Lymphedema is an accumulation of lymphatic fluid in tissue that causes swelling, most often in the arm(s) and/or leg(s). Left untreated, it causes tissue channels to increase in size and number, reduces oxygen availability, interferes with wound healing and can result in infection.

What causes Lymphedema?

Lymphedema can develop when lymphatic vessels are missing or impaired (primary), or when lymph vessels are damaged or lymph nodes removed (secondary). Primary lymphedema, can be present at birth, or develop later from unknown causes, or associated with arterial-venous abnormalities. Secondary lymphedema, or acquired lymphedema, can develop as a result of surgery, radiation, infection or trauma. Specific surgeries, such as surgery for melanoma or breast cancer, which require removal of lymph nodes, put patients at risk of developing secondary lymphedema. 30 percent of breast cancer survivors in the United States develop lymphedema sometime in their lives. Airplane flights can be triggers of lymphedema, due to the decreased cabin pressure, by the pooling of fluid in the limbs of people with already compromised lymphatic systems.

Symptoms of Lymphedema

Symptoms of lymphedema include: a full sensation in the limb(s), skin feeling tight, decreased flexibility in the hand, wrist or ankle, difficulty fitting into clothing in one specific area, or ring/wristwatch/bracelet tightness. If you notice persistent swelling, it is important that you seek immediate medical attention. Lymphedema develops in a number of stages, from mild to severe (referred to as Stage 1, 2 and 3). Stage 1, or mild lymphedema, is characterized by tissue which is soft but "non-pitting". There is less than a 2 cm increase in size of the limb. Stage 2, or moderate lymphedema is characterized by a 2-5 cm increase and may be "pitting" (when pressed in by fingertips the area indents and holds the indentation). Stage 3, or severe lymphedema is characterized by a more than 5 cm increase and tissue may become firm and fibrotic. When lymphedema remains untreated, the condition can lead to chronic infections, loss of function, postural abnormalities or angiosarcoma (Stewaard-Treves Syndrome), a rare but highly malignant condition that could warrant amputation.

Treatments for Lymphedema

Treatment depends on the cause of the lymphedema. If the symptoms of swelling are caused by infection (redness, rash, heat, blister or pain may indicate an infection), antibiotics will first need to be prescribed by your physician. If the lymphedema is not caused by infection: The recommended treatment plan should be determined by a qualified health professional using an approach based on the Complex Decongestive Physiotherapy (CDP) methods which consist of: a) manual lymphatic drainage; b) bandaging; c) proper skin care & diet; d) compression garments; e) remedial exercises; f) self-manual lymphatic drainage & bandaging; g) continue to follow prophylactic methods at all times.

Who is at Risk?

Anyone who has had either a simple mastectomy, lumpectomy or modified radical mastectomy in combination with axillary node dissection and, often, radiation therapy. Lymphedema can occur immediately postoperatively, within a few months, a couple of years, or 20 years or more after cancer therapy. With proper education and care, lymphedema can be avoided or, if it develops, kept well under control.

Prevention

Breast cancer patients should be seen immediately after surgery by a qualified therapist for routine evaluation and assignment of a home exercise program to restore range of motion in the arms, neck and trunk. In addition, the patient needs to be told that she is now at risk for developing lymphedema. For the breast cancer or post-traumatic injury or infection patient who is at risk of lymphedema, and for the breast cancer or post-traumatic injury or infection patient who has developed lymphedema, the following instructions should be reviewed carefully pre-operatively and discussed with your physician or therapist.

1. Absolutely do not ignore any slight increase of swelling in the arm, hand, fingers, or chest wall (consult with your doctor immediately).

2. Never allow an injection or a blood drawing in the affected arm(s).

3. Have blood pressure checked in the unaffected arm.

4. Avoid vigorous, repetitive movements against resistance with the affected arm (scrubbing, pushing, pulling).

5. Avoid heavy lifting with the affected arm. Avoid carrying heavy handbags or bags with over-the-shoulder straps.

6. Do not wear tight jewelry or elastic bands around affected fingers or arm(s).

7. Avoid extreme temperature changes when bathing, washing dishes, or (no sauna or hottub). Keep the arm protected from the sun with use of sunscreen.

8. Avoid any type of trauma (bruising, cuts, sunburn or other burns, sports injuries, insect bites, cat scratches).

9. Wear gloves while doing housework, gardening or any type of work that could result in even a minor injury.

10. When manicuring your nails, avoid cutting your cuticles (inform your manicurist).

11. Exercise is important, but consult with your therapist. Do not overtire an arm at risk; if it starts to ache, lie down and elevate it. Recommended exercises: walking, swimming, light aerobics, bike riding, and specially designed ballet or yoga. Exercise should be progressed slowly.

12. Patients with large breasts should wear light breast prostheses (heavy prostheses may put too much pressure on the lymph nodes above the collar bone). Soft pads may have to be worn under the bra strap. Wear a well-fitted bra: not too tight and with no wire support. A sports bra is helpful for swelling along the trunk.

13. Use an electric razor to remove hair from axilla. Maintain electric razor properly, replacing heads as needed.

14. Warning: If you notice a rash, blistering, redness, increase of temperature or fever, see your physician immediately. An inflammation or infection in the affected arm could be the beginning or a worsening of lymphedema.

15. Maintain your ideal weight through a well-balanced, low sodium, high-fiber diet. Avoid smoking and alcoholic beverages. Lymphedema is a high protein edema, but eating too little protein will not reduce the protein element in the lymph fluid - rather, this will weaken the connective tissue and worsen the condition. The diet should contain protein that is easily digested, such as chicken, fish or tofu.

Conclusion