What is Lymphedema?
Lymphedema is an obstruction of lymphatic system characterized by swelling and fluid retention in one or two extremities and is the result of impaired drainage ability of the lymphatic system.
The lymphatic system is composed of specialized vessels or known as lymphatic vessels which act by gathering excessive fluid of the lymph that contains protein, lipids and other waste products from the body tissue. The excess in fluid collected from the lymph is transported to the lymph nodes for filtration of waste products. The lymph nodes function in filtering waste product and hold the lymphocytes which are a cell responsible for battling infection. Swelling or lymphedema results when the lymph vessels are obstructed and unable to carry away from the tissue the lymphatic fluid.
Lymphedema are classified into two types according to the nature or cause of the condition and this include:
Primary lymphedema is a rare form that resulted from an anatomical abnormality in the lymph vessels while this form is believed to be an inherited condition.
Secondary lymphedema resulted from an underlying condition and procedure or trauma that directly damaged the lymphatic vessels and nodes while this is the most common form of lymphedema.
Lymphedema is most prevalent in patient who underwent breast cancer surgery and those who received radiation therapy after the axillary lymphadenectomy. It may involve one or both extremities with swelling that can be gauged from mild to severe that may be disfiguring.
Manifestation of lymphedema varies depending on the degree of severity. The onset of symptoms can be mild to severely disfiguring and enlarged and is potentially life-threatening. The swelling in the lymphatic system begins when there is an inadequate drainage of lymph fluid due to an obstruction.
The classic symptoms of lymphedema include the following:
- Noticeable change in the symmetry of the affected extremity or of the affected extremities
- Swelling of the affected part either one or both extremities including the fingers and toes
- Tightness and feeling of heaviness is observed around the affected arm or leg
- Range of motion on the arm or leg is limited
- Feeling of pain and discomfort around the affected arm or leg
- Noticeable thickening of the skin on the affected arm or leg which may appear like an orange peel and may become scaly and fissured
- Recurrent skin infection over the affected area
- Fatigue can be noted when swelling is pronounced due to additional weight brought by the swelling
- Swelling is characterized with tautness and firmness or may be described as non-pitting edema.
Lymphedema is the result of inadequacy in the drain of lymphatic fluid which may occur on its own or from other factors that can damage the normal-functioning lymphatic system. The occurrence may be described whether as primary or secondary and the cause may be implicated through the following:
Primary lymphedema is a rare and inherited form that the obstruction and swelling is often the result of anatomical abnormality in the development of the lymph vessels. This may be brought by the following condition:
- Lymphedema praecox or Meige’s disease – is a form of primary lymphedema that is most common and evident right after birth and before the age of 35 years with symptoms mostly occurring during the stage of puberty with prevalence higher in female than in male.
- Congenital lymphedema or Milroy’s disease – is evident at birth and most prevalent in female than in male while this form is believed to be inherited. Lymphedema resulted from an abnormality in the lymph nodes.
- Lymphedema tarda – occurs at later age usually after the age of 35 years although this condition is rare.
Secondary lymphedema is a lymphedema that occurs as a result of another underlying condition and procedures that directly damage the lymphatic system that is functioning normally. The damage may be due to the following:
- Cancer cells can obstruct the lymphatic vessels such as tumor growth in close proximity to lymph nodes or lymph vessels that can block the normal flow of the lymph fluid.
- Filariasis is the leading cause of lymphedema worldwide which is an obstruction that resulted from infestation directly to the lymph nodes of the parasite known as Wuchereria bancrofti. The infestation is carried out through mosquitoes to person with this cause endemic to subtropics in the regions of Africa, Asia and Central and South America.
- Surgical procedures especially those intended in removing breast cancer which may include removal of lymph nodes in the armpit. Entire lymph nodes need not be removed except for those with evident tumor growth while remaining lymph nodes and lymph vessels may not be able to compensate for what was removed and thus may result to lymphedema.
- Radiation therapy can result to scarring of the lymphatic vessels and lymphatic nodules leading to inflammation and subsequently obstruction to the flow and drain of lymphatic fluid.
The primary concern in diagnosing lymphedema is to rule out other underlying condition that contributes to the swelling and inflammation as swelling may be due to various reasons and not an obstruction in the lymphatic system alone. Gathering of data is the initial procedure in diagnosing the condition which includes the family medical history and previous surgical procedures undertaken. To further confirm suspicion of lymphedema, doctors may request for the following diagnostic procedures:
- Computerized tomography or CT scan can give details and cross-sectional images of the areas affected which may show blocking in the lymphatic system.
- Magnetic resonance imaging produces high-resolution images which can give doctors better visual of tissues of the affected arm or leg.
- Doppler ultrasound helps in diagnosing lymphedema through high frequency sound waves.
- Lymphoscintigraphy can give visuals of areas with obstructed lymphatic vessels and nodes through the dye injected.
Lymphedema has no definite treatment while the goal of management is towards the reduction of swelling to prevent obstruction of the lymphatic fluid drain. Exercise and therapeutic massage are recommended to help facilitate lymph fluid away from the affected limb. Pneumatic compression is applied to move the lymph fluid away from the fingers and toes and prevent swelling further of the arm and leg affected.