What is Lymphedema?
Lymphedema, also known as lymphoedema and lymphatic edema, is a condition of localized, high-protein fluid retention and tissue swelling just under the skin caused by a compromised lymphatic system.
Normally, the lymphatic system located just under the skin, returns interstitial fluid to the thoracic duct, then the bloodstream, however, when this lymphatic drainage system is compromised or impaired, lymphedema may occur.
The condition can be inherited or can be caused by a birth defect, though it is frequently caused by surgical procedures, cancer treatments and by parasitic infections.
Though incurable and progressive, a number of treatments can manage symptoms. Tissues with lymphedema are at high risk of infections and wounds.
References:
1. Brorson H, Ohlin K, Olsson G, Svensson B, Svensson H (June 2008). "Controlled compression and liposuction treatment for lower extremity lymphedema". Lymphology. 41(2): 52–63. PMID 18720912.
2. Jeannie Burt; Gwen White (1 January 2005). Lymphedema: A Breast Cancer Patient's Guide to Prevention and Healing. Hunter House. p. 9. ISBN 978-0-89793-458-9.
3. http://www.nhs.uk/ipgmedia/national/Lymphoedema%20Support%20Network/Assets/BreastandTruncalOedemaLSN8pages.pdf
4. Kissin MW, Querci della Rovere G, Easton D, Westbury G (July 1986). "Risk of lymphoedema following the treatment of breast cancer". Br J Surg. 73 (7): 580–4. doi:10.1002/bjs.1800730723. PMID 3730795.
5. Segerström K, Bjerle P, Graffman S, Nyström A (1992). "Factors that influence the incidence of brachial oedema after treatment of breast cancer". Scand J Plast Reconstr Surg Hand Surg. 26 (2): 223–7. doi:10.3109/02844319209016016. PMID 1411352.
Signs and Symptoms:
Lymphedema can develop in any part of the body, and it typically occurs in the part of the body that is “drained” by lymph vessels / nodes for that specific area. For example, if you had lymph nodes removed under your arm (axillary lymph nodes), you could develop lymphedema in the chest, back, or arm on that same side.
Lymphedema typically begins at the farthest part of the limb (hand/wrist or foot / ankle) but you should monitor all areas of your body that appear with uneven or asymetrical swelling.
Signs or symptoms of lymphedema include a full or heavy sensation in the limb(s), tightness of the skin or tissue, decreased flexibility in the hand / wrist / foot / ankle, difficulty fitting into clothing in one specific area, or ring / wristwatch / bracelet tightness.
If you notice swelling in an area, call your physician. Even if the swelling goes away—you could be experiencing an early sign of lymphedema. Early treatment minimizes the symptoms and can improve the outcome.
Causes of Lymphedema:
Lymphedema affects approximately 140 million people worldwide.1
Lymphedema may be inherited (primary) or caused by injury to the lymphatic vessels (secondary). It is most frequently seen after lymph node dissection, surgery and / or radiation therapy, in which damage to the lymphatic system is caused during the treatment of cancer, most notably breast cancer. In many patients with cancer, this condition does not develop until months or even years after therapy has concluded. Lymphedema may also be associated with accidents or certain diseases or problems that may inhibit the lymphatic system from functioning properly. In tropical areas of the world, a common cause of secondary lymphedema is filariasis, a parasitic infection. It can also be caused by a compromising of the lymphatic system resulting from cellulitis.
While the exact cause of primary lymphedema is still unknown, it generally occurs due to poorly developed or missing lymph nodes and/or channels in the body. Lymphedema may be present at birth, develop at the onset of puberty (praecox), or not become apparent for many years into adulthood (tarda). In men, lower-limb primary lymphedema is most common, occurring in one or both legs. Some cases of lymphedema may be associated with other vascular abnormalities.
Secondary lymphedema affects both men and women. In women, it is most prevalent in the upper limbs after breast cancer surgery, in particular after axillary lymph node dissection,2 occurring in the arm on the side of the body in which the surgery is performed. Breast and trunk lymphedema can also occur but, go unrecognised as there is swelling in the area after surgery and its symptoms ( peau d' orange and/or an inverted nipple ) can be confused with post surgery fat necrosis. 3 In Western countries, secondary lymphedema is most commonly due to cancer treatment.1 Between 38 and 89% of breast cancer patients suffer from lymphedema due to axillary lymph node dissection and/or radiation.1,4,5 Unilateral lymphedema occurs in up to 41% of patients after gynecologic cancer.1,6 For men, a 5-66% incidence of lymphedema has been reported in patients treated with incidence depending on whether staging or radical removal of lymph glands was done in addition to radiotherapy.1,7,8
Head and neck lymphedema can be caused by surgery or radiation therapy for tongue or throat cancer. It may also occur in the lower limbs or groin after surgery for colon, ovarian or uterine cancer, in which removal of lymph nodes or radiation therapy is required. Surgery or treatment for prostate, colon and testicular cancers may result in secondary lymphedema, particularly when lymph nodes have been removed or damaged.
The onset of secondary lymphedema in patients who have had cancer surgery has also been linked to aircraft flight (likely due to decreased cabin pressure or relative immobility). For cancer survivors, therefore, wearing a prescribed and properly fitted compression garment may help decrease swelling during air travel.
Some cases of lower-limb lymphedema have been associated with the use of tamoxifen, due to the blood clots and deep vein thrombosis (DVT) that can be caused by this medication. Resolution of the blood clots or DVT is needed before lymphedema treatment can be initiated.
