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What is Lymphedema?

Lymphedema is a condition characterized by swelling of the soft tissue of the limbs, or less often the trunk, caused by a buildup of lymph fluid. Of the two types primary lymphedema is less common.

Primary lymphedema is the term used for this swelling when the cause is not obvious. Primary lymphedema is most often seen in children due to genetic makeup. Symptoms appear at anytime but most often the onset is at puberty.

Secondary lymphedema is more common and the result of injury to the lymphatic system. The onset of secondary lymphedema may be triggered by tumor, surgery, radiation, trauma, deep vein thrombosis, or chronic infection as seen in venous ulcers. Many of these cases are mild. However, early lymphedema management will often prevent more severe edema and minimize complications. Adequate lymphedema management may prevent complications that could lead to disability and disfigurement.

Who is Affected by Lymphedema?

Lymphedema is not uncommon, affecting at least 5-7 million Americans. Some patients develop it after surgery or radiation therapy for various cancers (breast, prostate, bladder, uterus, melanoma, lymphoma) in which case it is referred to as secondary lymphedema. Other patients develop it without obvious cause at different stages in life (primary lymphedema), and still others develop it after trauma or deep vein thrombosis.

According to the World Health Organization (UN/WHO), each year approximately 250 million people acquire lymphedema, mainly as a result of mosquito-borne microfilaria parasite infection in the tropics. In industrialized nations, the onset of lymphedema is associated with complications following cancer treatment by means of surgery or radiation therapy. Women are particularly at risk of developing lymphedema in their arms following surgery or radiation therapy for breast cancer, or in their legs following treatment for cervical cancer, uterine cancer, etc. Men are particularly at risk of developing lymphedema in their legs following surgery for prostate cancer, testicular cancer, etc. Both men and women are at risk following treatment of malignant melanomas (skin cancer) with lymph node dissection and/or radiation involving an arm, hand, leg or foot.

About 50-70% of patients who have had axillary node surgery will develop lymphedema. Patients who have had axillary surgery plus radiation therapy are at even higher risk. It is estimated that at least 1-2 million breast cancer survivors are alive today after lymphadenectomy and that 400,000 of them cope daily with the disfigurement, discomfort and disability of arm and hand swelling. In six different recent reports from three different countries on the incidence of lymphedema in patients who had different breast cancer treatments, Petrek and Lerner noted that the incidence of lymphedema is about 20% (16-26%). They also noted that the incidence remains the same or higher in patients having breast conservation surgery because of the postoperative radiation reaching the axilla. Axillary radiation to a dissected axilla was a strong predictor of lymphedema in all studies that evaluated this issue. The true numbers of patients suffering from any form of lymphedema is unknown.

What are the Symptoms of Lymphedema?

Lymphedema symptoms usually begin with swelling of the arms, hands, or feet. Anyone who notices persistent swelling in an extremity should seek medical advice. If lymphedema is diagnosed and if treatment begins early, the prognosis for improvement of the condition is much greater than if the swelling is ignored and remains untreated.

How Can Lymphedema be Managed and Treated?

Lymphedema is incurable, but readily treatable.

Lymphedema management includes correct differential diagnosis and treatment. Treatment objectives are to control and decrease swelling, stabilize and prevent progression, prevent infection, improve quality of life.

Treatment options vary from simple measures such as limb elevation above the level of the heart, to mechanical devices such as the lymphedema pump. Other important treatment components include exercise, weight loss, physical therapy, antibiotics (in cases where infection is present), Diuretics (cautiously), lymphatic sleeve, or pneumatic sleeve.