Lymphedema

What is lymphedema?

Lymphedema, also known as lymphatic edema, is swelling caused by a problem with your lymphatic system. The swelling can affect various parts of your body.

Your lymphatic system is a drainage and defense network. It is responsible for moving a watery fluid called lymph back into your bloodstream and maintaining normal fluid levels. It also helps protect you from infection, destroys old or abnormal cells and helps your body absorb fats.

If there is a problem with your lymphatic system, fluid can build up in your body and cause swelling. This may be as a result of certain surgical procedures or medical conditions.

Are there different types of lymphedema?

There are two types of lymphedema:

• Primary lymphedema: This is caused by rare genetic conditions that affect how the lymphatic system develops.
• Secondary lymphedema: This happens as a result of surgery, radiation therapy or trauma that has caused damage to the lymphatic system.

Lymphedema is also classified in stages:

• Stage 0: An area feels swollen, tight or heavy but there are no visible signs of swelling.
• Stage I: There is occasional swelling, which goes away when the affected area is elevated.
• Stage II: The affected area is almost always swollen. The skin may also feel firmer in that area.
• Stage III: The affected area has significant swelling. There may also be changes in your skin color and texture.

What are the symptoms of lymphedema?

The most common symptom of lymphedema is swelling. In the early stages of lymphedema, you may not notice the swelling. In some people, the swelling may develop slowly, while in others, it can come on suddenly. Other symptoms may include:

• Arms, legs or other body parts feeling heavy or full
• Arms or legs that appear to be slightly different sizes
• Burning or itching sensation
• Clothes feeling tighter than usual
• Joints that feel tight
• Not being able to feel the veins or tendons in your hands and feet
• Puffy or red skin
• Thicker skin

What causes lymphedema?

Lymphedema may be caused by a number of different things, including:

• Obesity: Excess fat can put pressure on lymph nodes and vessels, which can affect lymphatic drainage.
• Blood vessel problems: Your blood vessels carry most of the fluid throughout your body. If you have a problem with your blood vessels, it can lead to chronic swelling and cause lymphedema.
• Breast cancer surgery: If the lymph nodes under your arms are removed as part of breast cancer surgery, the nearby lymph vessels may be damaged.
• Heart conditions: Conditions such as congestive heart failure can cause swelling that may be similar to lymphedema.
• Inactivity: Leg muscles help pump lymphatic fluid, so inactivity can contribute to swelling in the legs.
• Infection: This may cause damage to the lymphatic system.
• Kidney disease: If you have kidney disease, they may not be able to remove fluid properly, causing swelling
• Pelvic surgery: If the pelvic lymph nodes are removed, this may cause lymphedema.
• Radiation therapy: Radiation therapy can cause scarring or damage to the lymphatic system, which can affect lymphatic drainage.
• Trauma: If part of your body suffers trauma, it can damage lymphatic vessels under the skin, causing lymphedema.
• Tumors: Can block lymphatic drainage.

How is lymphedema diagnosed?

If your doctor suspects that lymphedema is causing swelling, they will perform tests to confirm the diagnosis and rule out other causes. These tests may include:

• Ultrasound: Can help identify blockages and rule out other causes of swelling.
• Magnetic resonance imaging (MRI): Detailed images can help doctors to see if something is putting pressure on your lymphatic system.
• Computed tomography (CT) scan: Can also check for signs of pressure on your lymphatic system.

How is lymphedema treated?

There is no cure for lymphedema, but there are different ways to manage it. The treatment you are offered for lymphedema will depend on the cause and stage of the condition.

Treatment for lymphedema usually includes physical treatments and garments which aim to move fluid from the affected area. These may include:

• Physical therapy: Gentle massage, called manual lymphatic drainage, aims to stimulate circulation.
• Exercise: This helps to stimulate lymphatic drainage.
• Compression garments: These may be socks or sleeves that put pressure on the affected area to help move fluid into circulation and reduce swelling.
• Compression bandaging: Multiple layers of compression bandages may be applied after physical therapy to the swollen area to apply pressure to the affected tissue and move fluid back into circulation.

Surgery may be recommended for some people as a treatment for lymphedema if it is severe and physical treatments haven’t helped the symptoms. These may include:

• Lymphatic bypass procedure: Involves connecting and rerouting the lymphatic vessels to avoid obstructions. This then allows lymph to drain into the venous system.
• Lymph node transfer: Involves replacing damaged lymph nodes with healthy ones that have been taken from other areas. This can help create new pathways for lymphatic drainage in the area affected by lymphedema.
• Debulking: For severe lymphedema, the procedure involves removing the skin, fat and tissue from the affected area and placing a skin graft over the area.

How can I reduce the risk of developing lymphedema?

There are things you can do to reduce, and in some cases, prevent swelling, such as monitoring your body for early signs of swelling, elevating affected areas, and keeping your body moving.

If you are having breast cancer surgery, talk to your doctor about exercises that you can do to help reduce swelling.