Fluid Retention (Oedema) in Childhood Cancer

Symptom Management, Palliative Care, or Supportive Care to relieve side-effects is an important part of cancer care and treatment and should always form part of the overall treatment plan.

Oedema is swelling from excessive accumulation of watery fluid in cells, tissues, or serous cavities in the body. The fluid collects under the skin within the tissues that are outside of the circulatory system, which transports the blood throughout your body.

Oedema most commonly occurs in one’s legs and feet, but it can also occur in one’s arms, hands, face, and abdomen. When oedema occurs in the abdomen, doctors call it ascites. When it occurs around the lungs, doctors call it pleural effusion.

 

Symptoms

Relieving side effects is an important part of total cancer care and treatment, which is why you should discuss any symptoms your child is experiencing, new symptoms and changes in symptoms with their Oncology Team so that they can work out a regimen of palliative or supportive care for them.

Individuals with oedema may experience the following symptoms:

  • A decrease in urine output
  • Decreased flexibility of the joints in the arms and legs, such as the ankles, wrists, and fingers
  • Indentation when pressing the skin (this does not happen when oedema is severe).
  • Puffiness, swelling, or a heavy feeling
  • Shiny, tight, or stiff skin
  • Sudden or rapid weight gain
  • The feeling that clothes, shoes, or jewellery are too tight

 

Causes

The following factors may cause oedema:

  • Cancer itself, especially liver, kidney, or ovarian cancers
  • Certain types of chemotherapy
  • Other medications, including:
    • Corticosteroids, which are drugs that reduce swelling
    • Hormone replacement medications
    • Nonsteroidal anti-inflammatory drugs (NSAIDS), drugs such as ibuprofen or naproxen
    • Some blood pressure drugs
  • Low levels of protein in the blood, caused by poor nutrition
  • Inactivity, which can cause fluid to collect in the feet and legs
  • Problems with kidney, liver, or heart function

 

Diagnosis

In order to diagnose oedema, your child’s doctor may check whether the skin over the swollen area indents when pressed. They will also probably ask you and/or your child questions about any tightness of clothes or jewellery, recent weight gain, and other symptoms.

Your child’s doctor may also schedule blood and urine tests as well as x-rays to help with the diagnosis.

 

Treatment/Management

Oedema management focuses on correcting the underlying cause the build-up of fluid.

Oedema caused by medication or poor nutrition is reversible in some individuals. Oedema caused by cancer or by kidney, heart, or liver problems may be more difficult to treat, and may be permanent in these situations.

The following suggestions may help reduce swelling and relieve symptoms:

  • Consult your child’s doctor about whether physical therapy or occupational therapy may be helpful.
  • Do Not reduce amount of water or other fluids you give your child to drink without consulting their doctor.
  • Encourage your child to walk or do other exercises that help pump fluids back to their heart.
  • Ensure that your child eats a well-balanced diet.
  • Help your child to raise the affected area when sitting or lying down (e.g. putting their feet on a chair/stool when sitting or putting a pillow under the affected area when lying down).
  • Reduce the amount of salt in your child’s diet.
  • Speak to your child’s doctor about prescription diuretics, which help get rid of extra fluid from the body by increasing urination.
  • Your child may have to wear compression stockings or elastic sleeves to help push fluids back into their circulatory system.
  • Your child must avoid standing for long periods or sitting with their legs crossed.

 

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