Chronic Lymphedema

What Is Chronic Lymphedema?

Lymphedema is swelling that is caused by a collection of too much lymph fluid. It usually happens in the arms and legs, though it can occur in other parts of the body, as well. The swelling may cause pain and limit the movement of the affected.

Lymph is a fluid that is protein-rich which moves in the body through lymph vessels. It scoops up material such as bacteria, viruses, and other wastes, and carry them to the lymph nodes. The lymph nodes then filter the fluid to get the impurities out of your body.

Commonly caused by the removal of or damage to your lymph nodes as a part of cancer treatment Lymphedema results from a blockage in your lymphatic system, which is part of your immune system. The blockage prevents lymph fluid from draining well, and the fluid buildup leads to swelling.

Causes Of Chronic Lymphedema

The lymphatic system is crucial to keeping the body’s health. It circulates protein-rich lymph fluid throughout the body. It also collects bacteria, viruses and other waste products, carries the fluid and harmful substances through the lymph vessels to the lymph nodes. The wasteis filtered out by infection-fighting cells that live in the lymph nodes (lymphocytes), and ultimately flushed from the body.

Lymphedema occurs when the lymph vessels are unable to drain lymph fluid, usually from an arm or leg. This condition can be either primary (means it can occur on its own) or secondary (it can be caused by another disease or condition). Secondary lymphedema is more common than the primary.

Causes of secondary lymphedema

Any condition or procedure that ends up damaging the lymph nodes or lymph vessels can cause lymphedema.

These may include:

• Surgery–An injury to or Removal of lymph nodes and lymph vessels may result in lymphedema. For example, while checking for the spread of breast cancer, lymph nodes may be removed. Surgery that involves blood vessels in the limbs could injure the Lymph nodes.
• Radiation – This treatment, usually for cancer can cause scarring and inflammation of the lymph nodes or lymph vessels.
• Cancer - If cancer cells block lymphatic vessels, it may result in lymphedema. For instance, a tumor growing near a lymph node or lymph vessel could grow large enough to block the flow of the lymph fluid.
• Infection - An infection of the lymph nodes or parasites could restrict the flow of lymph fluid. Lymphedema caused by infection is most common in tropical and subtropical regions and is more likely to occur in developing countries.

Causes of primary lymphedema

This is a rare, inherited condition caused by defects in the development of lymph vessels in the body.

Specific causes may include:

• Lymphedema praecox(Meige's disease) -This condition often causes lymphedema in women around puberty or during pregnancy, though it can occur much later in life.
• Congenital lymphedema(Milroy's disease) - This condition begins in infancy and causes lymph nodes to form abnormally.
• Lymphedema tarda(Late-onset lymphedema) - This is rare and usually begins after age 35.

Symptoms Of Chronic Lymphedema

The most common symptom of lymphedema is swelling in one or both arms or legs. This swelling, which usually develops gradually and over time can extend into the fingers or toes.

Initially, the swelling is soft and fluid. With time, it can become more dense and fibrous, and it may even make your skin look rough. One could also have pain, heaviness, or limited range of motion in the affected limb, which may make it hard to exercise or do other activities.

Over time, these symptoms may lead to other problems like infections, and in rare cases, cancer.

Fast Facts

• Experts believe primary lymphedema is caused by genetic mutation.
• Secondary lymphedema can be caused by other conditions such as infections and inflammatory diseases.
• In some cases, lymphedema can lead to lymphangitis and other skin infections.
• Protecting the skin can help reduce the risk of lymphedema.

Diagnosis Of Chronic Lymphedema

If you're at risk of lymphedema for instance, if you've recently had cancer surgery involving your lymph nodes our doctors' may diagnose lymphedema based on your signs and symptoms.

If the cause of your lymphedema isn't as obvious, your doctor may order imaging tests to get a look at your lymph system.

Tests may include:

• MRI scan: Using a magnetic field and radio waves, an MRI produces 3-D, high-resolution images.
• CT scan: This X-ray technique produces detailed, cross-sectional images of your body's structures. CT scans can reveal blockages in the lymphatic system.
• Doppler ultrasound: This variation of the conventional ultrasound looks at blood flow and pressure by bouncing high-frequency sound waves (ultrasound) off red blood cells. Ultrasound can help find obstructions.
• Radionuclide imaging of your lymphatic system (lymphoscintigraphy): During this test you're injected with a radioactive dye and then scanned by a machine. The resulting images show the dye moving through your lymph vessels, highlighting blockages.

Treatment for Chronic Lymphedema

Lymphedema is actually incurable. However, the right treatment can help reduce the swelling and pain.

• Complex decongestive therapy (CDT) - Highly intensive therapy during which the patient receives daily treatment and training. Usually, this will be followed by the maintenance phase when the patient is encouraged to take over their own care using techniques that they have been taught during therapy.

The four components of CDT are:

• Remedial exercises - Aimed at encouraging movement of the lymph fluid out of the limb, these arelight exercises.
• Manual lymphatic drainage (MLD) - The therapist uses special massage techniques to move fluid into working lymph nodes, where they are drained. The lymphedema therapist also teaches several massage techniques that can be used during the maintenance phase.
• Skincare - Good skincare reduces the risks of skin infections.
• Multilayer lymphedema bandaging (MLLB) - Muscles surrounding lymph vessels and nodes are wrapped to help the fluid move through the lymphatic system. The aim is to use bandages and compression garments to support the muscles and encourage them to move fluid out of the affected body part. The patient will also be taught how to apply bandagescorrectly at home so that the process can continue during the maintenance period.
• Surgery-This has brought disappointing results compared with non-surgical therapies for this condition. A new surgical technique using liposuction has howeverproven more successful. It removes fat from the affected limb and resultin less or no swelling.

Complications

Untreated lymphedema can lead to other complications such as:

Skin infections:  A bacterial infection called cellulitis for example is common with lymphedema. Cellulitis is of the deeper layers of skin as well as the fat and soft tissue layers under the skin.

Psychological effects: Lymphedema can affect the patient’s outward appearance. This can have a psychological impact on especially those living with cancer. Lymphedema increases the risk of developing depression

Lymphangitis: Ifinflamed, the lymph vessels can developinfections such as one usually caused by a Streptococcus bacteria. If left untreated, it can spread to the skin and adjacent soft tissues, causing cellulitis, or into the bloodstream, causing bacteremia.

Prevention for Chronic Lymphedema

Becausethe supply of lymphocytes which fight infection is reduced,the condition exposes the affected limb and makes it vulnerable to skin infections.Therefore measures to minimize the risk of cuts and grazes to the skin willbe necessary to significantly reduce the risk of subsequent infections.

Patients will have to:

• Avoid hot showers, steam rooms, and saunas
• Rest the affected limb while recoveringfrom cancer treatment.
• Avoid sun beds.
• Refrain from wearing tight-fitting clothes.
• Refrain from wearing tight-fitting jewelry.
• Avoid goingoutdoorsbarefooted.
• Watch out for changes or breaks in the skin.
• Keep the skin supple by moisturizing it every day.
• Make sure foot wears fit properly.
• Useanti-fungal foot powder to prevent developing athlete’s foot.
• Use gloves when gardening.
• Keep nails short.
• Use insect repellentwhen going outside in an area where there may be insects.
• Use a high factor sun blockwhen out in the sun,.
• Treat cuts immediately with an antiseptic cream. And keep the area clean.
• Raise the affected limb above the level of the heart whenever possible.
• Avoid blood pressure checks, blood draws, or injections in the affected limb.
• Diet, body weight, and obesity
• Avoid obesity. A heavy patient is likely to put higher strain on areas that are swollen. A healthy diet, aiming for an ideal body weight, may help alleviate the signs and symptoms of lymphedema.

Outlook

Presently, there is no cure for lymphedema. The outlook for this condition will depend on the extent on the severity of symptoms.

A healthy lifestyle,a balanced diet and regular exercise can help reduce fluid buildup and stimulate the flow of lymph.