WHAT IS LYMPHEDEMA?
Lymphedema is the swelling that develops due to an accumulation of liquid in the tissues of the body. This happens when the lymphatic system, which normally drains fluids away, is not functioning correctly. It can happen in any part of the body, though it is most likely to affect an arm or leg.
Lymphedema develops when the lymph nodes or vessels are damaged or blocked. Lymph is unable to pass through the lymph nodes and vessels. Since lymph cannot drain normally, the lymphatic system becomes overloaded and accumulates fluid between the tissues, causing swelling.
Lymphedema is a chronic swelling. This means that the condition never goes away because the causes cannot be reversed. However, it can be reduced in most people, and the swelling can often be kept to a minimum, especially when it is diagnosed early. Learning to manage it yourself is an important part of the treatment.
WHAT IS THE LYMPHATIC SYSTEM?
The lymphatic system is a drainage system that helps your body get rid of excess fluids and waste products. It also contains the white blood cells and helps fight against infection and disease. It is made up of:
- Lymph—formed when excess fluid drains from the body.
- Lymph vessels—tiny channels that run through the body, carrying lymph.
- Lymph nodes—small glands connected by lymph vessels that are found throughout the body, but especially in the neck, underarms, groin, and abdomen.
- Lymph nodes act as filters. They trap or destroy bacteria, viruses, damaged cells, or cancer cells as lymph flows through them. They contain cells that help fight against infection and diseases like cancer.
When lymph nodes swell, it is normally a sign of infection.
Sometimes, cancer cells spread into the lymph nodes from some other part of the body. Cancer can also start in the lymph nodes (lymphoma).
CAUSES AND WAYS TO REDUCE RISK
Lymphedema may be caused by the cancer itself or develop as a side effect of its treatment. Lymphedema is a condition that can appear months or years after cancer treatment. It may result from:
- surgery to remove the lymph nodes
- radiotherapy to the lymph nodes
- cancer that has spread to the lymph nodes or that presses on the lymph vessels
Lymphedema may affect different parts of the body, especially the arms and legs. However, not everyone who undergoes radiotherapy or surgery to the lymph nodes will develop lymphedema.
If you are at risk, there are several things you can do to reduce your likelihood of having lymphedema:
- Take care of your skin, trying to keep it moisturized and avoiding cuts and scrapes.
- Look out for risks of infection. Recognizing the first signs of infection will help you get treatment quickly.
- Stay active and get exercise. This will stimulate the flow of lymph in the body.
- Maintain a healthy weight.
- Be careful when traveling. Regular movement and stretching can reduce the risk of developing lymphedema.
EXERCISING AND STAYING ACTIVE TO REDUCE LYMPHEDEMA
Having lymphedema does not mean you shouldn't exercise or are incapable of it. In fact, staying physically active has many benefits, as it stimulates the flow of lymph, reduces swelling, helps keep joints flexible, strengthens muscles, and improves posture.
Maintaining physical activity does not necessarily mean exercising intensely. Light stretching can help; your specialist will inform you about the exercises to do. Always wear your compression garment when exercising and try to breathe deeply, as doing so improves circulation. The right amount of exercise should feel gentle and comfortable; if you do too much or exercise too quickly, your swelling may worsen.
Swimming, walking, stretching, and yoga are good options. Make sure to speak with your lymphedema specialist and your doctor before beginning any type of exercise program.
SYMPTOMS AND DIAGNOSIS OF LYMPHEDEMA
Early diagnosis of lymphedema makes it easier to control symptoms and swelling. The early symptoms of lymphedema include the following:
- swelling of the limb affected
- changes in sensation (the limb or area may feel heavy, tight, or stiff)
- skin changes
The symptoms vary depending on whether the lymphedema is mild, moderate, or severe. In early lymphedema, inflammation may not be very noticeable, but pressure may leave a mark or a indendation in the skin. In later phases, the skin often hardens and the skin may be affected by more complex problems. Severe lymphedema may interfere with your ability to perform daily tasks.
Treatment may improve lymphedema, and the earlier it begins, the more likely it will be successful. If you notice any type of swelling or tightness in a limb, tell your doctor.
A number of techniques can be used to treat lymphedema. Learning to manage it yourself is an important part of the treatment. Your lymphedema specialist will explain what you can do to reduce swelling and discomfort, and to avoid further build-up of lymph. This includes:
- skin care
- using compression garments
- exercising and keeping active
- using specialized massage techniques
- positioning and moving your limb
- deep breathing
Managing lymphedema may seem overwhelming at first, although little by little you will find that it becomes part of your daily routine. Some treatments must be done on a daily basis. It may take weeks or months to notice improvements, although after the treatment the area should feel less swollen, more comfortable, and easier to move.
Other, less common forms of treatment include surgery and laser therapy. Some of these are novel techniques and still require further research; your lymphedema specialist can provide you with more in-depth information.
SKIN CARE FOR LYMPHEDEMA
It is important to prevent skin infections that may worsen lymphedema. Some general tips are:
- Keep the skin clean and use soap-free cleansers.
- Moisturize well.
- Avoid cuts and scrapes, and immediately treat cuts and scrapes by washing the area and applying antiseptic.
- Avoid exposing the area to heat and the sun, as these elements may cause inflammation.
- Use insect repellent.
If you have lymphedema of the hand/arm or foot/leg, avoid activities that may cause muscle strain in the area; some examples of these activities include certain sports or carrying heavy bags. You should also avoid wearing heavy clothing, jewelry, or shoes.
It is important to recognize the first signs of infection. If any area of skin becomes red, hot, and painful, talk to your doctor immediately. This could be a sign of cellulitis, an infection that requires treatment with antibiotics. There is specific guidance on the use of antibiotics to treat cellulitis in people with lymphedema. Sometimes, the skin can break, allowing lymph to escape through these openings. This is called lymphorrhea. If this happens, contact your lymphedema specialist. He or she will try to stop the leaking and help prevent further infection.
CONTROLLING LYMPHEDEMA WITH COMPRESSION GARMENTS
Compression garments, such as a sleeve or a stocking, are an important way to control lymphedema. These put pressure on tissues to stop the build-up of fluid and to help the fluid drain out.
Your compression garment should be chosen by a specialist so as to ensure its effectiveness. If it fits too loosely, it will not help with drainage. If it is too tight, it will restrict the flow of blood. Your lymphedema specialist will select the appropriate garment type and degree of pressure for you. He or she will also explain how to put on and remove the garment.
At first, wear the garment for just a few hours a day. Then, gradually increase the time until you can wear it for most of the day. The garment should not be worn if your limb is very swollen, has an irregular shape, or if the skin is damaged.
If you cannot wear compression garments because your limb is too swollen, your lymphedema specialist may suggest using specialist multi-layer bandages (compression bandages).
POSITIONING AND MOVING A LIMB WITH LYMPHEDEMA
Carefully positioning your affected limb when resting or sitting can help prevent further swelling. If possible, always avoid sitting with your legs down, as having the legs down causes the fluid to drain into the feet and calves. Moving your muscles helps move the fluid throughout the body, so regular gentle movement or exercise can help prevent the build-up of fluid.
These tips will help you position your limb correctly.
- If you have arm swelling:
- Rest your arm on a cushion place on the arm of a chair.
- Try not to rest your arm above shoulder height, as doing so may reduce blood flow in the arm and increase your sense of discomfort.
- Raise your arm slightly on a pillow when you are lying down.
- Avoid carrying heavy shopping bags or other loads with the affected arm.
- Take care when using the affected arm for activities that involve extensive stretching—some people find that excessive activity worsens inflammation, especially if they are not accustomed to this type of stretching.
- If you have leg swelling:
- Avoid sitting with your legs crossed.
- Do not sit for long periods with your legs crossed.
- Get up and move about at least once an hour if possible.
- Avoid standing for long periods of time. If you must stand, do the following exercises:
- Raise yourself up on your toes frequently in order to tense and relax your calf muscles.
- Shift your weight from one leg to the other, transferring your weight from your heels to your toes as if walking.
- Try rocking back and forth between your heels and toes a couple of times.
Lymphatic drainage is an important part of lymphedema treatment. It is a kind of massage that helps stimulate the lymphatic system and stimulates the flow of lymph. Manual lymphatic drainage (MLD) is a specialized massage that should only be practiced by trained therapists.
You can also learn a simplified version of MLD yourself in your own home, called simple lymphatic drainage (SLD). It is important that a specialist teach you how to do this. SLD helps stimulate the lymph channels and drain excess fluid.
Lymphatic drainage should be used in combination with deep-breathing exercises before and after the massage.
LYMPHEDEMA IN DIFFERENT PARTS OF THE BODY
Cancer-related lymphedema can develop outside of the arms and legs, including:
- breast or chest
- genital area
- head and neck
As with any type of lymphedema, proper skin care is essential. Exercise is also important.
If you have breast or chest lymphedema, you should avoid wearing clothing or brassieres that are too tight on that area. Custom-fit compression vests or brassieres can help control lymphedema. Lymphatic drainage also helps prevent fluid build-up. If you have a breast prosthesis, choose a lightweight one.
If you have lymphedema in the genital area, proper skin care and avoiding infections are essential. Lymphedema can improve with lymphatic drainage and if specially made compression garments are worn. Pelvic-floor exercises and deep breathing may also help reduce swelling. Occasionaly, surgery may be performed.
Lymphedema of the head and neck tends to be treated with lymphatic drainage (MLD and SLD). It is sometimes possible to wear special compression garments over the affected area. Surgery is occasionally used.