When lymph nodes are removed or damaged, this can lead to a blockage in the lymphatic system. Lymph fluid is unable to drain properly and accumulates, causing swelling, “edema.” This is lymphedema. There is no cure for lymphedema, but early detection and proper treatment make it manageable.
What is the Lymphatic System?
To understand what lymphedema is, it is helpful to understand first the function of the lymphatic system. The lymphatic system helps keep you healthy by moving lymph fluid throughout your body, and is the immune system’s initial line of defense against infection. The lymph fluid, acting as a “garbage collector,” finds bacteria, viruses, and other waste products and carries them through your lymph vessels to your lymph nodes.
There, lymphocytes, which are among your body’s infection-fighting white blood cells, filter out the waste, which is eventually eliminated from your body. As we mentioned earlier, damage to the lymph nodes impedes this process; the lymph fluid is unable to continue circulating through your body, collecting and bringing waste to the lymph nodes. This waste builds up, causing swelling, often in an arm or leg, though lymphedema can occur anywhere in the body.
Types of Lymphedema
There are two types of lymphedema: hereditary and secondary. Up to 10 million people in the United States live with lymphedema.
Hereditary lymphedema results from complications in the development of the lymph vessels and nodes.
Dr. Stanley G. Rockson, LE&RN Scientific & Medical
Advisory Council Founding Chair, Etiology and Classification of Lymphatic Disorders Specific causes of primary lymphedema are:
This condition begins in infancy and produces improperly formed lymph nodes.
Lymphedema may occur as a result of Meige’s disease during puberty, pregnancy, or up until an individual is 35.
Late-onset lymphedema is atypical and often presents in individuals after age 35.
Dr. Stanley G. Rockson, LE&RN Scientific & Medical Advisory Council Founding Chair, Etiology and Classification of Lymphatic Disorders
Specific causes of primary lymphedema are:
Secondary lymphedema is more common than primary lymphedema and is caused by any circumstance, condition, or treatment that leads to damage to or impairment of the lymphatic system (the lymph vessels and the lymph nodes).
As you may know, lymph nodes are often removed from patients who have breast cancer to check to see whether the cancer has spread. Any surgery that affects the blood vessels may cause damage to the lymph vessels and nodes.
- Radiation treatment
During radiation treatment for cancer, it is possible for the lymph nodes to become damaged as a result of scarring and inflammation.
Tumor growth that occurs near lymph vessels and lymph nodes can cause lymphedema if the tumor blocks the flow of lymphatic fluid. Up to 50% of breast cancer survivors and 100% of those living with head and neck cancers will develop lymphedema.
Parasites that enter the lymphatic system or an infection in the lymph nodes can impede the movement of lymphatic fluid. This kind of secondary lymphedema is more prevalent in the tropic and subtropic areas of the world, and is more likely to occur in developing countries.
Any trauma to the body that results in damage to lymph vessels, lymph nodes, or both can lead to lymphedema.
As lipedema progresses, it can become secondary lymphedema, also known as lipolymphedema. This occurs when the fatty layers of lipedema have grown as fluid is collecting in the spaces between the fat cells, creating inflammation and fibrosis.
There are also several risk factors that can increase the likelihood that you may develop secondary lymphedema from any of the causes mentioned above. They include:
- older age
- excess weight or obesity
- rheumatoid or psoriatic arthritis
Again, none of the above is a direct cause of lymphedema alone.
- Swelling in a limb or other area of the body
- A sensation of tightness or heaviness
- A changed, restricted range of motion
- Aching, pain, or discomfort
- Persistent infections
- The thickening of the skin (fibrosis)
Stages of Lymphedema
There are four stages of lymphedema; they include some of the symptoms mentioned above.
Stage 0 Lymphedema
Before the onset of objective swelling in an affected body part, patients complain of symptoms, typically described as a generalized aching, heaviness or a "strange feeling." Focal discomfort and a change in contour or volume are not present in this stage.
- Hands or feet are puffy
- Pressing the skin over the affected area can leave impressions
- This called “pitting” edema.
- Veins on the tops of hands and feet may not be seen easily
- Swelling of the affected area(s) improves at night, but increases again during the day
- Keeping the affected area elevated may reduce swelling temporarily
This fluctuation could be the result of a lower concentration of protein if the lymphedema has only just begun to develop, or could occur because the lymphedema has not yet produced fibrosis.
- The swollen areas become “spongy” and there is less pitting
- Lymphedema is not affected by elevating the affected area
- Tissue changes occur in the affected area
Lymphedema causes tissue scarring (fibrosis). The tissue gradually thickens and the affected area begins to grow in size.
- The skin in the affected area becomes dry and scaly
- The limb grows in size, becoming noticeably bigger
- The limb’s weight may become incapacitating
- Lymph fluid may leak
- The skin may develop infections
- Skin growth (including blisters) may occur as the body works to stop fluid leakage, and these growths increase the risk of infection
Lymphedema can lead to other health complications including infections. Cellulitis is a bacteria infection of the skin. Lymphangitis is an infection of the lymph vessels. Lymphangiosarcoma is soft-tissue cancer that can be caused by severe cases of lymphedema that has gone untreated. Blue-red or purple marks on the skin are possible indicators of the disease.
If you have had or will have a procedure that affects your lymph nodes, talk to your doctor about the risk of developing lymphedema. To reduce the likelihood that you will develop secondary lymphedema:
Take care to protect affected limbs and areas of the body.
Cuts, scrapes, and burns can all invite infection. If you need to have blood drawn or get a vaccine, avoid your affected arm.
Rest your affected limbs (or other body parts) after treatment to let them recover.
Avoid exposing affected limbs to extreme temperatures.
(This includes the use of heating pads.)
Keep your limb raised above the level of your heart.
Avoid tight clothing.
If you have your blood pressure taken, if necessary, ask for it to be taken on your other arm.
Keep your skin clean.
Inspect it daily for changes, and for cuts. Don’t go barefoot.
Credit: © 2016 National Lymphedema Network • www.lymphnet.org
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