Lymphedema is one of the causes of swelling and edema in the arms or legs. It can occur on one side or both sides. It most commonly develops as a result of removal or damage to lymph nodes during cancer treatment. As a result, the circulation of the lymphatic system, which is a part of the immune system, may be blocked. Because of the obstruction, the lymph fluid cannot be drained well, it accumulates in the tissue and causes edema. Lymphedema can be controlled with good care of the affected limb and early intervention.
The following symptoms may appear in the affected arm or leg:
- Swelling and edema of part or all of the limb
- feeling of tension or heaviness
- Decreased freedom of movement
- Pain and discomfort
- recurring infections
- Thickening and hardening of the skin (fibrosis)
Swelling caused by lymphedema can range in severity from very mild to severe enough to severely impair use of the arm or leg. It can take months or years for lymphedema to appear after cancer treatment. Peope who notice permanent edema in the arm or leg should consult a doctor. Persons diagnosed with lymphedema should be examined if a sudden change (increase in diameter) occurs in their involved limbs, as a new process may be in question.l
The severity of lymphedema can be staged by comparing it to the healthy side. Accordingly, it is classified into four phases.
- In the first stage, the diameter difference with the healthy side is less than 4 cm. Edema can be reduced by keeping the limb above the level of the heart. There is swelling in the extremities such as fingers, hands and feet, the part close to the body may be normal. A pit is formed when pressed.
- In the second stage, it is not enough to raise the limb. There is a tight edema that does not form a pit when pressed. The skin is hardened. It affects the entire limb and the proximal quarter of the trunk. The difference in diameter with the healthy side is 4-6 cm. Infection is absent or rare. It can return with treatment.
- In stage three lymphedema, the diameter difference is more than 6 cm. There may be some improvement with treatment or the treatment may be ineffective. Infection occurs because the integrity of the skin is disrupted. The frequency of infection is less than four per year. With these symptoms, it is classified as stage 3a if only one limb is involved, and as 3b if two or more limbs are involved.
- The last and most advanced stage is the fourth stage. The lymph vessels are completely occluded. There is severe and irreversible edema. The frequency of infection is more than four per year.
Why Does It Happen?
The lymphatic system is a necessary structure for our body to be healthy. It ensures the circulation of protein-rich lymph fluid, collects bacteria, viruses and metabolic wastes. Harmful and waste materials are carried to the lymph nodes by lymph vessels. Here, cells called lymphocytes fight infection factors. Lymph nodes are an important defense against foreign microorganisms.
Lymphedema may develop if the lymphatic vessels cannot adequately drain the lymphatic fluid. Lymphedema can be primary or secondary. Primary lymphedema is called lymphedema that occurs on its own without any other disease. In secondary lymphedema, there is another disease or condition. The secondary type is more common.
Causes of Secondary Lymphedema
Any condition or process that injures lymph nodes or vessels can produce lymphedema.
Surgery: Surgery in which lymph nodes and vessels are removed or damaged can result in lymphedema. For example, in breast cancer surgery, lymph nodes may be removed to check the spread of the cancer. In surgeries on arm and leg vessels, lymph nodes may be damaged.
Arm lymphedema is most commonly associated with breast cancer treatments, while leg lymphedema may be associated with removal of lymph nodes or radiotherapy to treat uterine, prostate cancer, lymphoma, or melanoma.
Radiotherapy for cancer: Radiation causes tissue damage and scarring. Lymph nodes and vessels are damaged.
Cancer: Cancer cells can block lymphatic vessels, causing lymphedema. A tumor near a lymphatic vessel or node may impair lymph flow with a mass effect.
Infection: Infection of the lymph node and parasites can interfere with the circulation of lymph fluid. Infection-related lymphedema occurs mostly in developing countries with tropical or subtropical climates.
Causes of Primary Lymphedema
Primary lymphedema is a rare inherited disease characterized by the developmental disorder of lymphatic vessels. Conditions where primary lymphedema occurs:
- Milroy’s disease (congenital lymphedema): It starts in infancy, there is an abnormality in the development of the lymph nodes.
- Meige’s disease (lymphedema precox): It usually causes lymphedema in adolescence or pregnancy. The starting age is less than 35.
- Late-onset lymphedema (lymphedema tarda): It is rare, symptoms begin after the age of 35.
Advanced age, obesity, rheumatic diseases such as rheumatoid arthritis and psoriatic arthritis can be counted as factors that increase the risk of developing lymphedema associated with cancer, cancer treatment or other reasons.
Lymphedema may predispose to infections such as cellulitis and lymphangitis. In the most advanced stage of untreated lymphedema, there may be a possibility of cancer formation called lymphangiosarcoma.
People who have undergone surgery or radiotherapy affecting lymph nodes and vessels should pay attention to measures to prevent lymphedema.
It is necessary to protect the arm from injuries such as cuts, burns and scrapes. Medical procedures such as bloodletting and vaccination should not be performed on the affected side. Protective gloves should be used in occupations with a risk of injury. Sharp objects should be avoided. Electric tools are safer to shave than razors.
Some exercises are recommended to keep the muscles and ligaments flexible after cancer treatment, but rest should be avoided by avoiding heavy work that will cause excessive fatigue and strain.
Avoid applying heat or cold to the affected limb.
Whenever possible, the affected limb should be kept above the level of the heart so that the edema can be reduced by the effect of gravity.
Clothing that is tight on the arms or legs should not be worn. Blood pressure should not be measured on the affected arm.
Skin and nail care should be done regularly. The skin should be inspected daily for injuries such as grazes and cuts that may be a source of infection.
In people at risk of lymphedema, the diagnosis can be made based on the signs and symptoms. If there is no obvious reason, an examination can be performed to view the lymph vessels. MRI and CT can show whether there is a mass blocking the lymph circulation. Doppler ultrasonography serves to evaluate the circulation of blood vessels. Lymph circulation can be visualized by a method called lymphoscintigraphy.
Although there is no treatment method that completely eliminates lymphedema, there are treatments that control the condition by reducing swelling and pain.
Moving the arm and leg with light exercises can accelerate lymph circulation. The exercises should not be challenging. Regular exercise can make daily work more comfortable.
Tightly wrapping the affected limb with bandaging can reduce edema. Lymphedema bandage is made with a special technique. While it is tightest on the fingers, it wraps more loosely as it approaches the body. You can be taught how to bandage by your physiotherapist or doctor.
A special massage technique called manual lymph drainage can help the lymph flow from the arm or leg to the trunk. Massage may not be suitable f