What is lymphedema?

Lymphedema, or lymphatic obstruction, is a long-term condition in which excess fluid accumulates in swelling tissues (edema).

The lymph system is an essential part of the immune system and important to immune function. Within the lymphatic system the fluid called lymph circulates. Usually a blockage of this pathway causes lymphedema.

Lymphedema typically affects the legs or arms. In certain cases, it can involve both arms, or both legs. Some patients may experience headache, genitals or chest swelling.

Lymphedema is incurable but it can be managed with the proper treatment.

Important facts about lymphedema

Here are some of the primary points about lymphedema. In the main article, there is more explanation and facts to help.

  • Experts believe primary lymphedema is caused by genetic mutation.
  • Secondary lymphedema can be caused by other conditions such as infections and inflammatory diseases.
  • In some cases, lymphedema can lead to skin infections and lymphangitis.
  • Protecting the skin can help reduce the risk of lymphedema.

Treatment

Swelling is a typical symptom of lymphedema and commonly affects legs and arms.
Swelling is a typical symptom of lymphedema and commonly affects legs and arms.

Incurable lymphedema. Treatment can however help to reduce swelling and pain.

Complex decongestive therapy (CDT): This begins with a period of intensive therapy, during which the patient requires regular treatment and preparation. This is followed by the rehabilitation process when enabling the patient to take on their own treatment using the methods they were taught.

The four components of CDT are:

  1. Remedial exercises: These are light exercises aimed at encouraging movement of the lymph fluid out of the limb.
  2. Skincare: Good skincare reduces the risks of skin infections, such as cellulitis.
  3. Manual lymphatic drainage (MLD): The lymphedema therapist uses special massage techniques to move fluid into working lymph nodes, where they are drained. The lymphedema therapist also teaches several massage techniques that can be used during the maintenance phase.
  4. Multilayer lymphedema bandaging (MLLB): Wrapped over muscles surrounding lymph vessels and nodes to help the fluid move through the lymphatic system.

There is no central pump (heart), as opposed to blood circulation. The aim is to use bandages and protective clothing to stabilize the muscles and allow them to transfer fluid out of the part of the body affected. Patients will also be taught how to correctly apply their own bandages and compression garments so MLLB can continue throughout the maintenance time.

Historically, surgery has had poor outcomes compared with non-operative lymphedema treatments. A modern surgical technique using liposuction has turned out to be more effective though. It removes fat from the affected limb which leads to less swelling.

Causes

A CT scan
A CT scan can reveal blocked areas in the lymphatic system contributing to lymphedema.

Mutations can cause primary lymphedema in some of the genes involved in developing the lymphatic system. These defective genes interfere with the production of the lymph system, thereby weakening its capacity to adequately remove fluid.

Secondary lymphedema has many potential causes, including:

  • Cancer surgery: Cancer may spread through the body via the lymphatic system. Sometimes surgeons remove lymph nodes to stop the spread. There is a risk the lymphatic system may be affected, leading to lymphedema.
  • Radiation therapy: The use of radiation to destroy cancerous tissue can sometimes damage nearby healthy tissue, such as the lymphatic system; this can result in lymphedema.
  • Infections: Severe cellulitis infection may damage tissue around the lymph nodes or vessels. This may lead to scarring, increasing the risk of lymphedema. Some parasite infections can also increase the risk of lymphedema.
  • Inflammatory conditions: Conditions that cause tissue to swell (become inflamed) may permanently damage the lymphatic system, such as rheumatoid arthritis and eczema.
  • Cardiovascular diseases: These are diseases that affect blood flow. Some patients with cardiovascular diseases have a higher risk of developing lymphedema, such as DVT (deep vein thrombosis), venous leg ulcers, and varicose veins.
  • Injury and trauma: More rarely, severe skin burns or anything that results in excessive scarring may raise the risk of developing lymphedema.

Symptoms

Lymphedema affects the lymphatic system. This system has three main functions:

  • Draining excess tissue fluid: It balances the fluid in the blood and the fluid in the tissues. This is known as fluid homeostasis.
  • Fighting infection: It provides immunity by assisting the body’s immune defense against foreign bodies, such as bacteria.
  • Absorbing fats: It absorbs lipid nutrients from the intestine and transports them to the blood.

In the long term, a disturbance to the lymphatic system will weaken its ability to properly remove fluid. This can result in excess fluid building up in body sections.

Lymphedema raises the risk of infection and other complications, as lymphocytes are unable to enter areas of the body where swelling takes place.

Types

Two main forms of lymphedema exist:

Primary lymphedema – often called congenital lymphedema. At birth or shortly after puberty the lymphedema is apparent. This form of lymphedema is rare and affects around 1 in every six thousand people.

Secondary lymphedema – caused by something else, such as an illness , accident, trauma, or cancer that affects the lymph system.

Lymphedema may be a side effect of treatment for cancer, such as radiation therapy or the removal of the lymph nodes, which may weaken the lymph system. This type of lymphedema is more common.

Lymphedema symptoms include:

  • swelling of either a part or the whole leg or arm, including the fingers or toes, ranging from slight changes in limb size to severe swelling
  • difficulty wearing jewelry or watches or fitting into clothes or shoes
  • swelling in the head or neck
  • a heavy or tight feeling in the arms or legs
  • the range of motion of the limb is restricted
  • discomfort or aching in the affected limb
  • a tingling sensation in the affected limb, like pins and needles
  • recurring skin infections
  • thickening and hardening of the skin
  • blisters or wart-like growths on the skin
  • severe fatigue

Tests and diagnosis

A doctor may attempt to rule out any potential causes of swelling, including a blood clot or an infection not affecting the lymph nodes.

For example , if the patient is at risk of lymphedema, if they have recently had cancer surgery or treatment that involves the lymph nodes, the doctor might diagnose lymphedema based on the symptoms.

If there isn’t an obvious cause for the lymphedema, some imaging tests may be ordered. To take a closer look at the lymphatic system , the following imaging techniques can be used:

Lymphoscintigraphy may also be used – a radioactive dye is injected into the lymphatic system. The nuclear scanner displays the movement of the dye through the lymphatic system and can detect any blockages.

Exercises

People with lymphedema are advised to follow a healthy lifestyle which includes regular movement and exercise.

In certain situations, however, professional support may be required for safe and successful exercise.

A study found that if they do gentle lifting exercises, women who are at risk of lymphedema after breast cancer surgery would not have a higher risk of lyphedema in the arm. Such exercise can reduce the risk of lymphedema, the researchers add.

The types of exercises that might be useful are the ones that:

  • enhance flexibility
  • practice stretching
  • build strength

Aerobic exercise which focuses on the upper body, helps with weight loss and promotes deep breathing is also recommended.

It should be checked if any heaviness or form changes, texture or other changes in the limb. It may be an indication the current level of exercise is too high.

Experts believe that during exercise , the muscles act as a pump, moving the lymph to areas where it is needed.

But there is still insufficient evidence to support any particular form of lymphedema exercise. Women who have had breast cancer surgery are encouraged to seek out a specialist physical therapist or other health care provider who would be able to help them gradually build up exercise.

Complications

Some problems can be caused by frequent episodes or untreated lymphedema. Including:

Skin infections: Lymphedema is normal with frequent episodes of cellulitis. Cellulite is a bacterial infection of the deeper layers of the skin and the layers of fat and soft tissue under the skin.

Lymphangitis: An inflammation of the lymph vessels may develop and is typically caused by a Streptococcus bacterial infection when infectious. It can spread to the skin and adjacent soft tissues if left untreated, causing cellulitis, or into the bloodstream , causing bacteremia.

Psychological effects: The presence of lymphedema can be impaired and this can have a psychological impact , particularly in those who have had cancer. Lymphedema raises the risk of Depression.

Prevention

The affected limb is more vulnerable to skin infections because there is decreased supply of lymphocytes (which combat infection).

If the patient takes steps to mitigate the risk of skin cuts and grazes, their risk of subsequent infections can be decreased considerably. Might improve with the following measures:

Avoiding hot showers
Avoiding hot showers, steam rooms, and saunas may help prevent symptoms of lymphedema.
  • After cancer treatment, avoid heavy activity with the affected limb; rest it while recovering.
  • Avoid sun beds, steam rooms, and saunas.
  • Do not take very hot baths or showers.
  • Do not wear tight-fitting clothes.
  • Do not wear tight-fitting jewelry.
  • Don’t go barefoot outdoors.
  • Look for changes or breaks in the skin.
  • Keep your skin supple by moisturizing it every day.
  • Make sure footwear fits properly.
  • To prevent developing athlete’s foot, use an anti-fungal foot powder.
  • Use gloves when gardening.
  • Keep nails short.
  • When going outside in an area where there may be insects, use insect repellent.
  • When out in the sun, use a high factor sun block.
  • When you have a cut, treat it immediately with an antiseptic cream. And keep the area clean.
  • Raise the affected limb above the level of the heart whenever possible.
  • Avoid blood pressure checks, blood draws, or injections in the affected limb.

Diet, body weight, and obesity

The heavier a patient is, the greater the stress on swollen areas. A healthy diet aimed at an ideal body weight may help to relieve the lymphedema signs and symptoms.

Outlook

Lymphedema is not cured, it is a progressive condition. To some degree the outlook will depend on the severity of the symptoms.

Following a healthy lifestyle, including a balanced diet and exercise or movement, will help minimize fluid accumulation and promote lymph flow. Seek the advice of your doctor on the right choice for you.

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