Lymphedema
Definition
Lymphedema is a build up of fluid in the lymph system. This system is made of organs, vessels, nodes, and fluids. It is part of the immune system and balances fluids in the tissue.
The fluid build up leads to swelling in the area. It is most common in the arms and legs. It can spread to the core and head. Swelling may be mild to severe. It can dramatically increases the size of the limb. It can also cause color changes to the skin.
Causes
Primary lymphedema is caused by defects of the nodes or vessels. It is due to a birth defect or change in genes. Parts may be missing or not work as they should. Conditions with primary lymphedema include:
- Milroy’s disease
- Meige disease
Secondary lymphedema is caused by an injury or illness that blocks the flow of fluid. Examples include:
- Infection
- An abnormal growth in the area
- Medical conditions
- Medical treatments—such as removal of lymph nodes
- Trauma
Risk Factors
Lymphedema is more common in older adults.
Factors that may increase the chances of lymphedema include:
- Surgery that includes the removal of lymph nodes
- Radiation
therapy for cancer
- Cancer
- Infections
-
Burns
-
Obesity
—may increase risk of lymphedema after breast cancer surgery
- Immobility
Symptoms
Symptoms of lymphedema include:
- Swelling in arms, legs, fingers, or toes
- Clothes, shoes, or jewelry may feel tight even though there is no weight change
- Heaviness in one or more limbs
- Changes in skin such as a feeling of tightness, hardening, or reddening of the skin
- Loss in range of motion and flexibility in nearby joints
- Aching, pain, discomfort, or tingling in the limb
Lymphedema can also lead to complications like:
- Breakdown of the skin
- Infections of the skin
- Massive changes in the size and shape of the limb
Diagnosis
The doctor will ask about any symptoms and past health. A physical exam will be done. The amount fo swelling and size of limb will be measured. The doctor may diagnose lymphedema based on the exam and past health.
More tests may be needed if the cause is unclear. Image tests may include:
Treatment
Treatment will depend on the cause. Lymphedema will stop after treatment for some. Others will have a continued risk of lymphedema. Treatment may include different steps:
- The first part of treatment may be more intense. It may be given over a few weeks.
- The next step may be a long-term plan. This will include finding what makes swelling worse.
- Managing lymphedema flare up early may prevent complications.
When lymphedema is present, it is important to reduce swelling. Too much swelling can cause complications. Options to treat swelling include the following:
- Exercise—Strength training and range of motion can help decrease swelling. A doctor or a physical therapist can create a safe program to follow.
- Compression—A constant gentle pressure over the area may also help. Special stockings, sleeves, or elastic bandages can help. The care team will recommend which may work best.
- Manual therapy—A type of massage may help to move fluids. A therapist can teach the right steps. Some massage may add fluid to the area. Talk to your care team. Massage may also be harmful with cancer.
- Pneumatic compression—A sleeve is placed over the area. An attached machine will pump air into the sleeve. It will create a cycle of pressure to help move fluids.
Lifestyle habits can affect recovery and risk of future swelling. Steps may include:
- Healthy weight
- Healthy food choices—Certain foods can increase fluid kept in the body. Good nutrition choices will also affect overall health and weight.
-
Good skin health to reduce risk of swelling and complications. Basic steps may include:
- Keep affected arm or leg clean.
- Keep hands and feet protected with gloves and shoes.
- Use an electric razor to decrease cuts to skin.
- Use sunscreen when outdoors. It will help to prevent burns.
- Avoiding things that will block more fluid such as:
- Blood draws or blood pressure cuffs over area
- Positions that slow flow of fluid. This includes crossing legs or carrying items on shoulder.
- Ice or heat treatment to the area.
- A medical bracelet can let medical professionals know about risk for lymphedema. This may keep them from doing things that may make swelling worse.
A combo of treatments may lead to the best results. Different methods will be tried until the best method is found.
Surgery
Surgery may be needed for severe lymphedema. It will unblock the lymph to reduce swelling.
Prevention
Certain conditions or treatment have a high risk of lymphedema. The medical care team will take steps to prevent lymphedema. Early treatment can make a big difference.
A strength and activity program in recovery may help prevent lymphedema after removing lymph nodes.
Resources
National Cancer Institute
https://www.cancer.gov
National Lymphedema Network
https://www.lymphnet.org
Canadian Resources
Canadian Cancer Society
http://www.cancer.ca
Lymphedema Association of Quebec
http://www.infolympho.ca
References
Lymphedema. Society for Vascular Surgery website. Available at:
https://vascular.org/patient-resources/vascular-conditions/lymphedema. Accessed March 26, 2018.
Lymphedema—approach to the patient. EBSCO DynaMed Plus website. Available at:
http://www.dynamed.com/topics/dmp~AN~T909498/Lymphedema-approach-to-the-patient
. Updated October 18, 2017. Accessed March 26, 2018.
Patient Education: Preventing Lymphedema. EBSCO Nursing Reference Center website. Available at: http://www.ebscohost.com/nursing/products/nursing-reference-center. Updated September 29, 2017. Accessed March 26, 2018.
Poage E, Singer M, Armer J, Poundall M, Shellabarger MJ. Demystifying lymphedema: development of the lymphedema putting evidence into practice card. Clin J Oncol Nurs. 2008;12(6):951-964.
Torres Lacomba M, Yuste Sánchez MJ, Zapico Goñi A, et al. Effectiveness of early physiotherapy to prevent lymphoedema after surgery for breast cancer: randomised, single blinded, clinical trial.
BMJ.
2010;340:b5396.
Trayes KP, Studdiford JS, Pickle S, Tully AS. Edema: diagnosis and management. Am Fam Physician. 2013;88(2):102-110.