; onclick=)
Notice (8): Undefined index: api_key [APP/Controller/PageprocessController.php, line 111]Notice (8): Undefined index: site_id [APP/Controller/PageprocessController.php, line 112]/wp-content/uploads/2023/06/lymphedema_253377.jpg?fit=800%2C600&ssl=1" class="aligncenter wp-post-image" alt="" decoding="async" srcset="https://i0.wp.com/
Notice (8): Undefined index: api_key [APP/Controller/PageprocessController.php, line 111]
Notice (8): Undefined index: site_id [APP/Controller/PageprocessController.php, line 112]/wp-content/uploads/2023/06/lymphedema_253377.jpg?w=800&ssl=1 800w, https://i0.wp.com/
Notice (8): Undefined index: api_key [APP/Controller/PageprocessController.php, line 111]
Notice (8): Undefined index: site_id [APP/Controller/PageprocessController.php, line 112]/wp-content/uploads/2023/06/lymphedema_253377.jpg?resize=768%2C576&ssl=1 768w, https://i0.wp.com/
Notice (8): Undefined index: api_key [APP/Controller/PageprocessController.php, line 111]
Notice (8): Undefined index: site_id [APP/Controller/PageprocessController.php, line 112]/wp-content/uploads/2023/06/lymphedema_253377.jpg?resize=360%2C270&ssl=1 360w, https://i0.wp.com/
Notice (8): Undefined index: api_key [APP/Controller/PageprocessController.php, line 111]
Notice (8): Undefined index: site_id [APP/Controller/PageprocessController.php, line 112]/wp-content/uploads/2023/06/lymphedema_253377.jpg?resize=600%2C450&ssl=1 600w" sizes="(max-width: 800px) 100vw, 800px" data-attachment-id="254429" data-permalink="https://rxharun.com/rxharun/rx-cancer-and-neoplasms-a-z/lymphedema/attachment/lymphedema-2/" data-orig-file="https://i0.wp.com/
Notice (8): Undefined index: api_key [APP/Controller/PageprocessController.php, line 111]
Notice (8): Undefined index: site_id [APP/Controller/PageprocessController.php, line 112]/wp-content/uploads/2023/06/lymphedema_253377.jpg?fit=800%2C600&ssl=1" data-orig-size="800,600" data-comments-opened="0" data-image-meta="{"aperture":"0","credit":"","camera":"","caption":"","created_timestamp":"0","copyright":"","focal_length":"0","iso":"0","shutter_speed":"0","title":"","orientation":"0"}" data-image-title="Lymphedema" data-image-description="" data-image-caption="" data-medium-file="https://i0.wp.com/
Notice (8): Undefined index: api_key [APP/Controller/PageprocessController.php, line 111]
Notice (8): Undefined index: site_id [APP/Controller/PageprocessController.php, line 112]/wp-content/uploads/2023/06/lymphedema_253377.jpg?fit=800%2C600&ssl=1" data-large-file="https://i0.wp.com/
Notice (8): Undefined index: api_key [APP/Controller/PageprocessController.php, line 111]
Notice (8): Undefined index: site_id [APP/Controller/PageprocessController.php, line 112]/wp-content/uploads/2023/06/lymphedema_253377.jpg?fit=800%2C600&ssl=1" data-jpibfi-post-excerpt="" data-jpibfi-post-url="https://rxharun.com/rxharun/rx-cancer-and-neoplasms-a-z/lymphedema/" data-jpibfi-post-title="Lymphedema" data-jpibfi-src="https://i0.wp.com/
Notice (8): Undefined index: api_key [APP/Controller/PageprocessController.php, line 111]
Notice (8): Undefined index: site_id [APP/Controller/PageprocessController.php, line 112]/wp-content/uploads/2023/06/lymphedema_253377.jpg?fit=800%2C600&ssl=1">
Lymphedema is a chronic disease marked by the increased collection of lymphatic fluid in the body, causing swelling, which can lead to skin and tissue changes. The chronic, progressive accumulation of protein-rich fluid within the interstitium and the fibro-adipose tissue exceeds the capacity of the lymphatic system to transport the fluid. Swelling associated with lymphedema can occur anywhere in the body, including the arms, legs, genitals, face, neck, chest wall, and oral cavity. There are many psychological, physical, and social sequelae related to a diagnosis of lymphedema. This activity reviews the presentation of lymphedema and highlights the role of the interprofessional team in its management.
The lymphatic vessels transport lymph. Lymph is composed of white blood cells, triglycerides, bacteria, cell debris, water, and protein. It has a composition comparable to blood plasma. The lymph drainage system is complex and comprises initial lymphatics (lymph capillaries), pre-collectors, collectors, lymphatic trunks, and lymph nodes. Topographically, the lymph system is distinguished as superficial (subcutaneous) and deep (subfascial). The superficial system drains the skin and subcutis areas. The deep system drains muscles, joints, tendon sheaths, and nerves. Both systems are connected via the perforating vessels, which conduct lymph fluid from the subfascial areas to the surface.
Signs and symptoms of lymphedema include distal swelling in the extremities, including the arms, hands, legs, and feet; swelling proximally in the breast, chest, shoulder, pelvis, groin, genitals, face/intraoral tissues; a restricted range of motion in the joints because of swelling and tissue changes; skin discoloration; pain and altered sensation; limb heaviness; and difficulty fitting into clothing.
Types
Types of lymphedema, its causes, symptoms, and available treatment options.
- Primary Lymphedema: A primary lymphedema is a rare form of the condition that occurs due to inherent abnormalities in the lymphatic system. It can be further classified into three subtypes: congenital lymphedema, lymphedema praecox, and lymphedema tarda. Congenital lymphedema is present at birth, while lymphedema praecox usually develops during puberty. Lymphedema tarda, on the other hand, typically appears after the age of 35.
- Secondary Lymphedema: Secondary lymphedema is the most common type of lymphedema, and it is caused by damage or obstruction to the lymphatic system. This can result from various factors, including surgical procedures, radiation therapy, trauma, infections, or cancerous tumors. It typically develops after the lymph nodes or vessels have been removed, damaged, or blocked, leading to impaired lymphatic drainage.
- Filariasis-related Lymphedema: Filariasis-related lymphedema is prevalent in tropical and subtropical regions, particularly in developing countries. It is caused by parasitic infections transmitted by mosquitoes, primarily Wuchereria bancrofti. These parasites obstruct the lymphatic vessels, leading to the development of lymphedema over time.
- Cancer-related Lymphedema: Cancer-related lymphedema occurs as a result of cancer and its treatments. Lymph nodes may be removed or damaged during cancer surgery, and radiation therapy can cause scarring and inflammation, further impeding lymphatic drainage. This type of lymphedema commonly affects individuals who have undergone breast cancer treatment, but it can also occur in other cancer types.
Primary lymphedema is an inherited or congenital condition that causes a malformation of the lymphatics system, most often because of genetic mutation. Primary lymphedema can be subdivided into 3 categories: 1) congenital lymphedema, present at birth or recognized within two years of birth; 2) lymphedema praecox, occurring at puberty or the beginning of the third decade; or 3) lymphedema tarda, which begins after 35 years of age.
Secondary lymphedema results from insult, injury, or obstruction to the lymphatic system. While the most common cause of lymphedema worldwide is filariasis caused by infection by Wuchereria bancrofti, in developed countries, most secondary lymphedema cases are due to malignancy or related to the treatment of malignancy. This includes surgical excision of lymph nodes, local radiation treatment, or medical therapy. Breast cancer is the most common cancer associated with secondary lymphedema in developed countries.
Notice (8): Undefined index: api_key [APP/Controller/PageprocessController.php, line 111]
Notice (8): Undefined index: site_id [APP/Controller/PageprocessController.php, line 112]/wp-content/uploads/2023/05/661751-750.jpg?fit=750%2C779&ssl=1" data-orig-size="750,779" data-comments-opened="0" data-image-meta="{"aperture":"0","credit":"","camera":"","caption":"","created_timestamp":"0","copyright":"","focal_length":"0","iso":"0","shutter_speed":"0","title":"","orientation":"0"}" data-image-title="661751-750" data-image-description="" data-image-caption="" data-medium-file="https://i0.wp.com/
Notice (8): Undefined index: api_key [APP/Controller/PageprocessController.php, line 111]
Notice (8): Undefined index: site_id [APP/Controller/PageprocessController.php, line 112]/wp-content/uploads/2023/05/661751-750.jpg?fit=750%2C779&ssl=1" data-large-file="https://i0.wp.com/
Notice (8): Undefined index: api_key [APP/Controller/PageprocessController.php, line 111]
Notice (8): Undefined index: site_id [APP/Controller/PageprocessController.php, line 112]/wp-content/uploads/2023/05/661751-750.jpg?fit=750%2C779&ssl=1" decoding="async" loading="lazy" class="alignnone size-full wp-image-253378" src="https://i0.wp.com/
Notice (8): Undefined index: api_key [APP/Controller/PageprocessController.php, line 111]
Notice (8): Undefined index: site_id [APP/Controller/PageprocessController.php, line 112]/wp-content/uploads/2023/05/661751-750.jpg?resize=750%2C779&ssl=1" alt="" width="750" height="779" srcset="https://i0.wp.com/
Notice (8): Undefined index: api_key [APP/Controller/PageprocessController.php, line 111]
Notice (8): Undefined index: site_id [APP/Controller/PageprocessController.php, line 112]/wp-content/uploads/2023/05/661751-750.jpg?w=750&ssl=1 750w, https://i0.wp.com/
Notice (8): Undefined index: api_key [APP/Controller/PageprocessController.php, line 111]
Notice (8): Undefined index: site_id [APP/Controller/PageprocessController.php, line 112]/wp-content/uploads/2023/05/661751-750.jpg?resize=260%2C270&ssl=1 260w, https://i0.wp.com/
Notice (8): Undefined index: api_key [APP/Controller/PageprocessController.php, line 111]
Notice (8): Undefined index: site_id [APP/Controller/PageprocessController.php, line 112]/wp-content/uploads/2023/05/661751-750.jpg?resize=600%2C623&ssl=1 600w" sizes="(max-width: 750px) 100vw, 750px" data-jpibfi-caption="" data-jpibfi-post-excerpt="" data-jpibfi-post-url="https://rxharun.com/rxharun/rx-cancer-and-neoplasms-a-z/lymphedema/" data-jpibfi-post-title="Lymphedema" data-jpibfi-src="https://i0.wp.com/
Notice (8): Undefined index: api_key [APP/Controller/PageprocessController.php, line 111]
Notice (8): Undefined index: site_id [APP/Controller/PageprocessController.php, line 112]/wp-content/uploads/2023/05/661751-750.jpg?resize=750%2C779&ssl=1" data-recalc-dims="1">
Causes
Most common causes of lymphedema, shedding light on the symptoms and available treatment options. Understanding these causes can help individuals identify potential risk factors and take proactive steps toward prevention and management.
- Surgery-related causes: Surgical procedures involving lymph node removals, such as mastectomy or lymph node dissection, can disrupt the natural flow of lymph fluid, leading to lymphedema.
- Radiation therapy: Radiation treatment for cancer can damage lymph nodes and vessels, hindering proper lymphatic drainage and causing swelling.
- Cancer-related causes: Cancers, such as breast, prostate, or melanoma, can directly infiltrate or obstruct lymphatic pathways, resulting in lymphedema.
- Infection: Severe infections, particularly those affecting the lymphatic system, like cellulitis or lymphangitis, can trigger lymphedema.
- Primary lymphedema: Primary lymphedema is a hereditary condition where abnormalities in the lymphatic system are present from birth, leading to swelling later in life.
- Secondary lymphedema: Secondary lymphedema occurs as a result of acquired damage to the lymphatic system, commonly due to surgery, trauma, infection, or cancer treatment.
- Obesity: Excess body weight can place additional stress on the lymphatic system, impeding proper fluid drainage and potentially leading to lymphedema.
- Filariasis: This parasitic infection transmitted by mosquitoes can cause damage to lymph nodes and vessels, resulting in lymphedema.
- Deep vein thrombosis (DVT): Blood clots in deep veins, typically in the legs, can obstruct lymphatic flow and contribute to the development of lymphedema.
- Chronic venous insufficiency: When veins in the legs fail to efficiently return blood to the heart, it can lead to venous hypertension, increasing the risk of lymphedema.
- Trauma or injury: Severe injuries or trauma, including burns or fractures, can damage the lymphatic system and trigger lymphedema.
- Inflammatory conditions: Chronic inflammatory disorders like rheumatoid arthritis or lupus can cause inflammation and damage to lymphatic vessels, leading to lymphedema.
- Congestive heart failure: A weakened heart may struggle to adequately circulate blood, increasing fluid accumulation and potentially resulting in lymphedema.
- Blood vessel disorders: Certain vascular conditions, such as varicose veins or venous malformations, can disrupt lymphatic flow and contribute to lymphedema.
- Surgical scar tissue: Scar tissue formation from previous surgeries can impede lymphatic drainage, leading to swelling in the affected area.
- Venous stasis dermatitis: Poor circulation in the lower legs can cause chronic skin inflammation, ultimately leading to lymphedema.
- Inactivity or sedentary lifestyle: Lack of physical activity can hamper the lymphatic system’s ability to transport fluid, increasing the risk of lymphedema.
- Chronic liver disease: Liver dysfunction can disrupt the balance of proteins in the blood, leading to fluid retention and potentially causing lymphedema.
- Kidney disorders: Impaired kidney function can result in fluid retention, leading to lymphedema.
- Chronic respiratory conditions: Lung diseases like chronic obstructive pulmonary disease (COPD) can cause increased fluid retention and contribute to the development of lymphedema.
- Hypothyroidism: Underactive thyroid function can affect fluid balance and contribute to lymphedema.
- Certain medications: Some medications, such as tamoxifen or antidepressants, may increase the risk of developing lymphedema as a side effect.
- Autoimmune disorders: Conditions like systemic lupus erythematosus or scleroderma can cause inflammation and damage to the lymphatic system, leading to lymphedema.
- Lipedema: Lipedema is a condition characterized by the abnormal accumulation of fat cells, often affecting the legs and arms and leading to lymphedema in some cases.
- Chronic venous access: Frequent use of central venous catheters or needles for medical treatments can damage lymphatic vessels, increasing the risk of lymphedema.
- Chronic sinusitis: Recurrent inflammation and infection of the sinuses can affect lymphatic drainage in the head and neck area, potentially leading to lymphedema.
- Insect bites: Severe reactions to insect bites, especially ticks or spiders, can cause lymphatic vessel damage, resulting in localized lymphedema.
- Environmental factors: Exposure to certain toxins, chemicals, or pollutants may affect lymphatic function and contribute to the development of lymphedema.
- Emotional stress: Prolonged stress can impact the body’s overall health, potentially affecting lymphatic function and increasing the risk of lymphedema.
- Genetic predisposition: Individuals with a family history of lymphedema may have a higher likelihood of developing the condition.
Symptoms
Common symptoms of lymphedema, providing detailed explanations to enhance understanding and accessibility.
- Swelling: Swelling, often the first noticeable symptom of lymphedema, occurs due to the accumulation of lymph fluid. It may start gradually and worsen over time.
- Heaviness: A feeling of heaviness or fullness in the affected limb is a common symptom of lymphedema. This sensation can impact daily activities and mobility.
- Tightness: Lymphedema can cause tightness or a feeling of tension in the affected area. This tightness may worsen with prolonged periods of standing or sitting.
- Loss of Range of Motion: As lymphedema progresses, it can restrict the range of motion in the affected limb, making it difficult to perform certain movements.
- Aching or Discomfort: Individuals with lymphedema often experience aching or discomfort in the affected limb. This sensation may vary from mild to severe.
- Redness: In some cases, lymphedema can lead to redness or erythema in the affected area. The skin may feel warm to the touch.
- Skin Thickening: The skin over the affected limb may become thick and hardened over time. This symptom is known as fibrosis and can contribute to further complications.
- Skin Discoloration: Lymphedema can cause the skin to change color, becoming pale or discolored. This symptom may be more noticeable in advanced stages.
- Pitting Edema: Gently pressing on the swollen area may leave a temporary indentation or “pit.” This is known as pitting edema and is characteristic of lymphedema.
- Lymphatic Blisters: In rare cases, lymphedema can lead to the development of fluid-filled blisters on the skin. These blisters can be painful and prone to infection.
- Frequent Infections: Lymphedema weakens the immune system’s ability to fight off infections, making affected individuals more susceptible to cellulitis and other skin infections.
- Difficulty Fitting into Clothing: The swelling caused by lymphedema can result in a change in limb size, making it challenging to fit into regular clothing or accessories.
- Difficulty Wearing Shoes or Jewelry: Swelling in the lower limbs can make it difficult to wear shoes or jewelry comfortably. This symptom can significantly impact daily activities and quality of life.
- Reduced Sensation: Lymphedema can lead to reduced sensation or numbness in the affected area. This may affect the ability to detect pain or temperature changes.
- Recurring Skin Abscesses: People with lymphedema may experience recurring skin abscesses or boils. These infections can be painful and require medical attention.
- Limited Exercise Capacity: The swelling and discomfort associated with lymphedema can make physical exercise challenging, leading to reduced exercise capacity and overall fitness.
- Fungal Infections: The accumulation of moisture and compromised immune function in lymphedema can increase the risk of developing fungal infections, such as athlete’s foot.
- Reduced Flexibility: Lymphedema can cause a decrease in flexibility in the affected limb, making it harder to perform daily activities and engage in exercise routines.
Possible signs of lymphedema include swelling of the arms or legs.
Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems occur:
- Swelling of an arm or leg, which may include fingers and toes.
- A full or heavy feeling in an arm or leg.
- A tight feeling in the skin.
- Trouble moving a joint in the arm or leg.
- Thickening of the skin, with or without skin changes such as blisters or warts.
- A feeling of tightness when wearing clothing, shoes, bracelets, watches, or rings.
- Itching of the legs or toes.
- A burning feeling in the legs.
- Trouble sleeping.
- Loss of hair.
Diagnosis
Accurate diagnosis and appropriate testing play a crucial role in identifying and managing lymphedema effectively and present a comprehensive list of essential diagnoses and tests for lymphedema, providing you with valuable insights into this condition and enhancing its visibility and accessibility.
- Medical History Assessment: The first step in diagnosing lymphedema is a thorough medical history assessment. Healthcare professionals will inquire about any previous surgeries, infections, or traumas that may have contributed to lymphatic system damage.
- Physical Examination: A physical examination is performed to evaluate the affected area for signs of swelling, skin changes, or infection. This examination aids in identifying the severity and location of lymphedema.
- Bioimpedance Spectroscopy (BIS): Bioimpedance spectroscopy is a non-invasive test that measures the resistance of electrical currents passing through the affected limb. It helps assess the level of fluid accumulation and differentiate between lymphedema and other conditions.
- Lymphoscintigraphy: Lymphoscintigraphy involves injecting a radioactive dye into the lymphatic vessels and imaging the lymphatic system. This test provides detailed information about the flow and blockages within the lymphatic system.
- Lymphangiography: Lymphangiography is a diagnostic procedure in which a contrast dye is injected into the lymphatic vessels. X-rays or other imaging techniques are then used to visualize the lymphatic system and identify blockages.
- Duplex Ultrasound: Duplex ultrasound combines traditional ultrasound with Doppler technology to assess blood flow and detect any abnormalities or blockages in the lymphatic or vascular systems.
- Magnetic Resonance Imaging (MRI): MRI uses powerful magnets and radio waves to create detailed images of the body. It can help visualize the lymphatic system and identify any structural abnormalities or blockages.
- Computed Tomography (CT) Scan: CT scans use a series of X-ray images to create cross-sectional images of the body. They can be helpful in identifying lymphedema-related complications, such as infections or tumors.
- Differential Diagnosis: Differential diagnosis involves ruling out other conditions that may mimic lymphedema symptoms, such as deep vein thrombosis (DVT) or lipedema. Accurate differential diagnosis is essential for effective treatment planning.
- Complete Blood Count (CBC): A CBC test helps evaluate the overall health of an individual and detects any infections or abnormal blood cell counts that may contribute to lymphedema or its complications.
- Lymph Node Biopsy: In cases where lymphedema is suspected to be caused by cancer, a lymph node biopsy may be performed to analyze the lymph nodes for the presence of cancer cells.
- Genetic Testing: Genetic testing can help identify certain hereditary conditions that may lead to lymphedema, such as Milroy disease or lymphedema-distichiasis syndrome.
- Lymph Fluid Analysis: Lymph fluid analysis involves collecting a sample of lymph fluid from the affected area and examining it for infection, inflammation, or other abnormalities.
- Lymphatic Mapping: Lymphatic mapping involves using specialized imaging techniques to identify and map the lymphatic vessels, providing valuable information for surgical interventions or targeted therapies.
- Indocyanine Green (ICG) Lymphography: ICG lymphography is a non-invasive imaging technique that uses a fluorescent dye to visualize the lymphatic system. It helps identify lymphatic flow patterns and any blockages.
- Limb Volume Measurements: Measuring the circumference or volume of the affected limb helps track changes in swelling and assess treatment effectiveness over time.
- Photographic Documentation: Photographic documentation involves taking regular pictures of the affected limb to visually monitor changes in size, skin condition, or any other visible alterations.
- Quality of Life Assessment: Evaluating the impact of lymphedema on an individual’s quality of life is essential for understanding the emotional and functional implications of the condition.
- Lymphatic Function Assessment: Various tests, such as lymphatic drainage studies or lymphatic pump testing, can assess the functionality and effectiveness of the lymphatic system.
- Ankle-Brachial Index (ABI): ABI is a simple and non-invasive test that compares the blood pressure in the ankle to the blood pressure in the arm, helping evaluate peripheral arterial disease, which may affect lymphedema management.
- Microlymphatic Surgery: Microlymphatic surgery is a specialized procedure that aims to restore lymphatic flow and reduce swelling. Preoperative mapping and diagnostic testing are crucial for surgical planning.
- Complete Decongestive Therapy (CDT) Trial: A trial of CDT, which includes manual lymphatic drainage, compression therapy, exercise, and skincare, can help evaluate its effectiveness and tailor the treatment plan accordingly.
- Lymphedema Severity Assessment: Several tools and scoring systems, such as the Lymphedema Severity Score, are used to assess the severity and progression of lymphedema.
- Impedance Plethysmography: Impedance plethysmography measures changes in limb volume by assessing the electrical conductivity of tissues. It aids in monitoring lymphedema progression and treatment outcomes.
- Fluoroscopy: Fluoroscopy uses continuous X-ray imaging to examine the lymphatic system in real-time, providing dynamic information about lymphatic flow and potential blockages.
- Upper Extremity Function Assessment: For upper extremity lymphedema, evaluating functional abilities, such as range of motion, grip strength, or fine motor skills, is crucial in developing a comprehensive treatment plan.
- Imaging-Guided Biopsies: In cases where lymphedema may be related to tumors or infections, imaging-guided biopsies can help obtain tissue samples for further analysis and appropriate treatment planning.
- Inflammatory Biomarker Analysis: Analyzing inflammatory biomarkers, such as C-reactive protein (CRP) or interleukin-6 (IL-6), can provide insights into the inflammatory processes associated with lymphedema.
- Psychological Assessment: A psychological assessment helps evaluate the emotional well-being of individuals living with lymphedema and identifies potential psychological factors that may influence treatment outcomes.
- Ultrasound-Guided Thoracic Duct Cannulation: In complex cases, ultrasound-guided cannulation of the thoracic duct may be performed to assess lymphatic flow patterns and guide therapeutic interventions.
Treatment
Effective treatments for lymphedema. By optimizing its content for search engines and utilizing simple language, we aim to enhance the visibility and accessibility of this information for a wide range of readers.
- Manual Lymphatic Drainage (MLD): MLD is a gentle massage technique performed by trained therapists to stimulate lymph flow, reduce swelling, and enhance the body’s natural drainage system.
- Compression Therapy: Using compression garments or bandages, this therapy applies controlled pressure to the affected area, promoting lymph flow and reducing swelling.
- Complete Decongestive Therapy (CDT): CDT combines MLD, compression therapy, skincare, and exercise to effectively manage lymphedema and improve quality of life.
- Exercise and Physical Therapy: Engaging in regular exercises, such as walking, swimming, and low-impact activities, helps improve circulation, reduce swelling, and maintain mobility.
- Deep Breathing Exercises: Deep breathing exercises encourage lymph flow by stimulating the diaphragm and enhancing the contraction of lymph vessels.
- Pneumatic Compression Devices: These devices use sequential inflation and deflation to stimulate lymphatic flow, reduce swelling, and enhance circulation.
- Wrapping: Simple wrapping techniques with elastic bandages or compression garments help control swelling and prevent fluid buildup.
- Manual Lymphatic Mapping: This technique involves mapping the lymphatic system to identify areas of blockage, allowing therapists to focus treatment more precisely.
- Laser Therapy: Low-level laser therapy helps reduce inflammation, stimulate lymphatic vessels, and promote tissue regeneration.
- Transient Elastography: This non-invasive procedure measures tissue elasticity, aiding in the diagnosis and monitoring of lymphedema progression.
- Surgery: In severe cases, surgical interventions, such as lymphaticovenular anastomosis or vascularized lymph node transfer, may be recommended to improve lymphatic flow.
- Topical Medications: Certain medicated creams and ointments can help manage skin infections and prevent complications associated with lymphedema.
- Multilayer Lymphedema Bandaging: This technique involves applying multiple layers of bandages with varying degrees of compression to reduce swelling effectively.
- Aqua Lymphatic Therapy: Exercising in water can reduce the strain on limbs and enhance lymphatic flow, making it an ideal option for individuals with limited mobility.
- Kinesio Taping: Kinesio tapes applied to the affected area facilitate lymphatic drainage, reduce inflammation, and provide support.
- Electrotherapy: Electrotherapy techniques, such as electrical muscle stimulation and biofeedback, can help stimulate lymphatic flow and relieve pain.
- Weight Management: Maintaining a healthy weight through proper nutrition and regular exercise can reduce the burden on the lymphatic system and alleviate symptoms.
- Acupuncture: This traditional Chinese medicine technique involves inserting thin needles into specific points of the body to promote energy flow and improve lymphatic function.
- Yoga and Meditation: Practicing yoga and meditation can reduce stress, improve circulation, and promote overall well-being, indirectly benefiting lymphatic health.
- Herbal Remedies: Certain herbs, like calendula, cleavers, and red clover, have shown potential in reducing swelling and promoting lymphatic drainage.
- Aromatherapy: Using essential oils, such as lemon, grapefruit, and cypress, in massages or baths can support lymphatic circulation and reduce fluid retention.
- Dietary Modifications: Reducing sodium intake and consuming a balanced diet rich in fruits, vegetables, and lean proteins can help manage lymphedema symptoms.
- Hydration: Staying well-hydrated supports lymphatic function and prevents dehydration, which can exacerbate swelling.
- Self-Care Practices: Daily skincare routines, including moisturizing, cleansing, and avoiding injury, are crucial to prevent infections and maintain overall skin health.
- Education and Counseling: Receiving proper education about lymphedema and seeking counseling support can help individuals cope with the emotional and psychological aspects of the condition.
- Lymphatic Yoga: Specialized yoga practices, focusing on lymphatic flow and gentle movements, can aid in managing lymphedema symptoms.
- Sequential Gradient Pump: This device uses sequential chambers to apply pressure from distal to proximal, facilitating lymphatic drainage and reducing swelling.
- Herbal Tea Infusions: Drinking herbal teas like dandelion root, ginger, or parsley can have diuretic effects, promoting lymphatic drainage and reducing swelling.
- Reflexology: Applying pressure to specific points on the feet or hands can stimulate lymphatic circulation and alleviate lymphedema symptoms.
- Emotional Support Groups: Participating in support groups or seeking therapy can provide emotional support, reduce anxiety, and improve overall well-being.
Medications
Effective drug treatments for lymphedema, highlighting their mechanisms, benefits, and potential side effects.
- Diuretics: Diuretics are medications that increase urine production, helping reduce fluid retention and swelling associated with lymphedema. These drugs promote the elimination of excess fluid from the body, providing relief from edema symptoms.
- Benzopyrones: Benzopyrones are a class of drugs that improve lymphatic flow by increasing the pumping efficiency of lymphatic vessels. By enhancing the lymphatic system’s function, benzopyrones can reduce swelling and improve overall lymphedema symptoms.
- Pentoxifylline: Pentoxifylline is a medication that enhances blood flow and decreases blood viscosity. It helps improve lymphatic function and reduces the severity of lymphedema symptoms such as swelling and discomfort.
- Antibiotics: In cases where lymphedema leads to infections or cellulitis, antibiotics may be prescribed to treat the underlying infection. This helps prevent complications and reduces inflammation in the affected area.
- Analgesics: Analgesics, or pain relievers, can be prescribed to manage the discomfort associated with lymphedema. These medications help alleviate pain and improve the overall quality of life for individuals with lymphedema.
- Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): NSAIDs are commonly used to reduce inflammation and swelling in various conditions. When lymphedema causes inflammation, NSAIDs can be effective in providing relief and improving mobility.
- Steroids: Steroids, such as corticosteroids, have potent anti-inflammatory properties and may be prescribed in severe cases of lymphedema. They help reduce swelling, inflammation, and discomfort, promoting better lymphatic flow.
- Lymphatic Drainage Agents: Lymphatic drainage agents are medications that stimulate lymphatic contractions, enhancing the movement of lymph fluid. These drugs can facilitate lymphatic drainage and reduce swelling in affected areas.
- Anticoagulants: In some cases, lymphedema may cause blood clotting due to impaired circulation. Anticoagulant medications can prevent blood clots from forming, reducing the risk of complications associated with lymphedema.
- Calcium Channel Blockers: Calcium channel blockers are medications that relax and widen blood vessels, improving blood flow. By enhancing circulation, these drugs can indirectly alleviate lymphedema symptoms.
- Vasodilators: Vasodilators work by relaxing the smooth muscles of blood vessels, leading to increased blood flow. Improved blood circulation can help manage lymphedema symptoms and reduce swelling.
- Heparin: Heparin is an anticoagulant medication that prevents blood clotting. It may be used in cases where lymphedema leads to clot formation, reducing the risk of further complications.
- Vasoactive Agents: Vasoactive agents are drugs that regulate blood vessel constriction and dilation. By improving blood flow, they can indirectly benefit lymphatic circulation and reduce lymphedema symptoms.
- Alpha-Adrenergic Agonists: Alpha-adrenergic agonists are medications that promote vasoconstriction, narrowing blood vessels. These drugs can help reduce swelling and fluid buildup in affected areas of the body.
- Immunomodulatory Agents: Immunomodulatory agents, such as immunosuppressants, may be prescribed if lymphedema is associated with an autoimmune response. These medications help regulate the immune system and reduce inflammation.
- Prostaglandins: Prostaglandins are hormone-like substances that play a role in inflammation and blood flow regulation. Certain prostaglandin analogs can improve lymphatic flow and reduce swelling in lymphedema.
- Growth Factors: Growth factors are proteins that promote cell growth, repair, and regeneration. Some growth factors may be used to stimulate lymphatic vessel growth and improve lymphedema symptoms.
- Antioxidants: Antioxidants help reduce oxidative stress and inflammation in the body. They may be beneficial in managing lymphedema by minimizing tissue damage and promoting healing.
- Mast Cell Stabilizers: Mast cell stabilizers are medications that prevent the release of histamine and other inflammatory chemicals. They can help control inflammation and reduce swelling associated with lymphedema.
- Natural Supplements: Certain natural supplements, such as herbal remedies and plant-based extracts, have shown potential in managing lymphedema symptoms. Examples include horse chestnut, gotu kola, and bromelain.
Treatment of lymphedema may include the following:
Pressure garments
Pressure garments are made of fabric that puts a controlled amount of pressure on different parts of the arm or leg to help move fluid and keep it from building up. Some patients may need to have these garments custom-made for a correct fit. Wearing a pressure garment during exercise may help prevent more swelling in an affected limb. It is important to use pressure garments during air travel, because lymphedema can become worse at high altitudes. Pressure garments are also called compression sleeves and lymphedema sleeves or stockings.
Exercise
Both light exercise and aerobic exercise (a physical activity that causes the heart and lungs to work harder) help the lymph vessels move lymph out of the affected limb and decrease swelling.
- Talk with a certified lymphedema therapist before beginning exercise.
Patients who have lymphedema or who are at risk for lymphedema should talk with a certified lymphedema therapist before beginning an exercise routine. (See the Lymphology Association of North AmericaExit Disclaimer Web site for a list of certified lymphedema therapists in the United States.)
- Wear a pressure garment if lymphedema has developed.
Patients who have lymphedema should wear a well-fitting pressure garment during all exercise that uses the affected limb or body part.
When it is not known for sure if a woman has lymphedema, upper-body exercise without a garment may be more helpful than no exercise at all. Patients who do not have lymphedema do not need to wear a pressure garment during exercise.
- Breast cancer survivors should begin with light upper-body exercise and increase it slowly.
Some studies with breast cancer survivors show that upper-body exercise is safe in women who have lymphedema or who are at risk for lymphedema. Weight-lifting that is slowly increased may keep lymphedema from getting worse. Exercise should start at a very low level, increase slowly over time, and be overseen by the lymphedema therapist. If exercise is stopped for a week or longer, it should be started again at a low level and increased slowly.
If symptoms (such as swelling or heaviness in the limb) change or increase for a week or longer, talk with the lymphedema therapist. It is likely that exercising at a low level and slowly increasing it again over time is better for the affected limb than stopping the exercise completely.
More studies are needed to find out if weight-lifting is safe for cancer survivors with lymphedema in the legs.
Bandages
Once the lymph fluid is moved out of a swollen limb, bandaging (wrapping) can help prevent the area from refilling with fluid. Bandages also increase the ability of the lymph vessels to move lymph along. Lymphedema that has not improved with other treatments is sometimes helped with bandaging.
Skincare
The goal of skin care is to prevent infection and to keep skin from drying and cracking. See skin care tips, in the Managing Lymphedema section.
Combined therapy
Combined physical therapy is a program of massage, bandaging, exercises, and skin care managed by a trained therapist. At the beginning of the program, the therapist gives many treatments over a short time to decrease most of the swelling in the limb with lymphedema. Then the patient continues the program at home to keep the swelling down. Combined therapy is also called complex decongestive therapy.
Compression device
Compression devices are pumps connected to a sleeve that wraps around the arm or leg and applies pressure on and off. The sleeve is inflated and deflated on a timed cycle. This pumping action may help move fluid through lymph vessels and veins and keep fluid from building up in the arm or leg. Compression devices may be helpful when added to combined therapy. The use of these devices should be supervised by a trained professional because too much pressure can damage lymph vessels near the surface of the skin.
Weight loss
In patients who are overweight, lymphedema related to breast cancer may improve with weight loss.
Laser therapy
Laser therapy may help decrease lymphedema swelling and skin hardness after a mastectomy. A hand-held, battery-powered device is used to aim low-level laser beams at the area with lymphedema.
Drug therapy
Lymphedema is not usually treated with drugs. Antibiotics may be used to treat and prevent infections. Other types of drugs, such as diuretics or anticoagulants (blood thinners), are usually not helpful and may make the lymphedema worse.
Surgery
Lymphedema caused by cancer is rarely treated with surgery.
Massage therapy
Massage therapy (manual therapy) for lymphedema should begin with someone specially trained in treating lymphedema. In this type of massage, the soft tissues of the body are lightly rubbed, tapped, and stroked. It is a very light touch, almost like a brushing. Massage may help move lymph out of the swollen area into an area with working lymph vessels. Patients can be taught to do this type of massage therapy themselves.
When done correctly, massage therapy does not cause medical problems. Massage should not be done on any of the following:
- Open wounds, bruises, or areas of broken skin.
- Tumors that can be seen on the skin surface.
- Areas with deep vein thrombosis (blood clot in a vein).
- Sensitive soft tissue where the skin was treated with radiation therapy.
Preventive steps include the following:
Tell your health care provider right away if you notice symptoms of lymphedema.
See the General Information section for symptoms that may be caused by lymphedema. Tell your doctor right away if you have any of these symptoms. The chance of improving the condition is better if treatment begins early. Untreated lymphedema can lead to problems that cannot be reversed.
Keep skin and nails clean and cared for, to prevent infection.
Bacteria can enter the body through a cut, scratch, insect bite, or other skin injury. Fluid that is trapped in body tissues by lymphedema makes it easy for bacteria to grow and cause infection. Look for signs of infection, such as redness, pain, swelling, heat, fever, or red streaks below the surface of the skin. Call your doctor right away if any of these signs appear. Careful skin and nail care helps prevent infection:
- Use cream or lotion to keep the skin moist.
- Treat small cuts or breaks in the skin with an antibacterial ointment.
- Avoid needle sticks of any type into the limb (arm or leg) with lymphedema. This includes shots or blood tests.
- Use a thimble for sewing.
- Avoid testing bath or cooking water using the limb with lymphedema. There may be less feeling (touch, temperature, pain) in the affected arm or leg, and skin might burn in water that is too hot.
- Wear gloves when gardening and cooking.
- Wear sunscreen and shoes when outdoors.
- Cut toenails straight across. See a podiatrist (foot doctor) as needed to prevent ingrown nails and infections.
- Keep feet clean and dry and wear cotton socks.
Avoid blocking the flow of fluids through the body.
It is important to keep body fluids moving, especially through an affected limb or in areas where lymphedema may develop.
- Do not cross legs while sitting.
- Change sitting position at least every 30 minutes.
- Wear only loose jewelry and clothes without tight bands or elastic.
- Do not carry handbags on the arm with lymphedema.
- Do not use a blood pressure cuff on the arm with lymphedema.
- Do not use elastic bandages or stockings with tight bands.
Keep blood from pooling in the affected limb.
- Keep the limb with lymphedema raised higher than the heart when possible.
- Do not swing the limb quickly in circles or let the limb hang down. This makes blood and fluid collect in the lower part of the arm or leg.
- Do not apply heat to the limb.
