Lymphedema
Overview:
Lymphedema refers to tissue swelling caused by an accumulation of protein-rich fluid that’s usually drained through the body’s lymphatic system. It most commonly affects the arms or legs, but can also occur in the chest wall, abdomen, neck, and genitals.
Lymph nodes are an important part of your lymphatic system. Lymphedema can be primary or secondary.
Primary: This can be genetic – hypoplasia, hyperplasia, or underdeveloped lymph nodes.
Secondary: Lymphedema can be caused by cancer treatments that remove or damage your lymph nodes. Any type of problem that blocks the drainage of lymph fluid can cause lymphedema.
Severe cases of lymphedema can affect the ability to move the affected limb, increase the risks of skin infections and sepsis, and can lead to skin changes and breakdown. Treatment involves complete decongestive therapy, which includes patient education and evaluation, manual lymphatic drainage, multi-layer compression bandaging, controlled exercises, compression garments, sequential pneumatic pumping, skin care tip, wound care, rarely, surgery to remove swollen tissue or to create new drainage routes.
Signs and Symptoms:
- Swelling of part or all of the arm or leg, including fingers or toes
- A feeling of heaviness or tightness
- Restricted range of motion
- Recurring infections
- Hardening and thickening of the skin (fibrosis)
Causes
The lymphatic system comprises a network of vessels responsible for transporting protein-rich lymph fluid throughout the body and plays a vital role in the immune system. Lymph nodes serve as filters housing cells that combat infections and cancer.
Muscular contractions, occurring during daily activities, along with small pumps within the lymph vessel walls, propel lymph fluid through the lymphatic vessels. Lymphedema arises when lymph vessels fail to efficiently drain lymph fluid, typically in the limbs.
Lymphedema primarily stems from several common causes:
Cancer: When cancer cells obstruct lymph vessels, lymphedema can occur. For example, a tumor near a lymph node or lymph vessel might grow large enough to impede lymph fluid flow.
Radiation therapy for cancer: Radiation treatment can lead to scarring and inflammation of lymph nodes or lymph vessels.
Surgery: In cancer surgeries, lymph nodes are frequently removed to assess disease spread, but this does not always result in lymphedema.
Parasitic infections: In tropical regions of developing countries, threadlike worms causing lymph node blockages are the leading cause of lymphedema.
In rarer cases, lymphedema develops due to inherited conditions that affect the proper development of the lymphatic system.
Lymphedema complications may include:
- Skin infections (cellulitis). The trapped fluid provides fertile ground for germs, and the smallest injury to the arm or leg can be an entry point for infection. Affected skin appears swollen and red and is typically painful and warm to the touch. Your doctor may prescribe antibiotics to keep on hand so that you can start taking them immediately.
- Sepsis. Untreated cellulitis can spread into the bloodstream and trigger sepsis — a potentially life-threatening condition that occurs when the body’s response to an infection damages its own tissues. Sepsis requires emergency medical treatment.
- Leakage through the skin. With severe swelling, the lymph fluid can drain through small breaks in the skin or cause blistering.
- Skin changes. In some people with very severe lymphedema, the skin of the affected limb can thicken and harden so it resembles the skin of an elephant.
- Cancer. A rare form of soft tissue cancer can result from the most-severe cases of untreated lymphedema.