LYMPHEDEMA

LYMPHEDEMA

LYMPHEDEMA

Lymphedema is swelling due to build-up of lymph fluid in the body. Lymph nodes act like a drain in your sink. If the drain is clogged, the fluid cannot drain. It usually happens in the arms or legs, but can occur in other parts of the body. Lymph fluid is part of the lymph system that carries fluid and cells that help fight infections throughout the body. Sometimes this swelling develops quickly, or it may develop slowly over several months.

When lymphedema is due to congenital developmental abnormalities consisting of hypoplastic or hyperplastic involvement of the proximal or distal lymphatics, it is referred to as the primary form. The obstruction may be in the pelvic or lumbar lymph channels and nodes when the disease is extensive and progressive.

The secondary form of lymphedema involves inflammatory or mechanical lym­phatic obstruction from trauma, regional lymph node resec­tion or irradiation, or extensive involvement of regional nodes by malignant disease or filariasis.

Lymphedema may occur following surgical removal of the lymph nodes in the groin or axillae. Secondary dilation of the lymphatics that occurs in both forms leads to incompetence of the valve system, disrupts the orderly flow along the lymph vessels, and results in progressive stasis of a protein-rich fluid. Epi­sodes of acute and chronic inflammation may be superim­posed, with further stasis and secondary fibrosis.

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What Are the Symptoms of Lymphedema?

The symptoms of lymphedema may include—

  • Your arm, leg, or other part of your body has a little swelling at first, but gets bigger over time.
  • The skin in that area feels tight, and sometimes has a tingling sensation.
  • The arm or leg with lymphedema feels heavy.
  • Clothing and jewelry fit more tightly on the affected area.
  • The skin looks thicker or leathery.

If you notice any swelling after cancer treatment, talk to your doctor about what is causing it and how best to treat it.

What Health Problems Can Lymphedema Cause?

  • Lymphedema raises your risk of getting an infection in the swollen area. This happens because the cells that prevent infection can’t reach that part of your body.
  • Wounds may heal more slowly on the part of your body that has lymphedema.
  • You may feel upset, depressed, embarrassed, or angry about the lymphedema.
  • The joints in the part of the body with lymphedema may feel stiff or sore.

How Is Lymphedema Diagnosed?

First, your doctor will examine you and ask you when you first noticed the problem. If your arm or leg is swollen, your doctor may measure it to compare it with your other arm or leg. Usually, if your swollen arm or leg is 2cm (about 4/5 of an inch) bigger than your other arm or leg, you have lymphedema.

Your doctor may also suggest other tests to find out if you have lymphedema and if so, what is causing it. Lymphoscintigraphy is a test that uses radioactive material to see if the lymph vessels are blocked. Computed tomography (CT) scans and magnetic resonance imaging (MRI) can take pictures of the swollen area to find out why the lymph vessels are blocked.

Treatment

Since there is no effective cure for lymphedema, the treat­ment strategies are designed to control the problem and allow normal activity and function. Most patients can be treated with some of the following measures:

  • The flow of lymph out of the extremity can be aided through inter­mittent elevation of the extremity, especially during the sleeping hours (foot of bed elevated 15–20 degrees, achieved by placing pillows beneath the mattress); the constant use of graduated elastic compression stockings; and massage toward the trunk—either by hand or by means of pneumatic pressure devices designed to milk edema out of an extremity. Wound care centers special­izing in the care of patients with lymphedema may be helpful.
  • Secondary cellulitis in the extremity should be avoided by means of good hygiene and treatment of any trichophytosis of the toes. Once an infection starts, it should be treated by periods of elevation and antibiotic therapy that covers Staphylococcus
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    and Streptococcus organisms. Infections can be a serious and recurring problem and are often difficult to control. Prophylactic antibiotics have not been shown to be of benefit.
  • Intermittent courses of diuretic therapy, espe­cially in those with premenstrual or seasonal exacerba­tions, are rarely helpful.
  • Amputation is used only for the rare complication of lymphangiosarcoma in the extremity.

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