What is lymphedema?
Lymph is colorless fluid that circulates throughout your body. It flows through your lymphatic system—a network of lymphatic vessels, tissues and organs that help your body remove toxins and waste. Lymphedema occurs when there is an abnormal buildup of lymph just below your skin—in your body’s soft tissues—resulting in swelling. Lymphedema can affect many parts of the body, but it’s most common in the arms and legs.
Lymphedema is a chronic condition. It has no cure, but it can be medically managed in many cases. There are two types of lymphedema, primary and secondary. A defect in the lymphatic system itself causes primary lymphedema. This form is rare. Secondary lymphedema is the result of injury or damage to the system. Lymphedema symptoms progress through four stages.
While doctors cannot offer a cure for lymphedema, they work with patients on access to physical therapies and healthy living strategies to help manage the symptoms and improve quality of life.
What are the symptoms of lymphedema?
Lymphedema is most often caused by an injury to a lymph node, but the signs and symptoms may only begin weeks after the injury. Symptoms are evident in the limb or part of the body directly below the affected lymph nodes. There are four stages of lymphedema—from 0 to 3. The severity of lymphedema symptoms depends on the stage. They often begin in the extremities and move closer in to the center of the body as the condition progresses.
- Aching pain or discomfort in the limb
- Difficulty moving the limb and limited range of motion
- Hard and thickened skin in the limb
- Heavy or tight feeling in the limb
- Infections in the limb
- Swelling of part or all the affected part of your body, such as your fingers, hands or arm
Stage 0: The mildest stage of lymphedema. Your limb may feel heavy, but no obvious changes are seen.
Stage 1: You may notice puffiness in the affected limb. If you press down on the swelling, your skin doesn’t automatically come back up. This is pitting edema. If you elevate the swollen limb, the puffiness may go away.
Stage 2: The swelling is more evident and will not go away if you elevate the limb. Your skin may start to feel tougher and harder.
Stage 3: The swelling is pronounced and there may be fluid leaking directly from your skin. The skin on the affected limb may feel very dry and scaly.
Lymphedema itself is not a life-threatening condition, but it does put you at risk for serious infections, which can lead to tissue death or sepsis. Regular medical care with a vascular specialist can help reduce the risk of lymphedema complications.
What causes lymphedema?
Lymphedema develops when your lymph cannot drain properly through a lymph node or if the lymphatic system is damaged. This is lymphatic obstruction.
Primary lymphedema—caused by a defect in the lymphatic system due to either inherited or acquired genetic defects or syndromes—is rare. Secondary lymphedema is more common. It is caused by lymph node damage or removal, interfering with normal lymph drainage. Lymph nodes may be damaged by:
- Cancer
- Infection
- Injury
- Radiation treatment
- Scar tissue
- Surgery including lymph node removal for biopsy or cancer
What are the risk factors for lymphedema?
The most common cause of lymphatic obstruction leading to lymphedema is surgery for cancer treatment. The lymph node may be removed or damaged during the procedure.
Although surgeons try to limit the number of lymph nodes they must remove, removal is more common with some types of cancer surgeries. These include surgery for these types of cancers:
- Bladder
- Breast
- Colon
- Gynecologic such as ovarian cancer
- Head and neck
- Melanoma
- Prostate
- Testicular
Other risk factors include:
- Being older
- Being overweight or obese
- Having rheumatoid arthritis or psoriatic arthritis
Reducing your risk of lymphedema
Because cancer surgery is the greatest risk factor for lymphedema, preparing and planning ahead for surgery and your recovery is the best way to reduce your risk. Ask your surgeon about the extent of surgery and how many lymph nodes—if any—will be removed. If your surgeon removes lymph nodes, take steps to reduce the likelihood of problems, such as regular physical activity and maintaining a healthy weight. You may also want to discuss with your surgeon about minimizing lymph node or lymphatic vessel damage during surgery.
How is lymphedema treated?
Lymphedema cannot be cured, but therapies and certain lifestyle changes can help manage it. Lymphedema treatments and strategies include:
- Getting regular physical exercise, particularly of the affected limb
- Wearing a compression sleeve or stocking—as directed by your doctor
- Having regular lymphatic massages by a qualified massage therapist
- Keeping the skin on the affected limb clean and moisturized
- Losing weight if you are overweight or obese
What are the potential complications of lymphedema?
Aside from the discomfort that lymphedema may cause, you may be at risk for developing a serious infection in the affected limb. An infection in your skin, called cellulitis, or in the lymph vessels, called lymphangitis, should be treated as quickly as possible.
Rarely, some people with untreated lymphedema may develop a rare form of soft tissue cancer called lymphangiosarcoma.
