Lymph edema

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Overview

Lymphedema is a chronic disease marked by the increased collection of lymphatic fluid in the body, causing swelling, which can lead to skin and tissue changes. The chronic, progressive accumulation of protein-rich fluid within the interstitium and the fibro-adipose tissue exceeds the capacity of the lymphatic system to transport the fluid. Swelling associated with lymphedema can occur anywhere in the body, including the arms, legs, genitals, face, neck, chest wall, and oral cavity. There are many psychological, physical, and social sequelae related to a diagnosis of lymphedema. Lymphedema is classified as either (genetic) primary lymphedema or (acquired) secondary lymphedema.

The lymphatic vessels transport lymph. Lymph is composed of white blood cells, triglycerides, bacteria, cell debris, water, and protein. It has a composition comparable to blood plasma. The lymph drainage system is complex and comprises initial lymphatics (lymph capillaries), pre-collectors, collectors, lymphatic trunks, and lymph nodes.  Topographically, the lymph system is distinguished as superficial (subcutaneous) and deep (subfascial). The superficial system drains the skin and subcutis areas. The deep system drains muscles, joints, tendon sheaths, and nerves. Both systems are connected via the perforating vessels, which conduct lymph fluid from the subfascial areas to the surface.

Signs and symptoms of lymphedema include distal swelling in the extremities, including the arms, hands, legs, feet; swelling proximally in the breast, chest, shoulder, pelvis, groin, genitals, face/intraoral tissues; restricted range of motion in the joints because of swelling and tissue changes; skin discoloration; pain and altered sensation; limb heaviness; and difficulty fitting into clothing.

Symptoms

Swelling of part or all of the arm or leg, including fingers or toes.

A feeling of heaviness or tightness.

Restricted range of motion.

Recurring infections.

Hardening and thickening of the skin (fibrosis)

Causes

The lymphatic system is a network of vessels that carry protein-rich lymph fluid throughout the body. It's part of your immune system. Lymph nodes act as filters and contain cells that fight infection and cancer.

The lymph fluid is pushed through the lymph vessels by muscle contractions as you move through the tasks of your day and small pumps in the wall of the lymph vessels. Lymphedema occurs when the lymph vessels are not able to adequately drain lymph fluid, usually from an arm or leg.

The most common causes of lymphedema include:

Cancer. If cancer cells block lymph vessels, lymphedema may result. For instance, a tumor growing near a lymph node or lymph vessel could enlarge enough to block the flow of the lymph fluid.

Radiation treatment for cancer. Radiation can cause scarring and inflammation of lymph nodes or lymph vessels.

Surgery. In cancer surgery, lymph nodes are often removed to see if the disease has spread. However, this doesn't always result in lymphedema.

Parasites. In developing countries in the tropics, the most common cause of lymphedema is infection with threadlike worms that clog the lymph nodes.

Risk factors

Lymphedema that is related to cancer is most commonly caused by lymph node removal during surgery for cancer, radiation treatment to the lymph node area, and/or by the tumor itself, which might block part of the lymph system. Increased white blood cells due to leukemia or infection can also limit lymph flow and cause lymphedema.

People who have many lymph nodes removed and/or radiation therapy have a higher risk of long-term lymphedema. But at this time there’s no way to predict who will develop it.

Lymphedema can become a problem after surgery or radiation treatment for nearly any type of cancer, but it’s most common in:

Breast cancer

Prostate cancer

Pelvic area cancers (such as bladder, penile, testicular, endometrial, vulvar, or cervical cancer)

Lymphoma

Melanoma

Head and neck cancers

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Complications

Skin infections (cellulitis). The trapped fluid provides fertile ground for germs, and the smallest injury to the arm or leg can be an entry point for infection. ...

Sepsis. ...

Leakage through the skin. ...

Skin changes. ...

Cancer.

Prevention

There is no sure way to prevent lymphedema related to cancer. However, doctors can sometimes use a surgical technique to remove fewer lymph nodes, which can help  lower the risk of lymphedema.

Sentinel lymph node biopsy (SLNB) is a procedure used to find lymph nodes the tumor drains into so they can be removed and checked for cancer. SLNB checks only the lymph nodes the cancer would most likely go to first. If cancer is not found in these nodes, this procedure helps to limit the number of lymph nodes removed, so the risk of lymphedema might be lower.