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This section has been reviewed and approved by the PLWC Editorial
Board, 05/05
Lymphedema is the abnormal buildup of fluid in
an arm or leg due to a blockage in the lymphatic system, the series of
channels and nodes (small sacs of infection-fighting cells) that carries
lymph (a colorless fluid) through the body. The lymphatic system helps
fight infections and other diseases.
There are two types of lymphedema: primary and
secondary. Primary lymphedema is a rare,
natural disorder of the lymph system. More often, people with cancer
develop secondary lymphedema. Lymphedema can develop immediately after surgery or
radiation therapy, or it can develop months or years later. About 15% of
women who have radical mastectomies (removal of the breast, underarm
lymph nodes, and lining of the chest muscles) develop lymphedema.
The most common causes of secondary lymphedema
include the following:
- Surgery to remove the
lymph nodes, especially for breast cancer, prostate cancer, or
melanoma
- Radiation therapy to the
lymph nodes
- Metastatic cancer (cancer that has
spread from its primary location)
- Bacterial or fungal
infection
- Injury to the lymph
nodes
- Other diseases involving
the lymph system
Lymphedema can be acute
(lasting no more than six months) or chronic (lasting years). Acute lymphedema usually develops a few days or weeks after
radiation therapy or surgery and lasts less than six months. As the body
heals and normal lymph fluid motion resumes, the swelling usually goes
away. Chronic lymphedema occurs when the lymphatic
system changes and can no longer meet the body's demands for fluid
drainage. It can happen immediately after surgery or radiation therapy or
months or years after cancer treatment. There is no cure for chronic lymphedema.
Doctors describe lymphedema according to its
grade:
- Grade I
means that the skin indents when it is pressed, elevating the
affected limb helps reduce the swelling, and there is no visible
evidence of scarring.
- Grade II means that the
skin does not indent when it is pressed, elevating the affected limb
does not help the swelling, and there is moderate to severe
scarring.
- Grade III is
irreversible lymphedema. The skin has
hardened, the affected body part has swelled in size and volume, and
the skin has changed texture.
Symptoms
People with lymphedema may experience the
following symptoms:
- Slow, painless swelling
that begins in the hands or feet and progresses toward the trunk
- "Heavy"
feeling in the arms or legs
- Rings, watches, or
clothes that become too tight
- Tight or shiny skin
- Skin that does not
indent at all when pressed, or hardened skin
- Hyperkeratosis (thicker
skin)
- Skin that may look like
an orange peel (swollen with small indentations)
- The development of small
warts or blisters that leak clear fluid
If you are concerned about any of these symptoms, please
talk with your doctor.
Diagnosis
Some doctors may be able to diagnose lymphedema
by observing symptoms alone. However, some tests may be needed to confirm
a diagnosis, plan treatment, and rule out other causes of lymphedema.
- The doctor may measure
your arms or legs to monitor swelling or may calculate the volume of
fluid that has built up by placing the arm or leg into a water tank.
- Ultrasound (an imaging
test that uses sound waves to create a picture of the inside of the
body) helps the doctor see the flow of the lymph system.
- Lymphoscintigraphy is a reliable procedure
for confirming a diagnosis of lymphedema.
The lymph system is injected with a radioactive substance. A camera
takes pictures of this substance, which shows the pattern of lymph
drainage.
- A computerized
tomography (CT or CAT) scan creates a three-dimensional picture of
the inside of the body with an x-ray machine, and a magnetic
resonance imaging (MRI) test uses a magnetic field instead of an
x-ray to produce detailed images of the body. These tests can show
the placement and pattern of the lymph system and whether a tumor or
other mass is obstructing the flow of the lymph system.
It is important to make sure that other illnesses are not
causing the swelling. The doctor may perform other tests to rule out
heart disease, blood clots, infection, liver or kidney failure, or an
allergic reaction.
Treatment
Treatments for lymphedema are designed to
reduce swelling, prevent it from getting worse, prevent infection, and
improve the use and appearance of the arm or leg. Talk with your doctor
about the best way to manage lymphedema.
Treatments for lymphedema include the following:
Elevation. Keeping an affected limb elevated can often help reduce
swelling and encourage draining through the lymph system. However, it is
often not practical to maintain an elevated position over time.
Massage. A specialized technique called manual lymphatic drainage
can help reduce swelling. The results are better the earlier massage
begins. Your doctor or nurse can refer you to someone trained in this
technique.
Exercise. Exercising can improve the flow of the lymph system,
strengthen muscles, and improve the body's ability to absorb protein.
Exercising should be done while wearing a compression garment or bandage
(see below).
Compression. Compression garments or bandages apply pressure to
the limb and encourage draining through the lymph system and are useful
in preventing further swelling. There are different types of compression
garments or bandages:
- Compression bandages
wrap the affected limb and are usually used during the treatment
phase because the limb changes size.
- Compression garments are
elastic sleeves for the arm or leg that can be custom-fitted. These
are generally used during the maintenance phase once size of the
limb stays the same.
- Pneumatic compression
uses a machine to apply pressure to the arm or leg.
All compression devices apply the most pressure furthest
from the body and less pressure closer to the body.
Hygiene. Preventing infection from developing around lymphedema can prevent it from getting worse. Washing
the area often with soap and using alcohol-free lotions may help.
Antibiotic or antifungal drugs can also help prevent infections.
Low level laser treatments (LLLT). A small number of trials have
found LLLT could provide some relief of postmastectomy
lymphedema, particularly in the arms.
Treatments that are not usually recommended include the following:
- Diuretics, medicines
that lower the amount of water in the body
- Surgery to repair the
lymph system.
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