The lymph system is a network of lymph vessels, tissues, and organs that carry lymph throughout the body.

The parts of the lymph system that play a direct part in lymphedema include the following:

  • Lymph: Colorless, watery fluid that travels through the lymph vessels and carries, a type of white blood cell.
  • Lymph vessels: A network of thin tubes that collect lymph from different parts of the body and return it to the bloodstream.
  • Lymph nodes: Small, bean-shaped structures that filter lymph and store white blood cells that help fight infection and disease. Lymph nodes are found along a network of lymph vessels throughout the body. Groups of lymph nodes are found in the neck, underarm, chest cavity, abdomenpelvis, and groin.

Lymphedema occurs when lymph is not able to flow through the body the way that it should.

When the lymph system is working as it should, lymph flows through the body and is returned to the bloodstream.

  • Fluid and plasma leak out of the capillaries (smallest blood vessels) and flow around body tissues so the cells can take up nutrients and oxygen.
  • Some of this fluid goes back into the bloodstream. The rest of the fluid enters the lymph system through tiny lymph vessels. These lymph vessels pick up the lymph and move it toward the heart. The lymph is slowly moved through larger and larger lymph vessels and passes through lymph nodes, where waste is filtered from the lymph.
  • The lymph keeps moving through the lymph system and collects near the neck, then flows into one of two large ducts:
    • The right lymph duct collects lymph from the right arm and the right side of the head and chest.
    • The left lymph duct collects lymph from both legs, the left arm, and the left side of the head and chest.
  • These large ducts empty into veins under the collarbones, which carry the lymph to the heart, where it is returned to the bloodstream.

When part of the lymph system is damaged or blocked, fluid cannot drain from nearby body tissues. Fluid builds up in the tissues and causes swelling.

There are two types of Lymphedema.

Lymphedema may be either primary or secondary:

  • Primary lymphedema is caused by the abnormal development of the lymph system. Symptoms may occur at birth or later in life.
  • Secondary lymphedema is caused by damage to the lymph system.

Secondary lymphedema has a number of possible causes, including:

  • Cancer surgery: Cancer may spread through the body via the lymphatic system. Sometimes surgeons remove lymph nodes to stop the spread. There is a risk the lymphatic system may be affected, leading to lymphedema.
  • Radiation therapy: The use of radiation to destroy cancerous tissue can sometimes damage nearby healthy tissue, such as the lymphatic system; this can result in lymphedema.
  • Infections: Severe cellulitis infection may damage tissue around the lymph nodes or vessels. This may lead to scarring, increasing the risk of lymphedema. Some parasite infections can also increase the risk of lymphedema.
  • Inflammatory conditions: Conditions that cause tissue to swell (become inflamed) may permanently damage the lymphatic system, such as rheumatoid arthritis, dermatitis, and eczema.
  • Cardiovascular diseases: These are diseases that affect blood flow. Some patients with cardiovascular diseases have a higher risk of developing lymphedema, such as DVT (deep vein thrombosis), venous leg ulcers, and varicose veins.
  • Injury and trauma: More rarely, severe skin burns or anything that results in excessive scarring may raise the risk of developing lymphedema.

Cancer and its treatment are risk factors for Lymphedema.

Lymphedema can occur after any cancer or treatment that affects the flow of lymph through the lymph nodes, such as removal of lymph nodes. It may develop within days or many years after treatment. Most lymphedema develops within three years of surgery. Risk factors for lymphedema include the following:

  • Removal and/or radiation of lymph nodes in the underarm, groin, pelvis, or neck. The risk of lymphedema increases with the number of lymph nodes affected. There is less risk with the removal of only the sentinel lymph node(the first lymph node in a group of lymph nodes to receive lymphatic drainage from the primary tumor).
  • Being overweight or obese.
  • Slow healing of the skin after surgery.
  • A tumor that affects or blocks the left lymph duct or lymph nodes or vessels in the neck, chest, underarm, pelvis, or abdomen.
  • Scar tissue in the lymph ducts under the collarbones, caused by surgery or radiation therapy.

Lymphedema often occurs in breast cancer patients who had all or part of their breast removed and axillary (underarm) lymph nodes removed. Lymphedema in the legs may occur after surgery for uterine cancerprostate cancerlymphoma, or melanoma. It may also occur with vulvar cancer or ovarian cancer.

Possible signs of Lymphedema

Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems occur:

  • 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.
  • Swelling of an arm or leg, which may include fingers and toes.
  • Trouble sleeping.
  • Daily activities and the ability to work or enjoy hobbies may be affected by lymphedema.
  • These symptoms may occur very slowly over time or more quickly if there is an infection or injury to the arm or leg.

The goal of treatment is to control the swelling and other problems caused by lymphedema.

Damage to the lymph system cannot be repaired. Treatment is given to control the swelling caused by lymphedema and keep other problems from developing or getting worse. Physical (non-drugtherapies are the standard treatment. Treatment may be a combination of several of the physical methods. The goal of these treatments is to help patients continue with activities of daily living, to decrease pain, and to improve the ability to move and use the limb (arm or leg) with lymphedema

The first-line treatment for lymphedema is complex decongestive therapy, done by a qualified lymphedema therapist

This treatment is aimed at improving lymphedema with manual lymphatic drainage, massage, and exercise. The reduction of swelling is further enhanced and maintained with the use of compression garments, multilayer bandaging, or pneumatic pumps.

KEY POINTS

      • The goal of treatment is to control the swelling and other problems caused by lymphedema.
      • Treatment of lymphedema may include the following:
        • Pressure garments
        • Massage therapy
        • Exercise
        • Multilayer bandaging to reduce swelling
        • Laser therapy
        • Compression device
        • Skin care