Lymphedema is chronic swelling of a body part, most often an arm or leg, and often the unintended consequence of cancer surgery and/or radiation (secondary lymphedema).
For many it is a congenital abnormality (primary lymphedema) presenting at birth, puberty or even mid-life. Lymphedema is often confused with lipedema, an abnormal accumulation of fat cells, which may, over time, develop into a secondary lymphedema or combination lipo/lymphedema.
Lymph vessels are part of a one-way transport system which facilitates the return of tissue fluids back into the bloodstream. Along the way, this fluid is routed through lymph nodes which protect the body from infection and disease by storing and distributing the lymphocytes that attack dangerous pathogens.
Metabolic waste and plasma proteins, which are too large to be returned, or reabsorbed by the venous capillaries, are also filtered via the lymph nodes. Anytime this lymphatic transport mechanism is compromised, whether by surgery, radiation, or congenital deficiency or malformation, stagnation and swelling will develop, proteins will accumulate, and the affected area will be at great risk for infection. The condition is progressive, and left untreated may develop into irreversible fibrosis (hardening of the tissue), chronic infection or loss of limb function, not to mention the deleterious effect on the patient’s overall physical and emotional well-being.
top of page
World-wide, millions of people are afflicted with lymphedema. Some are born with the disease. Symptoms may appear at birth or later in life. This is called primary lymphedema and there is little research into its cause. Secondary lymphedema is often the unintended consequence of life-saving cancer treatments. It is estimated that 3.3 million breast cancer patients in the United States alone will develop lymphedema secondary to radiation or surgery. Everyone who has had cancer treatment that affects the lymph nodes needs to be aware of the possibility of lymphedema.
Treatment is basically the same for any form of lymphedema. Whatever the cause, prompt diagnosis and treatment are essential to prevent the disease from progressing.
top of page
Perhaps the greatest danger is infection. Because lymphedema leads to immune deficiency in the affected limb or area, persons with this disease are increasingly subject to infection, due to the inability of the stagnant lymph system to carry away impurities. Preventing infection is essential because each successive infection can further compromise the lymphatic and immune systems. In the most severe cases, infections can be life threatening.
Left untreated, lymphedema can have other complications. Severe swelling, discomfort, hardening of tissue, damage to skin, or even nerve damage due to the heavy weight of the limb can threaten the usefulness of an arm or leg. In addition, persons with lymphedema may be affected by emotional problems such as depression or anxiety, particularly if they feel isolated and know little about the condition.
top of page
Yes! Of course, nothing in medicine can be predicted with complete certainty, but there are many ways to influence a chronic condition like lymphedema and improve the quality of a patient’s life, health, and emotional well-being.
top of page
Since the introduction of CDT (Combined Decongestive Therapy) in North America, the medical community has been able to offer effective treatment for this condition. Daily CDT treatment by a skilled therapist consists of manual lymph drainage, compression bandaging, remedial exercise and skin care. This regimen usually extends over a three to four week period. Once the swelling has been reduced and is considered stable, the patient is measured for a compression garment which he or she will continue to wear as long as recurrent swelling is a possibility.
Although this type of treatment has proved very successful, lymphedema therapists and educators are discovering the vital role of patient education in the prevention and management of this condition, as there is no “cure” and long term maintenance inevitably becomes the responsibility of the patient. Those patients who have the opportunity to learn the basic anatomy and physiology of the lymphatic system better understand the risks and their own condition, and they are more willing to make the commitment to learn and implement self-care techniques.
With daily self-care practices, the likelihood of recurrence and/or infection is greatly reduced and patients have the peace of mind that comes with knowing they can keep the condition under control.
top of page
It is important for any patient undergoing cancer treatment or anyone with a family history of primary lymphedema to understand the principles of lymphatic return. If normal lymph transport capacity is ten times greater than normal lymph load (the accumulation of tissue fluid not reabsorbed by the venous capillaries), the body can quickly recover from traumatic injury or swelling. If the transport capacity is permanently compromised, for any reason, and this ten to one ratio decreases, the likelihood of developing chronic lymphedema increases.
A patient may remain in the latency stage of lymphedema for years following the initial insult until something as minor as a mosquito bite or an airplane ride pushes them “over the edge” and the swelling becomes obvious.There are self-care techniques which can help restore lost transport capacity. The well-informed patient who is willing to explore and implement these safeguards is more likely to discover lymphedema does not need to control their life.