I hope this page will to help you
understand more about lymphedema. Our lymphatic system has the pressure of
thousands of tiny hearts which pump lymph fluid throughout our bodies, most
often in the arm(s) and/or leg(s). When the flow of this fluid is interrupted or
impaired, swelling of the tissues and other problems can result.
Lymphedema can develop when lymphatic vessels are missing or impaired (primary),
or when lymph vessels are damaged or lymph nodes removed (secondary).
Some individuals may acquire
lymphovenous disorders as a result of the removal of lymph nodes during surgery
or through damage to the nodes and lymphatic vessels following radiation used in
the treatment of cancer. Other causes may include trauma to the limb or
parasitic infiltration of the lymph nodes and vessels (such as lymphatic
filariasis).
When the impairment becomes so
great that the lymphatic fluid exceeds the lymphatic transport capacity, an
abnormal amount of protein-rich fluid collects in the tissues of the affected
area. Left untreated, this stagnant, protein-rich fluid not only causes tissue
channels to increase in size and number, but also reduces oxygen availability in
the transport system, interferes with wound healing, and provides a culture
medium for bacteria that can result in lymphangitis (infection).
Lymphedema should not be confused
with edema resulting from venous insufficiency, which is not lymph-edema.
However, untreated venous insufficiency can progress into a combined
venous/lymphatic disorder which is treated in the same way as lymphedema.
What
Causes Lymphedema?
Primary
lymphedema, which can affect from one to as many as four limbs and/or
other parts of the body, can be present at birth, develop at the onset of
puberty or in adulthood, all from unknown causes, or associated with vascular
anomalies such as hemangioma, lymphangioma, or Port Wine Stain.
Secondary
lymphedema, or acquired lymphedema, can develop as a result of
surgery, radiation, infection or trauma. Specific surgeries, such as vulva
cancer, surgery for melanoma or breast, gynecological, head and neck, prostate
or testicular, bladder or colon cancer, all of which currently require removal
of lymph nodes, put patients at risk of developing secondary lymphedema. If
lymph nodes are removed, there is always a risk of developing lymphedema.
Secondary lymphedema can develop
immediately post-operatively, or weeks, months, even years later. It can also
develop when chemotherapy is unwisely administered to the already affected area
(the side on which the surgery was performed) or after repeated aspirations of a
seroma (a pocket of fluid which occurs commonly post-operatively) in the axilla,
around the breast incision, or groin area. This often causes infection and,
subsequently, lymphedema.
Aircraft flight has also been
linked to the onset of lymphedema in patients post-cancer surgery (due to the
decreased cabin pressure).
TIP:
Always be sure to wear a compression garment (sleeve, stocking) when you fly,
even if you do not have lymphedema. Also always get up and move around on those
long flights.
Another cause of lower extremity
lymphedema is that resulting from the use of Tamoxifen. This medication has been
linked to blood clots and subsequent DVT (deep venous thrombosis).
Radiation therapy, used in the
treatment of various cancers and some AIDS-related diseases (such as
Kaposi-Sarcoma), can damage otherwise healthy lymph nodes and vessels, causing
scar tissue to form which interrupts the normal flow of the lymphatic fluid.
Radiation can also cause skin dermatitis or a burn similar to sunburn. It is
important to closely monitor the radiated area for any skin changes, such as
increased temperature, discoloration (erythema) or blistering which can lead
into the development of lymphedema. Be sure to keep the area soft with lotion
recommended by your radiation oncologist.
TIP: Glaxal
Base cream is pure with no perfumes added. It's great for post radiation
dryness and wounds.
Lymphedema can develop secondary
to lymphangitis (an infection) which interrupts normal lymphatic pathway
function. A severe traumatic injury in which the lymphatic system is interrupted
and/or damaged in any way may also trigger the onset of lymphedema. Although
extremely rare in developed countries, there is a form of lymphedema called
Filariasis.
Symptoms
of Lymphedema
Lymphedema can develop in any
part of the body or limb(s). Signs or symptoms of lymphedema to watch out for
include: a full sensation in the limb(s), skin feeling tight, decreased
flexibility in the hand, wrist or ankle, difficulty fitting into clothing in one
specific area, or ring/wristwatch/bracelet tightness. If you notice persistent
swelling, it is very important that you seek immediate
medical advice, as early diagnosis and treatment improves both the
prognosis and the condition.
Stages
Lymphedema develops in a
number of stages:
Mild to Severe (referred to as Stage 1, 2 and 3:
STAGE 1 (spontaneously
reversible):
Tissue is still at the
"pitting" stage, which means that when pressed by fingertips, the area
indents and holds the indentation. Usually, upon waking in the morning, the
limb(s) or affected area is normal or almost normal size.
Stage 2 (spontaneously
irreversible):
The tissue now has a spongy
consistency and is "non-pitting," meaning that when pressed by
fingertips, the tissue bounces back without any indentation forming). Fibrosis
found in Stage 2 lymphedema marks the beginning of the hardening of the limbs
and increasing size.
Stage 3 (lymphostatic
elephantiasis):
At this stage the swelling is
irreversible and usually the limb(s) is/are very large. The tissue is hard
(fibrotic) and unresponsive; some patients consider undergoing reconstructive
surgery called "debulking" at this stage.
When lymphedema remains
untreated, protein-rich fluid continues to accumulate, leading to an increase of
swelling and a hardening or fibrosis of the tissue. In this state, the swollen
limb(s) becomes a perfect culture medium for bacteria and subsequent recurrent
lymphangitis (infections). Moreover, untreated lymphedema can lead into a
decrease or loss of functioning of the limb(s), skin breakdown, chronic
infections and, sometimes, irreversible complications. In the most severe cases,
untreated lymphedema can develop into a rare form of lymphatic cancer called
Lymphangiosarcoma (most often in secondary lymphedema).
Your
Immune System
Your body’s lymphatic system is part of your
immune system, which protects you against infection and disease. It includes
your spleen, thymus, bone marrow, lymph nodes and lymph channels, as well as
your tonsils and adenoids.
Lymphangitis (Infection)
Signs and symptoms of
lymphangitis (infection) may include some or all of the following: rash, red
blotchy skin, itching of the affected area, discoloration, increase of swelling
and/or temperature of the skin, heavy sensation in the limb (more so than
usual), pain, and in many cases a sudden onset of high fever and chills.
Treatment for infections: Contact
your physician as soon as possible.
A prescription of antibiotics will be given.
TIP: Always carry antibiotics or a prescription with you when you
travel.
Treatments
for Lymphedema
Planning the treatment program
depends on the cause of the lymphedema. For example: If the initial signs and
symptoms of swelling are caused by infection (redness, rash, heat, blister or
pain may indicate an infection), antibiotics will first need to be prescribed.
Treating an infection often reduces some of the swelling and discoloration.
If the lymphedema is not caused
by infection: Depending on the severity of the lymphedema, the recommended
treatment plan should be determined.
Click
here to view images of the lymphatic system and lymph nodes
While no cure currently exists,
there are a range of options available which can keep the swelling under
control, reducing the possibility of infection and secondary skin change. These
options can also help to maintain the motion and function of the affected limbs.
They include:
A) REDUCTION OF SWELLING (techniques used to push lymphatic fluid out of
the affected limb(s):
