Lymphedema (Lymphadema) is a medical condition that affects the body's lymph nodes and vessels (the lymphatic system). Lymph vessels transport body fluids to the lymph nodes, where the fluid is cleaned and filtered, then returned to the blood. If this system of lymph vessels and nodes is, or becomes, damaged, or if a vessel or node is removed, fluid cannot flow through the system correctly. The fluid overwhelms the damaged lymph vessels and nodes and can accumulate, causing swelling in the affected body part. Lymphedema most commonly affects the arms or legs, although it can affect any body part, and can occur in one limb to all four limbs.
A more thorough medical description of Lymphedema “is the accumulation of protein-rich interstitial fluid within the skin and subcutaneous tissue that causes chronic inflammation and reactive fibrosis of the affected tissues. Normally, lymph fluid is drained from the cells in the body and carried in the lymphatic system. Lymph is cleared through a network of thin-walled lymphatics, and ultimately empty into the venous system. The lymphatic system is part of the immune system, which carries lymphocytes throughout the body to respond to antigens and communicate responses to other parts of the body. The lymphatic system also carries excess fluid back to the venous bloodstream through a series of ducts or tubules, and empties excess fluid near the subclavian vein. Lymphedema occurs when the lymphatic ducts become blocked and a buildup of lymph fluid occurs in the fatty tissues just under the skin, resulting in swelling.”
There are two main types of lymphedema
Primary Lymphadema (Inherited): In primary lymphedema, some type of developmental abnormality exists in the lymphatic system. Congenital lymphedema accounts for 10% - 25% of all primary lymphedema cases, with females affected twice as often as males. Primary lymphedema may occur at any time in life; however, primary lymphedema is thought to be a genetically determined disease and may present at birth or shortly thereafter (Milroy disease), at puberty (referred to as lymphedema praecox), or after age 35 (lymphedema tarda) Primary lymphedema usually affects the lower extremities.
Secondary Lymphedema: Secondary lymphedema is a result of some sort of an injury to the lymphatic system caused by an obstruction or a disruption that prevents the system from draining fluid from the surrounding tissues. It may occur from infection caused by streptococci or filariasis (caused by a parasite), surgery, radiation therapy, or tumors. Lymphedema caused by infection must be treated with an antibiotic or antiparasitic agent. Secondary lymphedema may develop after surgery for malignant solid tumors, such as in breast cancer or lymphoma. It also may also develop after an axillary node dissection, breast surgery, or after radiation treatments.
Surgery or radiation treatments are the most common cause of lymphedema in the United States. Approximately 15%-20% of breast cancer patients develop lymphedema at some point, up to 20 years following treatment. With 2 million breast cancer survivors, this number translates into approximately 400,000 patients coping with lymphedema on a daily basis.
Breast cancer survivors are not the only ones at risk for lymphedema. Persons who have experienced or undergone any of the following are at an increased risk for developing secondary lymphedema:
· Treatment for one of the following cancers: breast, ovarian, uterine, colon, prostate, testicular, (all of these cancers involve treating or removing lymph nodes or vessels)
· Surgery involving blood vessels
· Infection caused by parasites; (more common in tropical areas)
Women who have undergone treatment for breast cancer are at a higher risk for developing lymphedema in the arm or upper body. Men who have undergone treatment for prostate or testicular cancer are at a high risk for developing lymphedema in the lower body and groin. All persons in general who have been treated for cancer are at an increased risk for developing lymphedema.
In addition to these two main types of lymphedema, some people can develop chronic lymphedema. Swollen body parts affected by lymphedema are more susceptible to damage and injury. Almost any ordinary wound on the skin, such as a scrape, cut, or bug bite, can cause the swollen limb to become infected. These infections are severe, and recurring infections causes tissue to become susceptible to even more swelling and infection.
Symptoms and Severity
Symptoms resulting from lymphedema usually manifest themselves in obvious ways. The following are all indicators a person may be suffering from lymphedema:
· A swollen limb or area of the body, including fingers and toes,
· A heavy or tight feeling in the arm or leg,
· Restricted motion in the arm or leg,
· Aching in the affected arm or leg,
· Thick or hard skin over the affected area,
· Discolored skin over the affected area,
· A general feeling of fatigue,
· Skin infections and/or ulcers in serious cases,
· A deformity in the affected area (elephantiasis),
· The affected area may also become infected, and persons may experience emotional problems as they deal with their frequently unsightly disorder.
The severity of a case of lymphedema is gauged with a medical lymphedema scaling system.
Grade 1: Mild edema;
Grade 2: Moderate edema;
Grade 3a: Severe edema;
Grade 3b: Massive edema;
Grade 4: Gigantic edema (also known as elephantiasis).
For persons suffering from lymphedema, the emotional difficulties may be trying. The pain and swelling associated with lymphedema can make daily activities and tasks difficult. Severe lymphedema can be a tragic circumstance for the person afflicted with it. Onlookers may find the extreme swelling or associated deformities of advanced lymphedema unsightly, even frightening. Persons with lymphedema may find it beneficial to seek counseling from a professional, or to join a support group, both of which can provide helpful care.