Lymphedema

OVERVIEW AND FACTS

Lymphedema means swelling of the lymph passages. Lymphedema, also called Lymphatic Obstruction, is a chronic disease involving blockage of the lymph nodes. Lymph nodes vessels drain fluid from tissues throughout the body and allow immune cells to travel where they are needed. When blockage occurs, it prevents lymph fluid from draining well and that fluid buildup leads to swelling.

Lymphedema is characterized by persistent and often chronic swelling, usually of a person’s arm or leg. Sometimes, both can swell.

Lymphedema is a chronic disease that usually requires lifelong management. In some cases, lymphedema improves with time. However, some swelling is usually permanent. There are steps that can be taken to prevent or relieve and reduce symptoms of lymphedema.

SYMPTOMS AND TYPES

There are many causes for lymphedema. This condition is most commonly caused by damage or removal of the lymph nodes as part of cancer treatment. Some other common causes include the removal of the breast (mastectomy), infections with parasites such as filariasis, injury or trauma to the area, past radiation therapy and surgeries, tumor and cellulitis. In a few cases the condition is present from birth (congenital). Lymphedema can develop in months or years after treatment.

In addition to swelling, the most common complications include chronic wounds and ulcers and skin breakdown. Patients with lymphedema must be vigilant about skin care and hygiene.

Your physician can offer different treatment options for lymphedema including:

Compression devices prescribed by a doctor usually with multi-layered bandages.
Manual lymph drainage (MLD) or light message to drain fluid.
Range-of-motion exercises done with the help of a physical therapist.
Surgery may be necessary in some cases. See surgical options here.

Contact your doctor if you have swelling of your arms, legs, or lymph nodes that does not go away.

DIAGNOSIS

By Mayo Clinic Staff

If you’re at risk of lymphedema — for instance, if you’ve recently had cancer surgery involving your lymph nodes — your doctor 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.

To prepare for your appointment you can list:

Your symptoms, including any that may seem unrelated to the reason you scheduled the appointment.
Key personal information, including major illnesses or trauma, other conditions, cancer treatment or life changes.
Medications, vitamins and any supplements that you take.
Questions to ask your doctor.

TREATMENT AND CARE

By Mayo Clinic Staff

There’s no cure for lymphedema. Treatment focuses on reducing the swelling and controlling the pain. Lymphedema treatments include:

Exercises. Light exercises in which you move your affected limb may encourage lymph fluid drainage and help prepare you for everyday tasks, such as carrying groceries. Exercises shouldn’t be strenuous or tire you but should focus on gentle contraction of the muscles in your arm or leg. A certified lymphedema therapist can teach you exercises that may help.
Wrapping your arm or leg. Bandaging your entire limb encourages lymph fluid to flow back toward the trunk of your body. The bandage should be tightest around your fingers or toes and loosen as it moves up your arm or leg. A lymphedema therapist can show you how to wrap your limb.
Massage. A special massage technique called manual lymph drainage may encourage the flow of lymph fluid out of your arm or leg. And various massage treatments may benefit people with active cancer. Be sure to work with someone specially trained in these techniques.
Massage isn’t for everyone. Avoid massage if you have a skin infection, blood clots or active disease in the involved lymph drainage areas.
Pneumatic compression. A sleeve worn over your affected arm or leg connects to a pump that intermittently inflates the sleeve, putting pressure on your limb and moving lymph fluid away from your fingers or toes.
Compression garments. Long sleeves or stockings made to compress your arm or leg encourage the flow of the lymph fluid out of your affected limb. Wear a compression garment when exercising the affected limb.
Obtain a correct fit for your compression garment by getting professional help. Ask your doctor where you can buy compression garments in your community. Some people will require custom-made compression garments.
If you have difficulties putting on or taking off the compression garment, there are special techniques and aids to help with this; your lymphedema therapist can review options with you. In addition, if compression garments or compression wraps or both are not an option, sometimes a compression device with fabric fasteners can work for you.
Complete decongestive therapy (CDT). This approach involves combining therapies with lifestyle changes. Generally, CDT isn’t recommended for people who have high blood pressure, diabetes, paralysis, heart failure, blood clots or acute infections.

In cases of severe lymphedema, your doctor may consider surgery to remove excess tissue in your arm or leg to reduce swelling. There are also newer techniques for surgery that might be appropriate, such as lymphatic to venous anastomosis or lymph node transplants.

LIVING YOUR LIFE

If you are at risk for developing lymphedema, there are steps you can take to help prevent it. Initially, if you have mild lymphedema, you can act to keep the condition from worsening. Here are some precautions to prevent or minimize symptoms:

Protect the arm on the side of the surgery.
Clean your affected limb regularly. Remember to dry it thoroughly and apply lotion.
Take good care of your fingernails.
Wear gloves while gardening and cooking.
If you shave the affected area, do so carefully using an electric razor.
Avoid crossing your legs when you sit.
Don’t go barefoot and remember to prevent sunburns.
Don’t carry handbags with your affected arm.
Don’t wear clothing with tight bands or elastic cuffs.
Do approved exercises and maintain a healthy, low-sodium diet.
Avoid extreme hot or cold temperatures on the affected area.
In addition, if you are at risk for lymphedema, avoid having injections and blood pressure readings performed on your affected limb. You can also wear a special bracelet or necklace to notify medical personnel of your risk for lymphedema and the risk for complications, such as infection.

For patients with lymphedema, the most common approach for treatment is to reduce swelling with compression and massage therapy and/or diet modifications. Some patients find greater relief with surgical management. Treatment for lymphedema depends on how severe it is. Other treatment options include special, approved exercises while wearing compression stockings or bandages and the use of external pumps to aid movement of fluid throughout your body.

Medication cannot cure lymphedema. However, your physician may prescribe medications to treat associated conditions. For example, antibiotics play an important role in combating infections that can worsen lymphedema.

Your doctor may consider surgery to remove excess tissue in your arm or leg to reduce swelling. There are also newer techniques for surgery that may be appropriate like lymphatic to venous anastomosis or lymph node transplant. Some other options your doctor may speak to you about include:

Liposuction.
Lymphaticovenous anastomosis (also referred to as lymphovenous bypass).
Vascularized lymph node transfer surgery (lymphovenous transplant).
Charles procedure (skin grafts).

To learn more about these surgery options, please visit this article.

Treating your lymphedema requires your participation. Because lymphedema can be very painful, you may benefit from individual counseling. You can also join support groups that provide practical advice as well as social and emotional support.

ASSISTANCE AND COMFORT

By Mayo Clinic Staff

It can be frustrating to know there’s no cure for lymphedema. However, you can control some aspects of lymphedema. To help you cope, try to:

Find out all you can about lymphedema. Knowing what lymphedema is and what causes it can help you communicate with your doctor or physical therapist.
Take care of your affected limb. Do your best to prevent complications in your arm or leg. Clean your skin daily, looking over every inch of your affected limb for signs of trouble, such as cracks and cuts. Apply lotion to prevent dry skin.
Take care of your whole body. Eat a diet rich in fruits and vegetables. Exercise daily, if you can. Reduce stress. Try to get enough sleep. Taking care of your body gives you more energy and encourages healing.
Get support from others with lymphedema. Whether you attend support group meetings in your community or participate in online message boards and chat rooms, it helps to talk to people who understand what you’re going through. Contact the National Lymphedema Network to find support groups in your area. The organization can also put you in touch with other people with lymphedema.