvasive techniques used to estimate the volume of a limb in people at risk of lymphedema.
• Bioimpedance spectroscopy is a noninvasive technique used to measure the amount of fluid in the body. It can help determine whether a person who does not have symptoms is in the beginning stages of lymphedema. This tool is sometimes used to help prevent lymphedema in people who are at risk.

Lymphedema stages

If you are diagnosed with lymphedema, your doctor will use a staging system to describe the severity of your lymphedema.

• Stage 0: The flow of lymph in the body is not moving as it should. You may or may not have symptoms.
• Stage I: The affected area is swollen and feels heavy. Pressing on the swollen area leaves a pit (dent) in the skin. Resting and elevating the limb can help reduce swelling at this stage.
• Stage II: The affected area is more swollen and may feel firmer than the area around it. Pressing on the swollen area does not leave a pit. Resting and elevating the limb no longer reduces swelling.
• Stage III: The affected area is extremely swollen and the skin feels hard and thick. You may also have decreased mobility and dry, blistered skin in the affected area.

How is lymphedema treated?

Treatments are available for managing the symptoms of lymphedema. Your health care team will talk with you about management techniques that can be done at home or under the supervision of a trained professional such as a nurse or a certified lymphedema therapist (CLT), a physical or occupational therapist trained to treat lymphedema. Treatments include:

Short stretch bandaging, compression wraps, leggings, or stockings

These can help move fluid around in your arms and legs to prevent it from building up. They may also be called compression garments. Your nurse or CLT will help you find garments that fit properly and will show you how to use them. 

Manual lymphatic drainage 

Manual lymphatic drainage, also called lymphatic drainage massage, involves gentle massage that helps move lymph fluid through the body. Lymphatic drainage is part of a treatment called complete decongestive therapy, which is managed by a CLT. Complete decongestive therapy may also include bandaging, exercises, and skin care to manage symptoms.

Compression pump

This is a device connected to a compression sleeve or sock that applies pressure intermittently to the arm or leg. The pumping action may help keep lymph fluid moving, preventing buildup in the limbs.

Surgery and other treatments

If lymphedema is advanced, your doctor may recommend surgery or another medical treatment.

• Lymphovenous bypass (also called lymphaticovenous anastomosis) is surgery that connects lymph vessels to a vein, creating a new path for lymph fluid to travel in the body.
• Lymphovenous transplant (also called vascularized lymph node transfer) is surgery that replaces damaged lymph nodes with healthy lymph nodes from elsewhere in a person’s body, helping improve lymph flow. 
• Liposuction removes extra fat in the affected part of the body and may improve lymphedema symptoms.
• Laser therapy uses light to stimulate new growth of lymphatic vessels, improve the flow of lymph fluid, and help repair skin affected by lymphedema.

Can I prevent lymphedema?

Although there is no way to prevent lymphedema, there are things you can do to lower your risk or keep it from getting worse. Your health care team may suggest the following things you can do at home:

• Protect your skin to prevent infection. Wear gloves when cooking and gardening to protect your hands from injury. Use lotion to prevent dry skin and cracks where bacteria can enter. If you get a burn or cut, ask your doctor about an antibacterial ointment to use. Always call your doctor if you notice redness or other signs of infection.
• Wear compression garments daily when you are up and moving around and at night as advised by your CLT.
• Learn manual lymph drainage techniques from your CLT that you can do at home.
• Exercise. Exercise is a natural pump for the lymph system. It can improve the flow of lymph fluid and keep the heart healthy, which may help treat lymphedema. Exercising may also help lower your risk of lymphedema. Talk with your doctor to find an exercise program that you enjoy and that is safe for you. 
• Elevate the affected area when possible. If you have lymphedema in your arm, try to keep it raised above the level of your heart when sitting or resting. If you have lymphedema in your leg, elevate it while lying down by resting it on a pillow or rolled-up blankets.
• Stay at or get to a healthy weight. Being at a healthy weight can keep lymphedema under control.
• Avoid putting pressure on the affected area. Wear loose jewelry and clothes without tight bands or elastic. Avoid carrying handbags or other items with an affected arm. Blood pressure and blood draws should be taken using the arm without lymphedema.
• Avoid extreme heat and sun. High temperatures can make lymphedema worse. Use sunscreen and wear sun protection like hats and lightweight, long-sleeved shirts when spending time in the sun.
• Stay hydrated. Drinking plenty of water will help keep lymph fluid moving through the body. 
• Reduce salt in your diet. Salt can make swelling worse by causing your body to retain fluid. 

Talking with your doctor about lymphedema

As you prepare for a visit with your doctor, nurse, or social worker, consider making a list of questions to ask and adding these questions about lymphedema: 

• Does my type of cancer or treatment put me at risk of developing lymphedema? 
• What changes should I look for? Which ones should I call you about? 
• If I am at risk of developing lymphedema, are there things I can do to prevent it from starting or worsening?
• How long after my cancer treatment might symptoms of lymphedema occur? Will I be monitored for early symptoms?
• What steps can I take to lower my risk for lymphedema?
• Are there special garments I should wear during the day or night to prevent or treat lymphedema?
• If I am diagnosed with lymphedema, is there a certified lymphedema therapist I could meet with?

Coping with lymphedema

The physical changes that result from lymphedema can affect your well-being. You may not be able to do the activities you once enjoyed or find clothes that fit properly. You may feel uncomfortable with the way you look and isolated from those around you. Working with a CLT is often the best way to manage and cope with lymphedema.

Side effects like lymphedema can be hard to deal with, both physically and emotionally. It’s important to ask for support from your health care team. They can help you prepare for and make it through difficult times. Learn more about ways to cope with cancer including emotions that people with cancer often have and ways to adjust to daily life during cancer treatment.

For family members and friends who are caring for someone with cancer, you may find these suggestions for caregivers to be helpful.

Lymphedema research

Research is ongoing to discover new ways to prevent, diagnose, and treat lymphedema. Research studies called clinical trials help advance knowledge about lymphedema and other side effects of cancer and cancer treatment. Learn more at Clinical Trials Information for Patients and Caregivers. 

To find NCI-supported clinical trials for lymphedema, go to Lymphedema Clinical Trials. Clinical trials supported by other organizations can be found at ClinicalTrials.gov.

Advances in cancer surgery and treatments are helping reduce the chances of lymphedema in people with cancer. For example, sentinel lymph node biopsy allows doctors to remove fewer lymph nodes when checking if the cancer has spread, decreasing the risk of lymphedema.

Cancer treatments can affect a boy’s or a man’s fertility. Most likely, your doctor will talk with you about whether or not cancer treatment may lower your fertility or cause infertility. Sometimes you, or parents of a child being treated for cancer, may need to initiate this conversation with the doctor.

Whether your fertility is affected depends on factors such as:

• your age at the time of treatment
• the type of cancer and treatment(s)
• the amount (dose) of treatment
• the length (duration) of treatment
• the amount of time that has passed since cancer treatment
• your baseline fertility status, such as any fertility problems in the past
• other personal health conditions and factors

Learn about fertility issues for females in Fertility Issues in Girls and Women with Cancer.

Ask your doctor how the recommended cancer treatment may affect your fertility before starting treatment. Consider asking questions such as:

• Could treatment increase the risk of, or cause, infertility?
• Are there other recommended cancer treatments that might not cause, or cause fewer, fertility problems?
• Which fertility preservation option(s) would you advise for me?
• What fertility preservation options are available at this hospital? At a fertility clinic?
• Would you recommend a fertility specialist, such as a urology fertility specialist, that I could talk with to learn more?
• Is condom use advised, based on the treatment I will be receiving?
• What are the chances that my fertility will return after the type of cancer treatment being advised?

Learn about side effects related to Sexual Health Issues in Men with Cancer.

Cancer treatments may affect a male’s fertility

Cancer treatments are important for your future health, but they may harm reproductive organs and glands that control fertility. Changes to your fertility caused by cancer treatment may be temporary or permanent.

Talk with your health care team to learn what to expect based on your treatment(s):

• Chemotherapy (especially with drugs called alkylating agents) can damage sperm in men and sperm-forming cells (germ cells) in young boys.
• Hormone therapy (also called endocrine therapy) can decrease the production of sperm.
• Radiation therapy to the reproductive organs as well as radiation therapy near the abdomen, pelvis, or spine may lower sperm counts and testosterone levels, causing infertility. It may also destroy sperm cells and the stem cells that make sperm. Radiation therapy to the brain can harm the pituitary gland and decrease the production of testosterone and sperm. 
• Stem cell transplants involve receiving high doses of chemotherapy and/or radiation. These treatments can damage sperm and sperm-forming cells and cause infertility.
• Surgery for cancers of the reproductive organs and for cancers in the pelvic region can damage these organs, nearby nerves or lymph nodes in the pelvis, leading to infertility.
• Other treatments: Talk with your doctor to learn how specific types of immunotherapy or targeted cancer therapy, may affect your fertility.

Making fertility-related decisions

Making decisions about whether or not to preserve your fertility isn’t easy. You’ll need to learn about the risks of the proposed cancer treatment to your fertility as well as the best fertility preservation options for you. Infertility can be a difficult and upsetting side effect of some cancer treatments.

Although it might feel overwhelming to think about your fertility right now, most people benefit from having talked with their doctor (or their child’s doctor, when a child is being treated for cancer) about how treatment may affect their fertility and options to preserve fertility.

Although many people want to have children at some point in their life, families can come together in many ways. For support during this time, reach out to your health care team with questions or concerns, as well as to professionally led cancer support groups.

If you are a young person with cancer, or the parent of a young boy or teen with cancer, this video of fertility options for young male cancer patients from the Children’s Hospital of Philadelphia may help you talk with the health care team.

Fertility preservation options for boys and men

Men and boys with cancer have options to preserve their fertility. These procedures may be available at the hospital where you are receiving cancer treatment or at a fertility preservation clinic. Talk with your doctor about the best fertility preservation option(s) for you based on your age, the type of cancer you have, and the specific treatment(s) you will be receiving.

The success rate, financial cost, and availability of these procedures vary. A growing number of states require insurance companies to cover fertility preservation methods. Learn if the state you live or work in requires insurance companies to cover fertility-related costs for people with cancer.

• Sperm banking (also called semen cryopreservation) is the most common and easy option for males who have gone through puberty, who would like to have biological children one day. Samples of semen are collected and checked under a microscope in the laboratory. The sperm are then frozen and stored (banked) for the future. Sperm can be frozen for an indefinite amount of time. Later, the sperm can be thawed and used during an IVF procedure so a woman may become pregnant.
• Testicular shielding (also called gonadal shielding) is a procedure in which a protective cover is placed on the outside of the body to shield the testicles from scatter radiation to the pelvis when other parts of the body are being treated with radiation.
• Testicular sperm extraction (TESE) is a procedure for males who are not able to produce a semen sample, or if the sperm count is low, for example. Sperm is collected through a medical procedure and frozen for future use.
• Testicular tissue freezing (also called testicular tissue banking and testicular tissue cryopreservation) is an option for boys who have not gone through puberty and are at high risk of infertility. It is still considered to be an experimental procedure for which clinical trials are ongoing.

If you choose to take steps to preserve your fertility, your doctor and a fertility specialist will work together to develop a treatment plan that includes fertility preservation whenever possible. Your health care team will advise you on the timing of fertility procedures you may choose to have and whether a delay may affect your treatment plan and prognosis.

Getting personalized care

It’s important to make decisions that reflect what is important to you. If having biological children is important, talk with your health care team about how the proposed cancer treatment may affect your ability to make a female pregnant. These conversations can help you get the information you need to make decisions. Most people with cancer are glad they had these discussions with their doctor.

Finding more resources, financial support, and clinical trials

These organizations have information about fertility preservation options for people with cancer:

• Oncofertility Consortium
  Learn more about fertility preservation options, connect with a patient navigator, and find community resources.
• Alliance for Fertility Preservation
  Comprehensive information on fertility preservation, including laws and legislation in some states that require insurance companies to cover the cost of fertility preservation as well as answers to commonly asked questions.
• Livestrong Fertility
  Access financial support and find a fertility clinic in your area if cancer treatment presents a risk to your fertility. Learn about a discount program for qualifying patients. 

Learn about clinical trials by searching NCI-funded clinical trials and these NIH-funded clinical trials. You can also get answers to commonly asked questions about clinical trials, learn how clinical trials work, and why people participate in a clinical trial: Clinical Trials Information for Patients and Caregivers.

Listen to tips on how to manage changes in sexuality and fertility caused by cancer treatments such as radiation therapy.
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Cancer treatments can lower your fertility by making it difficult to become pregnant or to carry a pregnancy. Most likely, your doctor will talk with you about whether or not cancer treatment may increase the risk of fertility problems or cause infertility. Sometimes you, or parents of a child being treated for cancer, may need to initiate this conversation with the doctor.

Whether fertility is affected depends on factors such as:

• your age at the time of treatment
• the type of cancer and treatment(s)
• the amount (dose) of treatment
• the length (duration) of treatment
• the amount of time that has passed since cancer treatment
• your baseline fertility status, such as any fertility problems in the past
• other personal health conditions and factors

Learn about fertility issues for males in Fertility Issues in Boys and Men with Cancer.

Ask your doctor how the recommended cancer treatment may affect your fertility before starting treatment. Consider asking questions such as:

• Could treatment increase the risk of, or cause, infertility? Could treatment make it difficult to become pregnant or carry a pregnancy in the future?
• Are there other recommended cancer treatments that might not cause, or cause fewer, fertility problems?
• Which fertility preservation option(s) would you advise for me?
• What fertility preservation options are available at this hospital? At a fertility clinic?
• Would you recommend that I talk with a fertility specialist, such as a reproductive endocrinologist, to learn more?
• Is birth control recommended, based on the treatment I will be receiving?
• After treatment, what are the chances that I will be able to get pregnant? How long might it take for my fertility to return?

Learn about side effects related to Sexual Health Issues in Women with Cancer.

Cancer treatments may affect a female’s fertility

Cancer treatments are important for your future health, but they may harm reproductive organs and glands that control fertility. Changes to your fertility may be temporary or permanent.

Talk with your health care team to learn what to expect, based on your treatment(s):

• Chemotherapy (especially with drugs called alkylating agents) can affect the ovaries, causing them to stop releasing mature eggs and producing estrogen. This consequence of chemotherapy is called primary ovarian insufficiency (also called premature ovarian failure). Sometimes it’s temporary and your menstrual periods and fertility return after treatment. Other times, damage to your ovaries is permanent and you may experience premature menopause. Symptoms may include hot flashes, night sweats, irritability, vaginal dryness, and irregular or no menstrual periods. Chemotherapy can also lower the number of total eggs in the ovaries. Women who are closer to the age of natural menopause may have a greater risk of ovarian failure and/or infertility. Learn more about primary ovarian insufficiency from the National Institute for Child Health and Human Development.
• Hormone therapy (also called endocrine therapy) to treat cancer can disrupt the menstrual cycle, which may affect your fertility. Side effects depend on the specific hormones used and may include hot flashes, night sweats, and vaginal dryness. Learn more about ways to manage hot flashes and nights sweats.
• Radiation therapy to or near the abdomen, pelvis, or spine can harm nearby reproductive organs. Radiation therapy to the ovaries can cause primary ovarian insufficiency, while radiation therapy to the uterus can affect blood flow, which may increase pregnancy-related complications. Radiation therapy to the brain can harm the pituitary gland. This gland is important because it sends signals to the ovaries to make hormones such as estrogen that are needed for ovulation. The amount of radiation given, and the part of your body being treated, play a role in whether fertility is affected.
• Stem cell transplants involve receiving high doses of chemotherapy and/or radiation. These treatments can damage the ovaries and may cause infertility as a result.
• Surgery for cancers of the reproductive organs and for cancers in the pelvic region can harm nearby reproductive tissues and cause scarring, which can affect your fertility. The size and location of the tumor are important factors in whether your fertility is affected.
• Other treatments: Talk with your doctor to learn how specific types of  immunotherapy or targeted cancer therapy may affect your fertility.

Making fertility-related decisions

Making decisions about whether to preserve your fertility isn’t easy. You’ll need to learn about the risks of the proposed cancer treatment to your fertility as well as the best fertility preservation options for you. Infertility can be a difficult and upsetting side effect of some cancer treatments.

Although it might feel overwhelming to think about your fertility right now, most people benefit from having talked with their doctor (or their child’s doctor, when a child is being treated for cancer) about how treatment may affect their fertility and options to preserve fertility.

Although many people want to have children at some point in their life, families can come together in different ways. For support reach out to your health care team with questions or concerns, as well as to professionally led cancer support groups.

If you are a young person with cancer or the parent of a young girl or teen with cancer, this video of fertility options for young female cancer patients from the Children’s Hospital of Philadelphia may help you talk with the healthcare team.

Fertility preservation options for girls and women

Fertility Preservation Safe for Young Women with Breast Cancer

The finding supports offering fertility preservation as part of standard care, experts say.

Fertility preservation is the process of saving or protecting your eggs, or reproductive tissue, in order to have biological children in the future. Women and girls with cancer have options to preserve their fertility. These procedures may be available at the hospital where you are receiving cancer treatment or at a fertility preservation clinic.

Talk with your doctor about the best option(s) for you based on your age, the type of cancer you have, and the specific treatment(s) you will be receiving.

The success rate, financial cost, and availability of these procedures vary. A growing number of states require insurance companies to cover fertility preservation methods. Learn if the state you live or work in requires insurance companies to cover fertility-related costs for people with cancer.

• Egg freezing (also called egg banking, egg cryopreservation, or oocyte cryopreservation) is a procedure in which mature eggs are removed from the ovary and frozen. Later, when you are ready to try to become pregnant, the eggs can be thawed, fertilized with sperm in the lab to form embryos, and placed in your uterus. Egg freezing is a newer procedure than embryo freezing and does not have as long of a track record of success as embryo freezing, but it may be especially suitable if you do not have a partner.
• Embryo freezing (also called embryo banking or embryo cryopreservation) is a procedure in which eggs are removed from the ovary and then fertilized with sperm in the lab to form embryos that are frozen for future use. When you are ready to try to become  pregnant, the frozen embryos are thawed and placed in the uterus.
• Gonadotropin-releasing hormone agonist (GnRHa) is a drug that causes egg maturation as well as estrogen and progesterone production in the ovaries to stop. Research in women with breast cancer has found that using GnRHa can protect against premature ovarian failure.
• Ovarian shielding (also called gonadal shielding) is a procedure that can be done during radiation treatment, in which a protective cover is placed over the ovaries and other parts of the reproductive system, to shield them from scatter radiation.
• Ovarian tissue freezing (also called ovarian tissue banking and ovarian tissue cryopreservation) involves surgically removing part or all of an ovary and then freezing the ovarian tissue, which contains eggs. Later, when you are ready to try to become pregnant, the tissue is thawed and placed back into your body.
• Ovarian transposition (also called oophoropexy) is an operation to move the ovaries away from the part of the body receiving radiation therapy to lessen the potential for damage from the radiation. This procedure may be done during surgery to remove the cancer.  
• Radical trachelectomy (also called radical cervicectomy) is surgery used to treat women with early-stage cervical cancer who would like to be pregnant in the future. This operation removes the cervix, nearby lymph nodes, and the upper part of the vagina. The uterus is then attached to the remaining part of the vagina, with a special band that keeps the uterus closed during pregnancy.

If you choose to take steps to preserve your fertility, your doctor and a fertility specialist will work together to develop a treatment plan that includes fertility preservation, whenever possible. Your health care team will advise you on the timing of fertility procedures you may choose to have and whether a delay may affect your treatment plan and prognosis.

Getting personalized care

It’s important to make decisions that reflect what is important to you. If having biological children is important, talk with your health care team about how the proposed cancer treatment may affect your ability to become pregnant. These conversations can help you get the information you need to make decisions. Most people with cancer are glad they had these discussions with their doctor.

Finding more resources, financial support, and clinical trials

These organizations also have information about fertility preservation options for people with cancer:

• Oncofertility Consortium
  Learn more about fertility preservation options, connect with a patient navigator, and find community resources.
• Alliance for Fertility Preservation
  Comprehensive information on fertility preservation, including laws and legislation in some states that require insurance companies to cover the cost of fertility preservation as well as answers to commonly asked questions.
• Livestrong Fertility
  Access financial support and find a fertility clinic in your area if cancer treatment presents a risk to your fertility. Learn about a discount program for qualifying patients.

Learn about clinical trials by searching NCI-funded clinical trials and these NIH-funded clinical trials. You can also get answers to commonly asked questions about clinical trials, learn how clinical trials work, and why people participate in a clinical trial: Clinical Trials Information for Patients and Caregivers.

Listen to tips on how to manage changes in sexuality and fertility caused by cancer treatments such as radiation therapy.
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What is cancer fatigue?

Cancer fatigue is a condition caused by cancer or cancer treatment in which you feel exhausted or extremely tired. Some people with cancer have extreme fatigue most of the time and are unable to carry out day-to-day tasks. Others feel only very tired. Cancer fatigue may also be called cancer-related fatigue or cancer treatment–related fatigue.

Cancer fatigue is different from fatigue you may have felt in the past. When a healthy person is tired, fatigue is usually caused by activity and goes away after resting or sleeping. However, cancer fatigue is not completely relieved by sleep or rest and may happen after no or minimal activity.

Cancer fatigue is common

Cancer fatigue is one of the most common side effects of cancer treatment. More than 80% of people with cancer experience fatigue while receiving chemotherapy or radiation therapy.

Cancer fatigue can occur at any time

Fatigue can begin at any time—before, during, or after cancer treatment. Sometimes it’s an early symptom of cancer, or it can be brought on by the stress of a cancer diagnosis. Fatigue may worsen gradually as you go through treatment, or it may come on suddenly. Fatigue usually decreases after cancer treatment ends, but some people may still feel fatigue for months or years.

Cancer fatigue can affect many areas of your life

Fatigue can affect not only your daily activities but also your family, work, and social life. Although cancer fatigue can feel overwhelming, your health care team can help you find ways to manage, treat, and cope with fatigue that are tailored to you.

Cancer fatigue symptoms

Whether and how you experience fatigue depends on factors such as the type of cancer, stage of cancer, cancer treatment(s) you are receiving, and your overall physical and emotional health, nutrition, and sleep patterns.

Symptoms of cancer fatigue include:  

• having no energy; feeling extremely tired, drained, or lethargic   
• having difficulty moving; feeling heavy or slow   
• having difficulty thinking, remembering, or paying attention   
• having a sense of physical, emotional, and/or mental exhaustion  
• not feeling rested, even after sleeping  

Causes of cancer fatigue

Cancer itself, cancer treatments, and the side effects of treatment can cause fatigue. Additional sources of fatigue may be stress, changes to your schedule, and other medical conditions.

Fatigue from cancer

Sometimes the source of fatigue in someone with cancer is the cancer itself. Cancer cells use calories and nutrients that your body needs for energy, making you feel fatigued. Cancer can also cause your body to release cytokines, naturally produced substances that help your body to fight infections and cancer but that can cause fatigue when released at high levels. Cachexia, a wasting syndrome that causes muscle and weight loss in some people with cancer, can also lead to fatigue.  

Certain types of cancer are more likely to cause fatigue than others.  

• Blood cancers such as leukemia, lymphoma, and multiple myeloma affect the bone marrow, making it difficult for your body to produce healthy blood cells. If your red blood cell count is low, your body’s tissues can’t get enough oxygen, resulting in fatigue.  
• Breast cancer and prostate cancer can affect your hormone levels, which can lead to fatigue.  
• Gastrointestinal system cancers such as stomach cancer and colorectal cancer can affect the way your body processes and uses food. 

Fatigue from cancer treatments

Many cancer treatments can reduce your energy level. Each treatment may affect fatigue differently, and the treatment’s schedule and dose can influence how fatigued you are and when you feel most tired. Receiving more than one treatment can increase fatigue.

• Fatigue after surgery. Fatigue is common following surgery while your body is using energy to heal. Pain medicine given after surgery can also cause fatigue. Fatigue from surgery usually improves with time, but when surgery is combined with other treatments, fatigue may last longer.  
• Fatigue from chemotherapy (chemo fatigue). Chemotherapy destroys healthy cells while treating cancer cells, causing you to feel fatigued. Some people feel the most tired after each chemotherapy treatment, whereas others may have worse fatigue halfway through their course of treatment. Fatigue decreases after chemotherapy is finished, but you may not feel back to normal for a month or more.  
• Fatigue from radiation therapy. Doctors don’t fully understand why radiation therapy causes fatigue. After radiation therapy begins, fatigue usually increases until midway through the course of treatment then stays about the same until treatment ends.  
• Fatigue from other treatments. Hormone therapies, immunotherapies, and targeted therapies can all cause fatigue. The timing of when fatigue arises and when it improves can vary depending on the specific treatments and the side effects you experience.

Fatigue from side effects of cancer treatment

Some side effects of cancer treatment can cause or worsen fatigue.   

• Anemia. Some types of chemotherapy stop bone marrow from making enough new red blood cells, causing anemia (too few red blood cells to carry oxygen to the body’s tissues). Being anemic can lower your energy level.  
• Appetite loss. Your body’s energy comes from food. If you are not eating well, your body may not get the energy it needs.   
• Diarrhea. Some cancer treatments cause the body to lose fluid and electrolytes in frequent loose stools. This can lead to dehydration and result in fatigue.  
• Hot flashes. Some medications change your hormone levels. This can cause hot flashes that may result in night sweats that disrupt your sleep.  
• Infection. Your body uses energy to fight an infection. You may also have other symptoms with an infection, such as a fever, that can cause fatigue.   
• Pain. Pain can cause fatigue for many reasons. Lack of sleep from any type of pain will cause fatigue. Medications for treating pain can also make your fatigue worse.  
• Sleep problems. Many people with cancer have trouble sleeping at night. This can be due to your cancer, medication, or a disrupted sleep pattern, such as sleeping a lot during the day.    
• Vomiting. Chemotherapy can cause nausea and vomiting before, during, or after it is given. This leads to dehydration from loss of body fluids, which can bring on fatigue.

Fatigue from the emotional impact of cancer

Having a major illness such as cancer can cause you to feel anxious, worried, or fearful. High levels of distress can lead to physical problems such as fatigue, insomnia, and appetite loss. Learn about common emotions experienced by people with cancer and ways to cope.  

Sometimes people experiencing fatigue develop depression. Although it’s normal to feel down at times, depression is more serious. Learn about distress and anxiety as well as symptoms and treatment for depression.

Talking with your doctor about cancer fatigue

Tell your health care team if you feel very weak and tired—especially if you are not able to do your normal activities or are still very tired even after resting or sleeping. 

Your doctor may give you a chart, log, or fatigue diary to help you record your energy level and fatigue each day. This information, together with medical tests, can help your doctor determine the best way for you to manage or cope with fatigue. 

Questions to ask your doctor, nurse, or social worker about cancer fatigue

• What is most likely causing my fatigue?    
• Am I at higher risk for fatigue based on the type of cancer I have or the treatment I am receiving?    
• What can I do to have more energy? Are medical treatments recommended?   
• Is exercise recommended? What types of movement or other relaxing activities have you found helps people with cancer fatigue?    
• How much sleep should I get at night? How much rest or sleep may be helpful during the day?    
• What foods and drinks do you advise? Which should I avoid?    
• What signs or symptoms should I call you about?

Medical tests used to assess fatigue

Your health care team may check for medical conditions that contribute to fatigue. They’ll perform a physical exam and blood test to check for anemia or infections.  

Your health care team may also ask a series of standard questions about how tired you feel and how it is affecting your daily life. This is called a fatigue assessment. Your health care team will repeat this assessment to see if there is a pattern for when fatigue starts or becomes worse and how to best prevent, manage, or treat it. The same method of measuring fatigue is used at each assessment. This helps show changes in fatigue over time.

Treating cancer fatigue

Your health care team will often treat fatigue by relieving related conditions. They’ll choose a treatment based on your symptoms and whether they know what’s causing the fatigue. When the cause of fatigue is not known, your doctor will treat your symptoms and teach you ways to manage or cope with fatigue.

Medical treatment for cancer fatigue

• Treating anemia. Treatments for anemia may include dietary changes, blood transfusions, or drugs. Learn more about Anemia: Cancer Treatment Side Effect.  
• Treating pain. Controlling pain can help you feel less tired, but fatigue can also be a side effect of pain medicine. To decrease fatigue, your doctor may recommend switching to a different pain medicine or adjusting the dose or time of day when you take it. Learn more about Pain Management for People with Cancer.
• Treating depression and anxiety. Sometimes fatigue is worsened by feelings of stress, fear, and hopelessness. Mental health therapists can use cognitive behavioral therapy and talk therapy to help you manage these feelings, which can help decrease fatigue. People with cancer who have a depression diagnosis may also take antidepressant drugs to manage fatigue.
• Other therapies that may help fatigue. Your health care team may recommend respiratory therapy to help with shortness of breath or other breathing problems that can cause fatigue. They also may recommend physical therapy, which can relieve nerve or muscle problems and help you maintain physical function and strength during and after treatment.
• Medicines for cancer fatigue. Although there are no standard drug treatments for cancer fatigue, several drugs are being studied for a possible role in treatment.  
  • Psychostimulants are drugs that improve mood and help decrease fatigue and depression. They may increase energy and improve the ability to think and concentrate in some people with cancer, but the FDA has not yet approved psychostimulants for treating fatigue.  
  • Bupropion is an antidepressant that is being studied to treat fatigue in people with cancer with or without depression.  
  • Steroids are being studied in people with advanced cancer. Dexamethasone is a steroid that reduces inflammation but has unwanted side effects.   

Managing cancer fatigue

Eliminating fatigue is not always possible, but there are ways to help lessen or manage cancer fatigue. Talk with your health care team about things you can try. Some possibilities include:

• Rest and sleep.
  • Practice good sleep habits. It is common for people going through treatment for cancer to have changes in their sleep patterns or difficulty sleeping. If you are having problems sleeping, learn how to manage sleep problems in Sleep Disorders.   
  • Plan time to rest. If you are tired, take short naps of less than one hour during the day. Keep in mind that sleeping too much during the day can make it difficult to sleep well at night.   
  • Start with what’s most important. Choose activities that are most important to you and do them when you have the most energy. Limit activities that increase your fatigue.
• Exercise and physical activity. Exercise (including walking) may help people with cancer feel better and have more energy during and after treatment. Choose a physical activity you enjoy. Talk with your health care team or a physical therapist to make an exercise plan that’s right for you.
• Food and drink. Meet with a registered dietitian to learn about foods and drinks that have the nutrients you need to keep up your energy level. Many people find it easier to eat many small meals throughout the day than three big meals. Drink plenty of water and limit your intake of caffeine and alcohol. Get more tips on eating well in this booklet: Eating Hints: Before, during, and after Cancer Treatment.​​​​​​
• Mind–body practices. Mind–body practices such as qigong, tai chi, and yoga have been found to reduce fatigue for people with cancer. Many of these practices combine movement, stretching, balance, and controlled breathing with meditation. Relaxation techniques, guided imagery, hypnosis, and acupuncture are other therapies that may help with fatigue. Ask your health care team if there are any programs offered in your community. Learn more about complementary, alternative, and integrative health practices.
• Supplements. American ginseng in the form of capsules of ground ginger root may be used to treat fatigue. Other dietary supplements, such as coenzyme Q10 and L-carnitine, are also being studied in clinical trials. However, there is no evidence that these supplements reduce cancer fatigue. Learn more about Coenzyme Q10.

Getting support if you have cancer fatigue

If you have fatigue from cancer, you or your caregivers may need help coping. Know that you are not alone and seek support from family and friends and your health care team.

• Support from family and friends. People close to you can help with important tasks such as making meals, cleaning, and driving. Get advice on how to ask for help at Changes for the Family.
• Support from health care providers. If you are having difficulty managing daily activities, your nurse or social worker may help you find services to assist with personal needs such as eating and bathing.
• Support for caregivers. If you are caring for someone who has fatigue, it is important to know what resources are available to you. Learn more in Support for Caregivers of Cancer Patients.

What is edema?

Edema is swelling caused by a buildup of fluid that gets trapped in your body’s tissues. Edema may also be called fluid retention. While edema is most common in your legs, ankles, and feet, it can occur anywhere in your body. 

Tell your doctor or nurse if you notice swelling so they can assess your symptoms and talk with you about ways to lower swelling.

Types of edema

This page focuses on peripheral edema, which is the buildup of fluid in your extremities, such as your legs, feet, or ankles, or in your arms or hands. Edema that happens in your lower legs or feet may be called pedal edema. 

Other types of edema occur in different parts of the body:

• Ascites: Fluid builds up in the abdomen. Learn more about Ascites and Cancer.
• Cerebral edema: Fluid builds up in the brain.
• Macular edema: Fluid builds up in a part of the eye called the macula.
• Pericardial effusion: Fluid builds up between the heart and the pericardium (the sac around the heart). Learn more about malignant pericardial effusion at Cardiopulmonary Syndromes. 
• Pleural effusion: Fluid builds up around the lungs in a space called the pleural cavity. Learn more about malignant pleural effusion at Cardiopulmonary Syndromes. 
• Pulmonary edema: Fluid builds up in the lungs.
• Scrotal edema: Fluid builds up in the scrotum (sac around the testicles).

What causes peripheral edema?

Peripheral edema may be caused by cancer, cancer treatments, or medicines you are taking. Peripheral edema can also be caused by health conditions that are not related to cancer.

Peripheral edema caused by cancer

Peripheral edema may be a sign or symptom of some types of cancer. For instance, cancers located near the pelvic veins, such as kidney cancer, liver cancer, ovarian cancer, and uterine cancer are most likely to cause edema in your leg or foot. 

Peripheral edema caused by cancer treatments

Chemotherapy may cause a buildup of fluid in the extremities, as can some types of hormone therapy, immunotherapy, and targeted therapy. Swelling caused by cancer treatment is generally mild and usually goes away after treatment ends.

Other causes of peripheral edema

• Medicines. Some medicines, such as blood pressure medicine, corticosteroids, birth control pills, and NSAIDs (e.g., ibuprofen) can cause your body to hold on to salt and water, leading to swelling in your arms, legs, and feet. In rare cases, swelling may be caused by a severe allergic reaction to a medicine. 
• Medical conditions. Congestive heart failure, chronic kidney disease, liver disease (cirrhosis), lung conditions, and thyroid conditions may cause edema. 
• Deep vein thrombosis (DVT). When a blood clot forms in a deep vein, such as those in the leg, it can cause edema. 
• Pregnancy. Edema is common during pregnancy. 
• Lifestyle and dietary factors. Being less active and more sedentary, as well as a diet high in sodium (salt) can also cause edema. Salt makes your body hold onto fluid. Not eating enough protein can also lead to edema.

Signs and symptoms of peripheral edema

• heaviness and swelling in one or both legs or arms 
• swollen ankles, feet, or hands
• skin changes, such as skin that is puffy, shiny, or slightly dented after being pressed

Tell your doctor about swelling that doesn’t go away. Early diagnosis and treatment of edema can prevent it from getting worse. Your doctor will determine the cause and talk with you about ways to lower the swelling.

Peripheral edema or lymphedema?

Both peripheral edema and lymphedema cause swelling, often in the arm or leg. But peripheral edema and lymphedema differ in important ways. Peripheral edema can have many causes, whereas lymphedema usually occurs after surgery to remove lymph nodes. Lymphedema and peripheral edema are also treated in different ways. Learn more about Lymphedema. 

Is peripheral edema life-threatening?

Peripheral edema caused by cancer and cancer treatment is usually mild. But severe swelling can be the sign of a more serious health condition and may become life-threatening.

Seek emergency medical care if you have: 

• shortness of breath
• sudden pain with swelling 
• swelling that is moving up your arms or legs
• a swollen area that becomes painful and warm to touch
• rapid weight gain
• the inability to empty your bladder

How is peripheral edema diagnosed?

Your doctor will usually diagnose peripheral edema during a physical exam. If more tests are needed, based on your symptoms, your doctor may order blood tests and imaging tests such as an ultrasound to examine the swollen area. 

Grading the severity of peripheral edema

The severity (or grade) of peripheral edema is assessed using a pitting edema scale. Your doctor will gently press on the swollen area to see if a pit or depression forms in the skin. Normally, no pit is seen when pressure is applied. 

If a pit or dimple forms after the skin is pressed, this is called pitting edema. Your doctor or nurse will record the depression and the time it takes for the pressed area to return to normal and diagnose the edema as grade 1, 2, 3, or 4, with grade 4 being the most severe. The grade of the edema is based on how deep the pit is when pressure is applied and how long it takes for the area to rebound or return to normal. 

Treatment and management of peripheral edema

Treatment for peripheral edema is based on what is causing your symptoms and their severity. Your doctor or nurse may talk with you about these and other ways to lower swelling:

• Compression stockings or sleeves. There are compression garments that can help move fluid around in your arms and legs to keep it from building up. They also help improve blood flow. Your nurse can help you find compression garments that fit properly and will show you how to use them.
• Avoid wearing tight-fitted clothing, shoes, and jewelry. These can make swelling worse.
• Raise your feet. Standing or sitting in one place for a long time can cause or worsen swelling in your legs and feet. Raising your feet with pillows or a footstool when you sit or lie down can help to prevent fluid from building up in your feet. Sitting with uncrossed legs can also help. 
• Take short walks and exercise. Walking and other light exercises can improve circulation and help to move fluid around in your body. Ask your nurse about an exercise program that is right for you.
• Diet. You may be advised to avoid foods high in sodium (salt) such as chips, bacon, ham, and canned soup. Talk with your nurse to get a list of foods and drinks to avoid.
• Diuretics (water pills). Medicines called diuretics may be prescribed to help your body get rid of fluid. These medicines cause the kidneys to make more urine, but they also come with some side effects that your doctor will discuss with you. Two diuretics used to treat edema are hydrochlorothiazide and furosemide. 
• Physical therapy or occupational therapy. A physical therapist can help you learn about exercises to help reduce swelling. An occupational therapist can help you manage activities related to daily living.

Talking with your doctor about peripheral edema

Tell your doctor or nurse as soon as you notice swelling or other symptoms of peripheral edema. Here are questions you may want to ask:

• Is the cancer I have or the treatment I’m receiving likely to cause edema?
• Are any of the medicines I’m taking likely to cause edema?
• What serious symptoms should I call you about?
• What treatments do you recommend based on my symptoms?
• Would compression socks or sleeves help? Which ones do you recommend? When and how often should I wear them?
• What foods or drinks should I avoid?
• What exercise or physical therapy do you recommend?

Getting support if you have peripheral edema

Side effects of cancer treatment, such as peripheral edema, can be hard to deal with, both physically and emotionally. It’s important to ask for support from your health care team. They can help you prepare for and make it through difficult times. Learn more about ways to cope with cancer, including ways to adjust to daily life during cancer treatment.

For family members and friends who are caring for someone with cancer, you may find these suggestions for caregivers to be helpful.

Peripheral edema research and clinical trials

Doctors and researchers are working to discover new and better ways to prevent, diagnose, and treat side effects such as peripheral edema. Your doctor may have information about open clinical trials at the hospital where you are receiving treatment or a nearby clinic.

What is diarrhea?

Diarrhea means having bowel movements that are soft, loose, or watery more often than normal. If diarrhea is severe or lasts a long time, the body does not absorb enough water and nutrients. This can cause you to become dehydrated or malnourished.

What causes diarrhea?

Cancer treatments, or the cancer itself, may cause diarrhea or make it worse. Some medicines, infections, and stress can also cause diarrhea. Tell your health care team if you have diarrhea.

What are the dangers of diarrhea?

Diarrhea that leads to dehydration (the loss of too much fluid from the body) and low levels of salt and potassium (important minerals needed by the body) can be life threatening. Call your health care team if you feel dizzy or lightheaded, have dark yellow urine or are not urinating, or have a fever of 100.5 °F (38 °C) or higher.

Ways to manage diarrhea

You may be advised to take steps to prevent complications from diarrhea:

Eating Hints: Before, during, and after Cancer Treatment

Learn about treatment side effects that may affect eating and what to do about them.

• Drink plenty of fluid each day. Most people need to drink 8 to 12 cups of fluid each day. Ask your doctor or nurse how much fluid you should drink each day. For severe diarrhea, only clear liquids or IV (intravenous) fluids may be advised for a short period.
• Eat small meals that are easy on your stomach. Eat six to eight small meals throughout the day, instead of three large meals. Foods high in potassium and sodium (minerals you lose when you have diarrhea) are good food choices, for most people. Limit or avoid foods and drinks that can make your diarrhea worse.
• Check before taking medicine. Check with your doctor or nurse before taking medicine for diarrhea. Your doctor will prescribe the correct medicine for you.
• Keep your anal area clean and dry. Try using warm water and wipes to stay clean. It may help to take warm, shallow baths. These are called sitz baths.

Questions to ask your health care team about diarrhea

Prepare for your visit by making a list of questions to ask. Consider adding these questions to your list:

• What is causing the diarrhea?
• What symptoms should I call you about?
• How much liquid should I drink each day?
• Can I speak to a registered dietitian to learn more about foods and drinks that are best for me?
• What medicine or other steps can I take to prevent diarrhea and to decrease rectal pain?

Listen to tips on how to manage diarrhea caused by your cancer treatments such as radiation therapy.
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