Lymphedema: What it is and how to treat it
What is Lymphedema?
Lymphedema refers to swelling that occurs in one of the arms or legs, and can affect both arms or both legs as well. The edema results from a blockage in the lymphatic system, a part of the immune system. The blockage prevents lymph fluid from draining well. Fluid buildups instead of draining properly, which causes swelling.
Signs and Symptoms of Lymphedema
- Swelling of part or all of your arm or leg, including fingers or toes
- A feeling of heaviness or tightness in the affected limb
- Restricted range of motion due to the tightness/fluid
- Aching or discomfort
- Recurring infections
- Hardening and thickening of the skin (fibrosis)
*The swelling can range from mild and barely noticeable to severe enough to limit the use of the limb.
Causes of Lymphedema
Lymphedema occurs when your lymph vessels cannot adequately drain lymph fluid, usually from an arm or leg. The fluid pools in the tissues, causing swelling. It is classified as either primary or secondary lymphedema. Primary lymphedema develops without a secondary cause, while secondary lymphedema is caused by another disease or condition. Secondary lymphedema is far more common than primary lymphedema.
Lymphedema is commonly caused by removal of or damage to the lymph nodes as part of cancer treatment. It may not appear for months or years after treatment has concluded.
Causes of Secondary Lymphedema include:
- Surgery. Removal of or injury to the lymph nodes and vessels may lead to edema.
- Radiation treatment for cancer. Radiation can cause scarring and inflammation in the lymph nodes and vessels.
- Cancer. If a tumor growing near a lymph node or lymph vessel enlarges enough it can block the flow of the lymph fluid.
- Infection. An infection (of the lymph nodes) or parasites can restrict the flow of lymph fluid. Infection-related lymphedema is most common in tropical and subtropical regions and is more likely to occur in developing countries.
Primary Lymphedema is a rare and inherited condition. It is caused by issues with the development of lymph vessels in the body.
Causes of Primary Lymphedema:
- Milroy's disease (congenital lymphedema). Beginning in infancy, this disorder causes the lymph nodes to form abnormally.
- Meige's disease (lymphedema praecox). Lymphedema from this disease typically develops around puberty or during pregnancy, though it can occur later up until until age 35.
- Late-onset lymphedema (lymphedema tarda). This occurs rarely and usually begins after age 35.
The Lymphatic System's Role
The lymphatic system is crucial to your health. It circulates protein-rich lymph fluid throughout your body. It collects viruses, bacteria, and waste products. The lymphatic system then carries this fluid and harmful substances through your lymph vessels, then on to the lymph nodes. The wastes are filtered out by the lymphocytes (cells living in your lymph nodes that fight infection) and are flushed out of the body.
Lymphedema can lead to serious complications, such as:
- Infections that can result from lymphedema include cellulitis, which is a serious bacterial infection of the skin and lymphangitis, which is an infection of the lymph vessels. The smallest injury to the arm or leg can be an entry point for infection to set in.
- Lymphangiosarcoma is a rare form of soft tissue cancer that can result from the most-severe cases of untreated lymphedema. Symptoms of lymphangiosarcoma can include blue-red or purple marks on the skin.
Risk Factors of Developing Lymphedema
Factors that can lead to lymphedema other than cancer and cancer related treatment include:
- Excess weight or obesity
- Rheumatoid or psoriatic arthritis
Lymphedema has no cure, but it can be treated. The goal of lymphedema treatment is to restore functioning, reduce physical and psychological damage, and to prevent the development of infections.
Strict adherence to treatment is essential, even though it is often uncomfortable, inconvenient, and time-consuming. Treatment is lifelong. Cooperative patients receive the most benefit from treatment.
In secondary lymphedema, the underlying cause should also be treated, in order to relieve the obstruction causing the edema. Diuretics are not effective in treating lymphedema.
Appropriate skin care and/or debridement are stressed to prevent recurrent cellulitis or lymphangitis.Meticulous attention to hygiene is necessary to remove keratinous debris and bacteria. Cleanse the skin regularly and dry thoroughly. Regular skin checks are necessary in order to identify any open wounds or developing cellulitis. Skin moisturizers should be applied conservatively.
The first-line treatment for lymphedema is complex physical therapy.Treatment is aimed at improving lymphedema using manual lymphatic drainage, massage, and exercise. It emphasizes the use of compression stockings (at a minimum of 40 mm Hg),multilayer bandaging, or pneumatic pumps. Leg elevation is imperative especially at night. Elevating the foot of the bed can be immensely helpful.
Surgical treatment for lymphedema is palliative, it does not cure the disease. It is not considered a primary treatment. Surgical treatment is reserved for those patients who do not have success with conservative measures, and cases in which the extremity is so large that it impairs daily activities. Generally, surgical procedures are classified as either physiologic or excisional.
According to Stanford Health Care, "The two categories of surgical intervention that are currently available in the United States are lymphatic reconstruction and excisional surgeries."
Lymphatic Reconstruction involves the following:
- Lymph node transplant - lymph nodes are moved from one part of the body (usually the abdomen) to the affected area. The transplanted lymph node will theoretically stimulate the growth of new lymph channels.
- Anastamotic reconstruction - surgical re-joining of the damaged lymph channel to another lymphatic vessel or to a vein in an attempt to restore lymph flow.
*A significant potential for risk exists, including unexpected worsening of the edema, and scarring complications related to the surgical intervention. With lymph node transplantation, there is a chance that lymphedema could also develop where the transplanted lymph node was harvested from. These risks are why surgical intervention is selectively performed as mentioned above.
- Debulking - surgically removing excess tissue that hangs in folds.
- Liposuction - an excisional procedure where a tube is inserted underneath the skin. A high-pressure vacuum then breaks up and vacuums out the excess fat cells. This procedure often results in excess loose skin. According to Stanford Health Care, "The surgical technique has been perfected in Europe over the past two decades and now has an extensive documentation of efficacy without complications or untoward outcomes."
Do you know someone who suffers from Lymphedema
Lymphedema is a complex medical condition that can occur without a secondary cause, or as a result of cancer, cancer treatment or surgery. It cannot be cured, but treatment options can manage symptoms and improve quality of life for the afflicted patient. It can range from mild to severe, impacting one's ability to function and provide self-care. Limb elevation and compression are important treatment modalities. Surgery is typically a last resort, as risks are high and often outweigh any benefit unless symptoms are severe. If you suspect that you or a loved one may be developing symptoms of lymphedema, consulting your health care provider should be done promptly.
© 2017 Michelle Mollohan