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Lymphedema (Lymphatic Dysfunction): Types, Causes, Symptoms, Risk Factors, Diagnosis & Treatment

Lymphedema or lymphatic dysfunction refers to the dysfunction of your lymphatic system, which causes swelling in the legs or arms. The lymphatic system is made up of lymph nodes and lymph vessels that drain fluids from your body's tissues. Subsequently, when the lymph nodes are damaged or removed as a part of cancer treatment, the condition tends to develop [1] .

The condition develops from a blockage in your lymphatic system, as the blockage prevents the lymph fluid from draining well and hence, leading to fluid buildup and swelling. Apart from this, lymphedema can also result from a variety of complex genetic conditions, diseases and injuries.

Types Of Lymphedema

There are two types of lymphedema - hereditary or primary lymphedema and secondary lymphedema [2] .

  • Hereditary (primary) lymphedema: Less common than secondary lymphedema, you are more likely to develop the condition, if a family member also has it. Milroy disease and Meige disease are classified as primary lymphedema.
  • Secondary lymphedema: This type of condition is commonly reported and treatment for breast cancer with a mastectomy is one of the most common causes of secondary lymphedema [3] .

Causes Of Lymphedema

The reasons behind the rare and inherited condition, primary lymphedema are as follows [4] :

  • Milroy's disease
  • Meige's disease
  • Late-onset lymphedema

The causes of secondary lymphedema are as follows [5] :

  • Surgery
  • Radiation treatment for cancer
  • Infection
  • Cancer

Symptoms Of Lymphedema

The common signs of the condition are as follows [6] :

  • Swelling of part or all of your arm or leg, including fingers or toes
  • Hardening and thickening of the skin
  • Blisters
  • Aching or discomfort
  • Recurring infections
  • Restricted range of motion
  • A feeling of heaviness or tightness
  • Skin discolouration
  • Drooling
  • Ear pain

Consequently, the condition can cause the difficulty with the following too:

  • Breathing (nasal congestion)
  • Swallowing
  • Talking
  • Vision

The symptoms of secondary lymphedema can appear any time after surgery, with some appearing within several months to a few years after surgery.

Risk Factors Of Lymphedema

  • Excess weight or obesity
  • Rheumatoid or psoriatic arthritis
  • Older age

Diagnosis Of Lymphedema

If you have recently had cancer surgery involving your lymph nodes, the doctor may diagnose lymphedema based on your signs and symptoms[7] .

If the cause of your lymphedema is not obvious, you will be required to undergo the following tests:

  • MRI scan
  • CT scan
  • Radionuclide imaging of your lymphatic system (lymphoscintigraphy)
  • Doppler ultrasound

Complications Of Lymphedema

Lymphedema in your arm or leg can lead to serious complications such as bacterial infection of the skin (cellulitis) and infection of the lymph vessels (lymphangitis). It can also lead to lymphangiosarcoma, a rare form of soft tissue cancer [8] .

Treatment For Lymphedema

Currently, there are no cures developed for the condition. The treatment measures focus on reducing the swelling and controlling the pain, and they are as follows [9] :

  • Pneumatic compression
  • Compression garments
  • Complete decongestive therapy (CDT)
  • Routine skincare
  • Limb exercises
  • Lymphatic drainage massage

Apart from these, wrapping your arm or leg using a bandage and performing light exercises can be beneficial in managing the condition [10] .

View Article References
  1. [1] Bjork, R., & Hettrick, H. (2019). Lymphedema: New Concepts in Diagnosis and Treatment. Current Dermatology Reports, 1-9.
  2. [2] Brorson, H. (2016). Liposuction in lymphedema treatment. Journal of reconstructive microsurgery, 32(01), 056-065.
  3. [3] Narushima, M., Yamamoto, T., Ogata, F., Yoshimatsu, H., Mihara, M., & Koshima, I. (2016). Indocyanine green lymphography findings in limb lymphedema. Journal of reconstructive microsurgery, 32(01), 072-079.
  4. [4] Mansour, S., Brice, G. W., Jeffery, S., & Mortimer, P. (2019). Lymphedema-distichiasis syndrome. In GeneReviews®[Internet]. University of Washington, Seattle.
  5. [5] Ezzo, J., Manheimer, E., McNeely, M. L., Howell, D. M., Weiss, R., Johansson, K. I., ... & Karadibak, D. (2015). Manual lymphatic drainage for lymphedema following breast cancer treatment. Cochrane Database of Systematic Reviews, (5).
  6. [6] Lee, B. B., Rockson, S. G., & Bergan, J. (Eds.). (2018). Lymphedema: a concise compendium of theory and practice. Springer.
  7. [7] Jiang, X., Nicolls, M. R., Tian, W., & Rockson, S. G. (2018). Lymphatic dysfunction, leukotrienes, and lymphedema. Annual review of physiology, 80, 49-70.
  8. [8] Chang, D. W., Masia, J., Garza III, R., Skoracki, R., & Neligan, P. C. (2016). Lymphedema: surgical and medical therapy. Plastic and reconstructive surgery, 138(3S), 209S-218S.
  9. [9] Tummel, E., Ochoa, D., Korourian, S., Betzold, R., Adkins, L., McCarthy, M., ... & Klimberg, V. S. (2017). Does axillary reverse mapping prevent lymphedema after lymphadenectomy?. Annals of surgery, 265(5), 987-992.
  10. [10] Ly, C. L., Kataru, R. P., & Mehrara, B. J. (2017). Inflammatory manifestations of lymphedema. International journal of molecular sciences, 18(1), 171.

Story first published: Wednesday, November 27, 2019, 9:00 [IST]
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