Lymphedema: symptoms, treatments, and causes


Lymphedema: symptoms, treatments, and causes

Lymphedema, or lymphatic obstruction, is a long-term condition where excess fluid collects in tissues causing swelling (edema).

The lymphatic system is a part of the circulatory system and vital for immune function. Lymphedema is caused by a blockage of this system.

Lymphedema commonly affects one of the arms or legs. In some cases, both arms or both legs may be affected. Some patients might experience swelling in the head, genitals, or chest.

Lymphedema is incurable. However, with the right treatment, it can be controlled.

Here are some key points about lymphedema. More detail and supporting information is in the main article.

  • Experts believe primary lymphedema is caused by genetic mutation.
  • 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.
  • Protecting the skin can help reduce the risk of lymphedema.

What is the lymphatic system?

The lymphatic system has three main functions:

  1. Draining excess tissue fluid - this maintains the balance of fluid in the blood versus the tissues (fluid homeostasis).
  2. Fighting infection - the system provides immunity by assisting the body's immune defense against foreign bodies such as bacteria.
  3. Absorption of fats - the lymphatic system absorbs lipid nutrients from the intestine and transports them to the blood.

A disruption to the lymphatic system can eventually undermine its ability to drain fluid properly, resulting in excess fluid in parts of the body. Patients with lymphoma have a higher risk of infection complications because their lymphocytes cannot reach parts of the body where swelling occurs.

Symptoms of lymphedema

There are two main types of lymphedema:

Swelling is a typical symptom of lymphedema and commonly affects legs and arms.

Primary lymphedema - often called congenital lymphedema. The lymphedema is evident at birth or shortly after puberty. This type of lymphedema is rare, affecting approximately 1 in every 6,000 people.

Secondary lymphedema - the lymphedema occurs as a result of something else, such as an infection, injury, trauma, or cancer that affects the lymphatic system.

Lymphedema may be a side effect of cancer treatment, such as radiation therapy or the removal of some lymph nodes, which can damage the lymphatic system. This type of lymphedema is more common. More women are affected than men.

Lymphedema symptoms include:

  • Swelling of either a part or the whole leg or arm may also include the fingers or toes. Some patients experience just slight changes in limb size, while others have severe swelling.
  • Some people may find it difficult to wear jewelry, watches, or fit into clothes or shoes.
  • Sometimes the head or neck may swell.
  • The arm or leg feels heavy or tight.
  • The range of motion of the limb is restricted (affected limb loses some of its mobility).
  • Discomfort or aching in the affected limb.
  • There may be a tingling sensation in the affected limb, much like pins and needles.
  • Recurring skin infections.
  • The skin may thicken and harden; blisters or wart-like growths may develop on the skin.
  • Severe fatigue.

Tests and diagnosis for lymphedema

A doctor will try to rule out other possible causes of swelling, including a blood clot or an infection that does not involve the lymph nodes.

If the patient is at risk of lymphedema, for instance, if they recently had cancer surgery or treatment involving the lymph nodes, the doctor may diagnose lymphedema based on the symptoms.

If there isn't an obvious cause for the lymphedema, some imaging tests may be ordered. The following imaging techniques may be used to have an in-depth look at the lymphatic system:

  • MRI scan
  • CT scan
  • Doppler ultrasound scan

Lymphoscintigraphy may also be used - a radioactive dye is injected into the lymphatic system. The scanner follows the dye's movement through the lymphatic system and identifies any blockages.

Treatments for lymphedema

Lymphedema is incurable. However, treatment can help reduce the swelling and pain.

Compression stockings work to encourage the movement of lymph out of an affected limb.

Complex Decongestive Therapy (CDT) - this starts 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 over their own care using techniques that they have been taught.

The four components of CDT are:

  1. Remedial exercises - these are light exercise aimed at encouraging movement of the lymph fluid out of the limb.
  2. Skincare - good skincare reduces the risks of skin infections, such as cellulitis.
  3. MLD (manual lymphatic drainage) - the lymphedema therapist uses special massage techniques to move fluid into working lymph nodes, where they are drained. The lymphedema therapist also teaches several massage techniques that can be used during the maintenance phase.
  4. MLLB (multilayer lymphedema bandaging) - muscles surrounding lymph vessels and nodes move the fluid through the lymphatic system.

Unlike the circulation of blood, there is no central pump (heart). The aim is to use bandages and compression garments to support the muscles and encourage them to move fluid out of the affected body part. Patients will also be taught how to apply their own bandages and compression garments correctly so that MLLB can continue during the maintenance period.

Surgery has historically had disappointing results compared with non-surgical therapies for lymphedema. However, a new surgical technique using liposuction has proved more successful. It removes fat from the affected limb, resulting in less swelling.

Causes of lymphedema

A CT scan can reveal blocked areas in the lymphatic system contributing to lymphedema.

Causes of primary lymphedema - experts say it is caused by mutations in some of the genes involved in the development of the lymphatic system. These faulty genes interfere with the lymphatic system's development, undermining its ability to drain fluid properly.

Causes of secondary lymphedema - this type of lymphedema has a number of possible causes, including:

  • Cancer surgery - cancer may spread through the body via the lymphatic system. Sometimes surgeons remove lymph nodes to stop the spread. There is a risk the lymphatic system may be affected, leading to lymphedema.
  • Radiation therapy (radiotherapy) - the use of radiation to destroy cancerous tissue can sometimes damage nearby healthy tissue, such as the lymphatic system; this can result in lymphedema.
  • Infections - severe cellulitis infection may damage tissue around the lymph nodes or vessels. This may lead to scarring, increasing the risk of lymphedema. Some parasite infections can also increase the risk of lymphedema.
  • Inflammatory conditions - conditions that cause tissue to swell (become inflamed) may permanently damage the lymphatic system, such as rheumatoid arthritis, dermatitis, and eczema.
  • Cardiovascular diseases - these are diseases that affect blood flow. Some patients with cardiovascular diseases have a higher risk of developing lymphedema, such as DVT (deep vein thrombosis), venous leg ulcers, and varicose veins.
  • Injury and trauma - more rarely, severe skin burns or anything that results in excessive scarring may raise the risk of developing lymphedema.

Possible complications of lymphedema

Repeated episodes or untreated lymphedema can lead to other complications. These include:

Skin infections

Repeated episodes of cellulitis are common in patients with lymphedema. Cellulitis is a bacterial infection of the dermis - the deep layer of skin - and the subcutaneous tissues (fat and soft tissue layer) under the skin.

Lymphangitis

An infection of the lymph vessels, usually caused by Streptococcus bacteria. If left untreated, it can spread to the skin, causing cellulitis, or into the bloodstream, causing septicemia (sepsis).

Psychological effects

Lymphedema can affect the way the patient looks, which in turn can have a psychological impact, especially among patients who have been coping with the stresses of living with cancer. Patients with lymphedema have a higher risk of developing depression.

Lymphedema prevention

The affected limb is more vulnerable to skin infections because the supply of lymphocytes (which fight infection) is reduced.

If the patient takes measures to minimize the risk of cuts and grazes to the skin, their risk of subsequent infections may be significantly reduced. The following measures may help:

Avoiding hot showers, steam rooms, and saunas may help prevent symptoms of lymphedema.

  • After cancer treatment, avoid heavy activity with the affected limb; rest it while recovering.
  • Avoid sun beds, steam rooms, and saunas.
  • Do not take very hot baths or showers.
  • Do not wear tight fitting clothes.
  • Do not wear tight fitting jewelry.
  • Don't go barefoot outdoors.
  • Look for changes or breaks in the skin.
  • Keep your skin supple by moisturizing it every day.
  • Make sure footwear fits properly.
  • To prevent developing athlete's foot, use an anti-fungal foot powder.
  • Use gloves when gardening.
  • Keep nails short.
  • When going outside in an area where there may be insects, use insect repellent.
  • When out in the sun, use a high factor sun block.
  • When you have a cut, treat it immediately with an antiseptic cream. And keep the area clean.
  • Raise the affected limb above the level of the heart whenever possible.

Lymphedema's relation to diet, body weight, and obesity

The heavier a patient is, the higher the strain on the areas that are swollen. A healthy diet, aiming for an ideal body weight, may help alleviate the signs and symptoms of lymphedema. Some patients report that spicy foods make swellings worse.

Lymphedema - causes, symptoms, diagnosis, treatment & pathology (Video Medical And Professional 2020).

Section Issues On Medicine: Disease