Lymphedema, or lymphatic obstruction, is a long-term condition where excess fluid collects in tissues causing swelling (edema).
The lymphatic system is a part of the circulatory system and vital for immune function. Lymphedema is caused by a blockage of this system.
Lymphedema commonly affects one of the arms or legs. In some cases, both arms or both legs may be affected. Some patients might experience swelling in the head, genitals, or chest.
Lymphedema is incurable, but with the right treatment, it can be controlled.
Fast facts on lymphedema
Here are some key points about lymphedema. More detail and supporting information is in the main article.
Experts believe primary lymphedema is caused by genetic mutation.
Secondary lymphedema can be caused by other conditions such as infections and inflammatory diseases.
In some cases, lymphedema can lead to skin infections and lymphangitis.
Protecting the skin can help reduce the risk of lymphedema.
Swelling is a typical symptom of lymphedema and commonly affects legs and arms.
Compression stockings work to encourage the movement of lymph out of an affected limb.
Lymphedema is incurable. However, treatment can help reduce the swelling and pain.
Complex decongestive therapy (CDT): This starts with an intensive therapy phase, during which the patient receives daily treatment and training. This is followed by the maintenance phase when the patient is encouraged to take over their own care using techniques that they have been taught.
The four components of CDT are:
Remedial exercises: These are light exercises aimed at encouraging movement of the lymph fluid out of the limb.
Skincare: Good skincare reduces the risks of skin infections, such as cellulitis.
Manual lymphatic drainage (MLD): The lymphedema therapist uses special massage techniques to move fluid into working lymph nodes, where they are drained. The lymphedema therapist also teaches several massage techniques that can be used during the maintenance phase.
Multilayer lymphedema bandaging (MLLB): Muscles surrounding lymph vessels and nodes move the fluid through the lymphatic system.
Unlike the circulation of blood, there is no central pump (heart). The aim is to use bandages and compression garments to support the muscles and encourage them to move fluid out of the affected body part. Patients will also be taught how to apply their own bandages and compression garments correctly so that MLLB can continue during the maintenance period. A range of compression stockings is available for purchase online.
Surgery has historically had disappointing results compared with non-surgical therapies for lymphedema. However, a new surgical technique using liposuction has proved more successful. It removes fat from the affected limb, resulting in less swelling.
What you need to know about lymphoma
Find out lymphoma, another condition that affects the lymphatic system
A CT scan can reveal blocked areas in the lymphatic system contributing to lymphedema.
Primary lymphedema may be caused by mutations in some of the genes involved in the development of the lymphatic system. These faulty genes interfere with the lymphatic system’s development, undermining its ability to drain fluid properly.
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.
Lymphedema affects the lymphatic system. This system has three main functions:
Draining excess tissue fluid: It balances the fluid in the blood and the fluid in the tissues. This is known as fluid homeostasis.
Fighting infection: It provides immunity by assisting the body’s immune defense against foreign bodies, such as bacteria.
Absorbing fats: It absorbs lipid nutrients from the intestine and transports them to the blood.
A disruption to the lymphatic system can, in the long term, undermine its ability to drain fluid properly. As a result, excess fluid can build up in parts of the body.
Lymphedema increases the risk of infection and other complications because the lymphocytes cannot reach parts of the body where swelling occurs.
There are two main types of lymphedema:
Primary lymphedema – often called congenital lymphedema. The lymphedema is evident at birth or shortly after puberty. This type of lymphedema is rare, affecting approximately 1 in every 6,000 people.
Secondary lymphedema – the lymphedema occurs as a result of something else, such as an infection, injury, trauma, or cancer that affects the lymphatic system.
Lymphedema may be a side effect of cancer treatment, such as radiation therapy or the removal of some lymph nodes, which can damage the lymphatic system. This type of lymphedema is more common. More women are affected than men.
Lymphedema symptoms include: