Lymphedema is a medical condition characterized by swelling in the arms or legs, which usually happens as a consequence of the removal or damaging of the lymph nodes. Lymph nodes are an important part of the lymphatic and immune system. It is where the most common type of blood cancer, lymphoma, develops. Lymphoma occurs when white blood cells called lymphocytes reproduce and enlarge abnormally — especially the cells in the lymph nodes.
Lymphedema and lymphoma are related, since lymphedema occurs mainly in patients who are receiving cancer treatment. The treatments used for lymphoma can block the lymphatic system, disabling the normal draining of the lymph fluid. Since the fluid accumulates in the body’s soft tissue, the limbs can swell. Despite the fact that there is no cure for lymphedema, it can be treated when diagnosed early in order to reduce damage to the affected limb.
Lymphedema Development and Risk Factors
The lymphatic system is key to the overall health of the body, since bacteria, viruses, and other noxious materials are conducted to the lymph nodes, where they are filtered and eliminated by the lymphocytes. Patients who suffer from lymphedema cannot properly perform this process, leading to swollen limbs.
Patients who are older, carry excess weight or are obese, or suffer from rheumatoid or psoriatic arthritis are risk factors that impact the development of the disease. The disease can be classified as primary or secondary, depending on the causes of its development.
Primary lymphedema, a rare and inherited disease, is caused by the abnormal development of the lymph system, which is consistent with illnesses like Milroy’s disease (congenital lymphedema), Meige’s disease (lymphedema praecox), and late-onset lymphedema (lymphedema tarda). Symptoms can occur at birth or later in life.
Secondary lymphedema is caused by a condition or procedure that damages the lymph system, including a surgery to remove the lymph nodes or lymph vessels, radiotherapy to treat cancer that can cause scarring and inflammation in the lymph nodes or vessels, a cancer that blocks the lymph vessels, and an infection in the lymph nodes caused by a parasite.
Lymphedema Symptoms and Diagnosis
Lymphedema affects one or both of the limbs and symptoms associated with the disease, include swelling of part or all of the arm or leg; feeling heavy or tight; motion limitations; aching or discomfort; persistent infections; or hardening or thickening skin, also known as fibrosis. When developed as a result of cancer or cancer treatment, lymphedema can show up months or even years afterward.
The signs of the disease are clear, and physicians may diagnose it just by seeing the patient, while in others additional exams may be needed. Tests to conduct the diagnosis include a complete medical exam and family history, an MRI scan, a CT scan, a Doppler ultrasound that analyzes blood flow and pressure, and a radionuclide imaging of the lymphatic system, also known as lymphoscintigraphy.
Prevalence and Treatment of Lymphedema
The prevalence of lymphedema is fairly high, as are related medical costs. There is no cure for the disease, but there are treatment options to help reduce the swelling and control the pain. Medically supervised exercise or wrapping the affected limb can help recover the lymph fluid drainage and mobility.
A specialized massage technique called manual lymph drainage has the same purpose, but it is not indicated for patients with skin infection, active cancer, blood clots, congestive heart failure, or those being treated with radiation therapy.
During pneumatic compression, the affected limb is placed in a sleeve that inflates, creating pressure to conduct the lymph fluid to the fingers or toes, while compression garments are long sleeves or stockings with the same intention that can be used during exercise.
In addition, complete decongestive therapy (CDT) is a combined treatment that includes the therapies above and lifestyle changes. It is recommended in case of high blood pressure, diabetes, paralysis, heart failure, blood clots, or severe infections.
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