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What Is Lymphedema?
Lymphedema occurs when lymphatic fluid accumulates in limb tissue that causes swelling, usually in the arms or legs. There are two types of lymphedema.
Primary Lymphedema
Primary lymphedema can be present at birth, or occur later in life, during puberty or adulthood. Lymphatic vessels are missing or impaired; the causes are generally unknown.
Secondary Lymphedema
Secondary lymphedema occurs when lymphatic vessels are damaged or lymph nodes are removed. This is often associated with a variety of cancers, because it can result from radiation, chemotherapy, or surgery.
- Mastectomy: breast and surrounding lymph nodes are removed.
- Radiation: can damage otherwise healthy lymph nodes and vessels; scar tissue forms, interrupting the normal flow of lymphatic fluid.
- Chemotherapy: when administered unwisely on the side of surgery.
Lymphedema that is associated with breast cancer occurs in the arm on the same side of the infected breast. Risk increases with aircraft flight after surgery. Secondary lymphedema can develop immediately after surgery, or other treatments, or occur weeks, months, even years later.
Stages of Lymphedema
Stage 1 – Spontaneously Reversible
Tissue is “pitting,” which means when you press the affected area with your fingertips, the area will indent and hold that indentation. Usually, when you wake up in the morning, the affected limb is normal or almost normal size.
Stage 2 – Spontaneously Irreversible
Tissue has a spongy consistency and is “non-pitting,” which means when you press the affected area with your fingertips, the tissue bounces back without any indentation forming. You may experience the early stages of fibrosis, with the hardening and increasing size of limbs.
Stage 3 – Lymphostatic Elephantiasis
At this stage, swelling is irreversible and the affected limb is very large. Tissue is hard (fibrotic) and unresponsive. Some consider undergoing reconstructive surgery, called “debulking.”
Lymphangitis:
Lymphangitis is an infection that occurs in parts of the body with lymphedema. Symptoms may include: rash, red blotchy skin, discoloration of the skin, increased swelling, increased temperature of the skin, high fever and chills, heavy sensation in the limb, and pain. If you suspect that your lymphedema is coupled with an infection, discontinue all current lymphedema treatments and call your physician immediately. Treatment for lymphangitis will include antibiotics, usually penicillin, unless an allergy exists.
Prevention, Increased Risk
Risk for secondary lymphedema increases if you:
- Are a heavy smoker
- Have diabetes
- Have had previous surgeries in the armpit area or on your arm
- Have any other condition that affects the circulation of blood and lymph fluid
- Are very overweight, which can limit the flow of blood and lymph fluid
Infection of the lymphatic limb can lead to lymphangitis. To limit your risk of infection practice good skin care to avoid burns, chafes, dryness, cuticle injury (such as hangnails), cracks, cuts, splinters, and insect bites.
Symptoms
Some common symptoms include:
- Full sensation in limb
- Skin feels tight
- Decreased flexibility in hand/wrist/ankle
- Difficulty fitting clothing in one specific area
- Ring/wristwatch/bracelet feeling tight
- Persistent swelling
If left untreated, the protein-rich lymph fluid will accumulate in the limb, leading to increased swelling and the hardening (fibrosis) of tissue. Swollen limbs are the perfect culture for bacteria, which could lead to lymphangitis (infection); infection may become chronic. Untreated lymphedema could also lead skin breakdowns, the decreased or complete loss of functioning of the affected limb, and in rare cases, lymphangiosarcoma (lymphatic cancer).
Treatments
If an infection is present (lymphangitis), it must first be treated with an antibiotic, usually penicillin. If there is no infection present, lymphedema may be treated using Complex Decongestive Therapy, which includes:
- Manual lymphatic drainage
- Bandaging
- Proper skin care and diet
- Compression garments (sleeves, stockings, etc.)
- Remedial exercises
- Self-manual lymphatic drainage and bandaging
- Continue to follow prophylactic (preventative) methods at all times
- Look for changes in skin: temperature, discoloration, blistering
- Keep area soft with lotion as directed by your radiation oncologist
We treat lymphedema in our Women’s Health Center, because it can result after receiving treatment for breast cancer. Lymphedema is inhibitive to normal body motion, as well as extremely painful, but treatment is available through our Women’s Health Center. Please call 434-244-4480 for more information. |
