Lymphedema or lymphatic obstruction is a long-term condition where excess fluid builds up in the tissues causing swelling (edema). There are two main types: primary lymphedema and secondary lymphoedema; each is explained below.
The lymphatic system is a part of the circulatory system and is vital for immune function. A blockage of this system causes lymphedema.
Lymphedema commonly affects one of the arms or legs. In some cases, both arms or legs may be affected. Some patients may experience swelling of the head, genitals, or chest.
Lymphedema is incurable. However, with proper treatment, it can be controlled.
General data on lymphedema, these are some key points:
- Experts believe that a genetic mutation causes primary lymphedema.
- Secondary lymphedema can be caused by other conditions such as infections and inflammatory diseases.
- In some cases, lymphedema can lead to skin infections and lymphangitis.
- Skin protection can help reduce the risk of lymphedema.
What is the lymphatic system?
The lymphatic system has three main functions:
- Excess drainage of tissue fluid maintains the balance of fluid in the blood versus tissues (homeostasis of fluids).
- Fight against infection – the system provides immunity by helping the body’s immune defense against foreign bodies, such as bacteria.
- Fat absorption – the lymphatic system absorbs the lipid nutrients from the intestine and transports them to the blood.
An interruption in the lymphatic system can undermine its ability to drain fluid properly, resulting in excess fluid in parts of the body.
Patients with lymphoma have an increased risk of complications from the infection because their lymphocytes can not reach the parts of the body where the swelling occurs.
There are two main types of lymphedema:
For example, a doctor evaluating a swollen foot will see whether or not there is a relationship with lymphedema. Well, swelling is a typical symptom of lymphedema and commonly affects the legs and arms.
- Primary lymphedema: often called congenital lymphedema. This type of lymphedema is evident at birth or shortly after puberty. However, this type of lymphedema is rare, affecting approximately 1 in 6,000 people worldwide.
- Secondary lymphoedema: this type of lymphedema occurs as a result of another pathology, as well as an infection, injury, trauma, or cancer that is affecting the lymphatic system.
Also, lymphedema may be a side effect of cancer treatment, such as radiation therapy or removing some lymph nodes, which can damage the lymphatic system.
This type of lymphedema is more common. There are more affected women than men.
Other symptoms include:
The swelling of a part or all of the leg or arm may also include the fingers or toes. Some patients experience only slight changes in the size of the limbs, while others have severe swelling.
- Some people may have difficulty wearing jewelry, watches, clothing, or shoes.
- Sometimes the head or neck may swell.
- The arm or leg feels heavy or tight.
- The range of movement of the limb is restricted (the affected limb loses part of its mobility).
- Discomfort or pain in the affected limb.
- There may be a tingling sensation in the affected limb.
- Recurrent skin infections may occur.
- The skin may thicken and harden; blisters or growths similar to warts can develop on the skin.
- Severe fatigue
Tests and diagnosis for lymphedema
A doctor will rule out other possible swelling causes, including a blood clot or an infection that does not affect the lymph nodes.
If the patient is at risk for lymphedemas, such as having recently had cancer surgery or lymph node treatment, the doctor can diagnose lymphedema based on the symptoms.
Some imaging tests may be ordered if there is no apparent cause for lymphedema. The following imaging techniques can be used to take an in-depth look at the lymphatic system:
- Magnetic resonance
- Computed tomography
- Doppler ultrasound
Lymphoscintigraphy can also be used – a radioactive dye is injected into the lymphatic system. The scanner tracks the movement of the paint through the lymphatic system and identifies any blockage.
Lymphedema is incurable. However, treatment can help reduce swelling and pain.
Complex decongestive therapy (CDT) – begins with an intensive therapy phase, during which the patient receives daily treatment and training.
This is followed by the maintenance phase, when the patient is encouraged to take charge of their care using techniques that have been taught.
The four components of this therapy are:
- Recovery exercises: these are light exercises designed to stimulate the movement of the lymphatic fluid outside the limb.
- Skincare: good skincare reduces the risks of skin infections, such as cellulite.
- Lymphatic drainage manual: the lymphedema therapist uses special massage techniques to move fluid to work lymph nodes, where they drain. The lymphedema therapist also teaches several massage techniques that can be used during the maintenance phase.
- Multilayer lymphedema bandage: The muscles surrounding the lymphatic vessels and the nodes move the fluid through the lymphatic system. Like blood circulation, there is no central pump (heart).
The goal is to use bandages and compression garments to support the muscles and encourage them to move the fluid out of the affected part of the body.
Patients will also be taught how to apply their bandages and compression garments correctly to continue during the maintenance period.
Surgery has historically had disappointing results compared to non-surgical therapies for lymphedema.
However, a new surgical technique with liposuction has proven more successful. Removes fat from the affected limb, resulting in minor swelling.