What is Lymphedema?
Lymphedema swelling is a long-term problem that requires daily support. This condition concerns the situation where unnatural swelling of the arms and legs occurs due to a lymphatic system blockage. When the lymph fluid is unable to drain well, the fluid will continue to build up. This causes the swelling in the limbs. The most common cause of (secondary) lymphedema is cancer treatment, where damage to, or removal of, lymph nodes may occur.
There is no true cure for lymphedema, but there are daily care regimens that can help patients cope with the condition.1 The tissues which have been affected by the swelling are put at a greater risk of getting an infection. Symptoms of this lymphatic condition, other than the swollen limb(s), include discoloration of the skin, deformity, fluid accumulation in places other than the primary areas of the legs and arms, such as the head and neck, and fatigue. Patients who are experiencing any unusual symptoms and those who have a history of possible causes for the condition should seek advice and diagnosis from a medical professional.2
What Are Some of the Possible Causes?
Radiation therapy or lymph node dissection
There are a wide variety of factors which could affect the lymphatic system and be the reason behind the development of lymphedema. Radiation therapy or lymph node dissection or surgery are all possible situations which could trigger damage to the lymphatic system. Breast cancer patients, in particular, are at an increased risk of developing the condition. Radiation treatments which were meant to help the patient overcome throat or tongue cancer can cause lymphedema in the head and neck. For ovarian, prostate, testicular, uterine, melanoma, and colon cancer patients, lymphedema can affect the groin and lower limbs.
Diseases or accidents that interfere with the lymphatic system
Sometimes the condition can be caused by diseases or accidents that interfere with the lymphatic system. In some tropical regions, filariasis, which is a type of parasitic infection, can be the cause of lymphedema. Cellulitis can also harm the lymphatic system. For some patients, their primary lymphedema may have started as far back as from birth. While others may develop it later, over the course of puberty. Some vascular abnormalities may also be the cause of this lymphatic condition. Patients with lymphedema should also take care during air travel. They should wear special compression garments to reduce swelling which is caused by the decreased pressure in the cabin during flight.
4 States of Lymphedema
There are 4 states of this disease in the lymphatic system:
- latent, where the lymphatic vessels are damaged,
- spontaneously reversible, in which the tissue is still able to bounce back,
- spontaneously irreversible, wherein the tissue is spongy and pitting, and
- lymphostatic elephantiasis, in which the tissue is hard, unresponsive, and the swelling is large and irreversible.
This lymphatic condition is also rated by grades for its severity. Mild, moderate, severe, massive, or gigantic are the levels of severity which have been categorized.3
Other risk factors
Besides cancer treatments, risk factors for lymphedema include obesity, slow skin healing after surgery, a tumor causing lymph node blockage, and scar tissue from surgery or radiation.4
Treatment and Prevention
The general medical treatment options for lymphedema include physical compression (i.e., garments, bandaging, pump therapy with a pneumatic sleeve), decongestive therapy or manual drainage of the lymphatic ducts, surgery (i.e., lymphatic vessel grafting, vascularized lymph node transfer, lymphaticovenous anastomosis, liposuction), and low-level laser therapy.5
There are prevention options patients may want to consider. Before undergoing cancer treatments, patients can be taught to identify the early symptoms of edema to get immediate treatment. The effectiveness of treatment decreases with time as the lymphedema is left to develop without intervention. Exercise may be helpful for cancer patients. Skin and nail hygiene can prevent cellulitis infection. Treating breaks in the skin with moisturizers or topical ointments, using sunscreen, keeping feet dry and clean, and being aware of infection can also help cancer patients avoid lymphedema problems. Keeping the affected arm or leg elevated, changing positions often, wearing loose clothing, and other positional considerations are useful practices. Patients who begin to notice any unusual symptoms should talk to a medical professional immediately in order to determine whether lymphedema or some other condition is a cause for concern.6
Complete Decongestive Therapy (CDT) is a non-invasive treatment option for the condition. This includes manual lymph drainage (MDL), a gentle massage technique, as well as compression therapy, exercise, which the patient performs while they are wearing bandages or compression garments, and taking care of the skin and nails to prevent infection.7 Patients may also want to lose weight if necessary, eat a healthy diet, which would include the elimination of processed foods and unhealthy oils, and consider some dietary supplements and herbs (i.e., bromelain, flax seed, fish oil, ginger tea, calcium and magnesium, colloidal silver, etc.) in order to strengthen the immune system and fight inflammation.8