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Lymphedema

Lymphedema

Definition

The lymph system is a series of organs, vessels, nodes, and fluids. This system creates and carries fluids that play an important role in the immune system and maintaining the balance of fluids in the tissue. Lymphedema is a build up of fluid normally transported by the lymph system. The fluid build up leads to swelling in the affected area. While lymphedema occurs most often in the arms and legs, it can eventually spread to the core of the body and head. Lymphedema can range from mild swelling to swelling that dramatically increases the size of the limb and causes skin discoloration.

Damaged Lymph Nodes
damaged lymph
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Causes

Lymphedema is caused by defect, damage, or infection of an area in the lymph system.

Primary lymphedema is caused by defects of the lymph nodes or lymph vessels. The structures may be missing or may not work properly. Though the defects are present from birth, lymphedema may not develop until later in life. Conditions associated with primary lymphedema include:

  • Milroy’s disease
  • Meige disease

Secondary lymphedema develops when there is injury, infection, or nearby growth that blocks the flow of fluids in the lymph nodes or lymph vessels. It may be caused by medical conditions, medical treatments, or trauma.

Planned Lymph Removal for Cancer Treatment
lymph nodes to be removed
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Risk Factors

Lymphedema is more common in older adults.

Medical treatments or conditions that may increase your risk of lymphedema include:

  • Surgery that includes the removal of lymph nodes—common in cancer-related surgeries
  • Radiation therapy for cancer
  • Cancer
  • Infections—especially infections caused by parasites such as filariasis
  • Burns
  • Obesity—may increase risk of lymphedema after breast cancer surgery
  • Immobility

Symptoms

Symptoms of lymphedema include:

  • Swelling in arms, legs, fingers, or toes
  • Clothes, shoes, or jewelry may begin to feel tight even though there is no weight change
  • Heaviness in one or more limbs
  • Changes in skin such as a feeling of tightness, hardening, or reddening of the skin
  • Loss in range of motion and flexibility in nearby joints
  • Aching, pain, discomfort, or tingling in the limb

Lymphedema can also lead to complications like a breakdown of the skin, infections of the skin, or massive changes in the size and shape of the limb.

Diagnosis

The doctor will ask about any symptoms and medical history. A physical exam will be done. The degree of swelling can be tested by pressing a finger into the swollen area. The indent in the skin will indicate the severity of swelling. Measurements will also be taken around the affected limb and compared to the healthy limb. The doctor may diagnose lymphedema based on the swelling and appearance of the skin and medical history.

If the cause of swelling is unclear, the doctor may want to do further testing. Image tests may help to determine the cause of the lymphedema. Tests may include:

  • MRI scan
  • CT scan
  • Duplex ultrasound or Doppler ultrasound

Lymphangiography is a test that uses a radioactive dye to create images of the lymph system but it is rarely used.

Treatment

Treatment will depend on the severity and cause of lymphedema. Some causes may respond to treatment and stop causing lymphedema, but most will have a continued risk of lymphedema. Initial treatment may require more intensive treatment over a few weeks. A long-term plan will be developed once initial goals are reached. Long-term plans will include understanding factors that may worsen swelling . Managing lymphedema flare up early may prevent complications.

Options to treat lymphedema itself and prevent complications include the following:

Prevention

Doctors or physical therapists will work with you if you are at risk for developing lymphedema because of medical treatments or conditions. Certain lifestyle changes and monitoring may prevent the development of lymphedema. If you had lymph nodes in your armpit removed during cancer surgery, a strength and physical activity program in recovery may help prevent lymphedema.

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