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 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 may include compression bandages, massage, compression stockings, sequential pneumatic pumping, careful skin care and, rarely, surgery to remove swollen tissue or to create new drainage routes.

Symptoms

Lymphedema signs and symptoms include:

• 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)

Signs and symptoms can range from mild to severe. Lymphedema caused by cancer treatment may not occur until months or years after treatment.

Treatment

There's no cure for lymphedema. Treatment focuses on reducing the swelling and preventing complications.

Medications

Lymphedema greatly increases the risk of skin infections (cellulitis). Your doctor may prescribe antibiotics for you to keep on hand so that you can start taking them immediately once symptoms appear.

When to see a doctor

Make an appointment with your doctor if you notice persistent swelling in your arm or leg. If you've already been diagnosed with lymphedema, see your doctor if there is a sudden dramatic increase in the size of the involved limb.

Causes

The lymphatic system is a network of vessels that carry protein-rich lymph fluid throughout the body. It's part of your immune system. Lymph nodes act as filters and contain cells that fight infection and cancer.

The lymph fluid is pushed through the lymph vessels by muscle contractions as you move through the tasks of your day and small pumps in the wall of the lymph vessels. Lymphedema occurs when the lymph vessels are not able to adequately drain lymph fluid, usually from an arm or leg.

The most common causes of lymphedema include:

Cancer. If cancer cells block lymph vessels, lymphedema may result. For instance, a tumor growing near a lymph node or lymph vessel could enlarge enough to block the flow of the lymph fluid.

Radiation treatment for cancer. Radiation can cause scarring and inflammation of lymph nodes or lymph vessels.

Surgery. In cancer surgery, lymph nodes are often removed to see if the disease has spread. However, this doesn't always result in lymphedema.

Parasites. In developing countries in the tropics, the most common cause of lymphedema is infection with threadlike worms that clog the lymph nodes.

Less commonly, lymphedema results from inherited conditions in which the lymphatic system doesn't develop properly.

Risk factors

Factors that may increase the risk of developing lymphedema include:

• Older age
• Excess weight or obesity
• Rheumatoid or psoriatic arthritis

Complications

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.

Diagnosis

If you're at risk of lymphedema — for instance, if you've recently had cancer surgery involving your lymph nodes — your doctor may diagnose lymphedema based on your signs and symptoms.

If the cause of your lymphedema isn't as obvious, your doctor may order imaging tests to get a look at your lymph system. Tests may include:

MRI scan. Using a magnetic field and radio waves, an MRI produces 3D, high-resolution images of the involved tissue.

CT scan. This X-ray technique produces detailed, cross-sectional images of the body's structures. CT scans can reveal blockages in the lymphatic system.

Ultrasound. This test uses sound waves to produce images of internal structures. It can help find obstructions within the lymphatic system and vascular system.

Lymphoscintigraphy. During this test, the person is injected with a radioactive dye and then scanned by a machine. The resulting images show the dye moving through the lymph vessels, highlighting blockages.

Therapy

Specialized lymphedema therapists can teach you about techniques and equipment that can help reduce lymphedema swelling. Examples include:

Exercises. Gentle contraction of the muscles in the arm or leg can help move the excess fluid out of the swollen limb.

Manual lymph drainage. Therapists trained in this massage-like technique use very light pressure to move the trapped fluid in the swollen limb toward an area with working lymph vessels. People should avoid manual lymph drainage if they have a skin infection, blood clots or active cancer in the affected limb.

Compression bandages. Using low-stretch bandages to wrap the entire limb encourages lymph fluid to flow back toward the trunk of the body.

Compression garments. Close-fitting elastic sleeves or stockings can compress the arm or leg to encourage lymph fluid drainage. These garments often require a prescription to ensure that the proper amount of compression is used. You may need to be measured by a professional to ensure proper fit.

Sequential pneumatic compression. A sleeve worn over the affected arm or leg connects to a pump that intermittently inflates the sleeve, putting pressure on the limb and moving lymph fluid away from the fingers or toes.

Preparing for your appointment

Here's some information to help you get ready for the appointment with your doctor.

What you can do

List the following:

• Your symptoms, including any that may seem unrelated to the reason for which you scheduled the appointment
• Key personal information, including major illnesses or trauma, cancer treatments or recent life changes
• Medications, vitamins and supplements you take

Questions to ask the doctor

For lymphedema, some basic questions to ask the doctor include:

• What's the likeliest cause of this swelling?
• Could there be another cause?
• What tests do I need? Do these tests require special preparation?
• Is the swelling temporary or long lasting?
• What's the treatment for lymphedema?
• Are there alternatives to the approach you're suggesting?
• Are there medications to ease the swelling?
• I have other health conditions. How can I best manage them together?
• Do I need to restrict my diet or activities?
• Do you have brochures or other printed material that I can take? What websites do you recommend?

What to expect from the doctor

Your doctor is likely to ask you a number of questions, such as:

• When did the swelling begin?
• Did anything precede the swelling, such as surgery, trauma, radiation therapy or new medications?
• Do you have other signs or symptoms?
• Has the swelling been continuous or occasional?
• Does anything seem to make the swelling better?
• Does anything seem to worsen the symptoms?
• What have you tried to treat the edema, and how did it work?

Is lymphedema a cancer?

Lymphedema is a common cancer treatment side effect that can cause swelling in a patient's arm or leg. It may lead to discomfort, pain and infection. It may make it difficult for patients to find clothes that fit. Lymphedema can also lead to skin infections.

What are the four stages of lymphedema?

Stages

Stage 1: Abnormal flow in the lymphatic system. No signs or symptoms.

Stage 2: Accumulation of fluid with swelling. ...

Stage 3: Permanent swelling that does not resolve with elevation. ...

Stage 4: Elephantiasis (large deformed limb), skin thickening with “wart-like” growth and extensive scarring.

Why is lymphedema so painful?

Lymphedema occurs after several lymph nodes are removed, or in the natural absence or impairment of them. The lymphatic systems of some patients can no longer manage the fluid, which builds up and collects in the arm or other areas of the body, causing swelling and pain.

What foods help with lymphedema?

Choose grilled or baked lean proteins, like fish or poultry, and use higher fat meat, like beef and pork, sparingly. Also consider low-sugar Greek yogurt and cottage cheese for versatile lean proteins. Choose carbs like sweet potatoes, beans, brown rice and oatmeal, which have fiber.

What is the best exercise for the lymphatic system?

3 simple exercises that stimulate the lymphatic system

1 - Breathing squats - 20 reps. Inhale as you raise your arms up. Exhale, lightly draw in your pelvic floor and squat down. TIPS. ...

2 - Calf raises - 20 reps. Press the feet into the floor in order to rise up onto the toes. TIPS.