Chemotherapy, a common cancer treatment, often causes various side effects, with swelling being a frequent concern. This fluid accumulation, particularly noticeable in the feet and ankles, is often referred to as edema. Understanding why this symptom occurs, how it can be managed, and when medical attention is needed is an important aspect of managing chemotherapy’s effects.
Causes of Chemotherapy-Related Swelling
Chemotherapy can induce swelling through several physiological mechanisms. One common cause is fluid retention, where the body holds onto excess water and salt. This can occur due to the direct impact of certain chemotherapy drugs on kidney function, or indirectly through hormonal changes that influence fluid balance. Additionally, some chemotherapy regimens involve the co-administration of steroids, which are known to promote water retention.
Specific chemotherapy drugs can also directly affect the body’s vascular and lymphatic systems. Certain agents, such as taxanes (e.g., docetaxel, paclitaxel), increase the permeability of blood vessels, allowing fluid to escape into surrounding tissues. This increased vascular permeability can overburden the lymphatic system, which drains excess fluid. When lymphatic drainage becomes insufficient, fluid accumulates, leading to swelling.
Another contributing factor is decreased levels of protein, specifically albumin, in the blood. Albumin maintains oncotic pressure, helping keep fluid within blood vessels. When albumin levels drop, fluid can leak out of capillaries and accumulate in interstitial spaces, resulting in edema. This low albumin (hypoalbuminemia) can stem from poor nutritional intake during treatment, or from the cancer itself disrupting protein balance. Inactivity, often a consequence of chemotherapy-induced fatigue, can also worsen swelling by reducing the natural pumping action of muscles that aids fluid return to circulation.
Managing Swelling During Chemotherapy
Managing chemotherapy-induced swelling involves several practical strategies to alleviate discomfort and prevent worsening. Elevating affected limbs, particularly the feet, above heart level helps gravity assist in draining accumulated fluid. This can be done by propping feet on pillows while resting or using a footstool when sitting.
Wearing compression stockings, if advised by a healthcare professional, can also be beneficial. These garments apply gentle pressure that helps prevent fluid from pooling in the lower extremities and promotes better circulation. Ensure proper fit and discuss their use with the oncology team. Avoiding prolonged periods of standing or sitting, and instead incorporating regular, gentle movement, can help stimulate blood flow and lymphatic drainage. Simple exercises like ankle pumps, marching in place, or mini squats can be effective.
Maintaining adequate hydration helps the kidneys process fluids more effectively, even with swelling. While a balanced diet is recommended, monitoring salt intake may be advised, as high sodium levels can contribute to fluid retention. Choosing comfortable, non-restrictive footwear and clothing can also prevent additional pressure on swollen areas. Discuss any new management strategies with the healthcare team to ensure they are appropriate for your specific situation.
When to Contact Your Healthcare Team
While swelling can be a common and often manageable side effect of chemotherapy, certain signs indicate serious swelling requiring medical attention. Sudden or severe swelling, especially if it affects only one leg or arm, should be reported promptly. Such unilateral swelling, accompanied by pain, redness, or warmth, could be a symptom of a deep vein thrombosis (DVT), a blood clot that can form in the veins. Chemotherapy can increase the risk of blood clots.
Other concerning symptoms include skin changes over the swollen area, such as the skin becoming tight, shiny, or discolored. If swelling is accompanied by shortness of breath, chest pain, or an unexplained cough, it could indicate a more severe condition, such as a pulmonary embolism, which occurs when a blood clot travels to the lungs. Rapid weight gain (e.g., 5 pounds or more in a week) can also signal significant fluid retention.
Avoid self-diagnosing these symptoms. Any new or worsening swelling, particularly when accompanied by these warning signs, should be communicated to the oncology team or a doctor without delay. They can assess the situation, determine the underlying cause, and recommend appropriate interventions to ensure patient safety.