Lymphedema

Lymphedema is a condition in which an arm or a leg swells because of a blockage in your lymphatic system. The lymphatic system is a network of vessels carrying lymph, a clear fluid made mostly of water, proteins, salts and white blood cells. Any obstruction in the lymphatic system hinders the proper drainage of lymph and as the fluid builds up, the swelling progresses. Generally lymphedema tends to affect just one arm or leg, but sometimes both arms or both legs may be swollen.

Lymphedema is most commonly caused by the removal of, or damage to your lymph nodes as a part of cancer treatment. There's no cure for lymphedema, but it can be controlled. Controlling lymphedema involves meticulous care of the affected limb.

Causes:

Lymphedema can be either occur on its own (primary lymphedema), or it can be caused by another disease or condition (secondary lymphedema). Secondary lymphedema is far more common than primary lymphedema.

Causes of secondary lymphedema

Any condition or procedure that damages your lymph nodes or lymph vessels can cause lymphedema. Common causes include:

• Surgery: Several surgeries, especially those for cancer involve the removal of lymph nodes. The remaining lymph nodes and vessels often compensate for those that have been removed, but if this does not happen, secondary lymphedema may develop.
• Radiation treatment for cancer: Radiation can cause scarring and inflammation of your lymph nodes or lymph vessels, restricting the flow of lymph fluid leading to lymphedema.
• Cancer: If cancer cells block lymphatic vessels, lymphedema may result. For instance, a tumor growing near a lymph node or lymph vessel could become large enough to block the flow of the lymph fluid.
• Infection: Infection related lymphedema is common in tropical and subtropical countries. It occurs because of the restricted flow of lymph through infected lymph nodes or blockage of lymph vessels by parasites.

Causes of primary lymphedema

Primary lymphedema is a rare, genetic condition caused by the faulty development of lymph vessels in your body. Primary lymphedema is more common in women. Types of primary lymphedema include:

• Milroy's disease (lymphedema from birth): Caused by abnormal formation of lymph nodes. Symptoms present from infancy.
• Meige's disease (Also known as lymphedema praecox): Defect in the formation of valves that prevent the backward flow of lymphatic fluid. Symptoms start in childhood or puberty, but may show up as late as your 20s or 30s.
• Late-onset lymphedema (lymphedema tarda): A rare condition that usually manifests in late 30s.  

Complications:

Lymphedema in your limbs can lead to serious complications, such as:

• Infections: Limbs affected by lymphedema are prone to cellulitis — a serious bacterial infection of the skin — and lymphangitis — an infection of the lymph vessels.
• Lymphangiosarcoma: Severe cases of untreated lymphedema can lead to this rare form of soft tissue cancer.

Treatment:

Lymphedema cannot be cured. Management is directed towards reducing the swelling and controlling the pain. It includes:

• Exercises: Gentle exercise of affected arm or leg promotes drainage of fluid out of your limb. These exercises should be done under the supervision of a doctor or physiotherapist
• Wrapping your arm or leg: Appropriate wrapping of bandages around the affected limb can encourage lymph fluid to flow towards the trunk of your body. The bandage should be tightest around your fingers and toes and loosen up as you move up your arm or leg. It should be done under the guidance of a trained therapist.
• Massage: Massage is aimed at manual lymph drainage to encourage the flow of lymph fluid out of your arm or leg. It involves special hand strokes on your affected limb to gently move lymph fluid to healthy lymph nodes, where it can drain.
• Pneumatic compression. It involves wearing a sleeve over your affected arm or leg. The sleeve is connected to a pump that intermittently inflates the sleeve, putting pressure on your limb.
• Compression garments: These are long sleeves or stockings made to compress your arm or leg to encourage the flow of the lymph fluid out of your affected limb. They are generally used to prevent the recurrence of lymphedema after the swelling has been reduced through other measures.
• Surgery: Surgical removal of excess tissue in the affected limb maybe required for severe cases of lymphedema.