Lymphedema

What is lymphedema?
Lymphedema is an abnormal buildup of fluid that causes swelling, most often in the arms or legs. The condition develops when lymph vessels or lymph nodes are missing, impaired, damaged, or removed.

There are two types of lymphedema: primary and secondary. Primary lymphedema is rare and is caused by the absence of certain lymph vessels at birth, or abnormalities in the lymphatic vessels. Secondary lymphedema occurs as a result of a blockage or interruption that alters the flow of lymph through the lymphatic system and can develop from an infection, malignancy, surgery, scar tissue formation, trauma, deep vein thrombosis (blood clot in a vein), radiation, or other cancer treatment.

How does the the lymphatic system work?
The lymphatic system helps coordinate the immune system's function to protect the body from foreign substances and includes an extensive network of lymph vessels and lymph nodes.

Excess fluid is collected from the space between tissues in the body and moves through the lymph vessels. The fluid (now called lymph) isn't pumped through the body like blood, but instead is "pushed" through the lymph system as the vessels are compressed by surrounding muscles.

Filters called lymph nodes remove certain harmful substances from the lymph fluid, such as bacteria and debris. The fluid from most tissues or organs is filtered through one or more lymph nodes before draining into the bloodstream.

Who is at risk for developing lymphedema?
People who have had any of the following procedures may be at risk for developing lymphedema:

• Simple mastectomy in combination with axillary (arm pit) lymph node removal.
• Lumpectomy in combination with axillary lymph node removal.
• Modified radical mastectomy in combination with axillary lymph node removal.
• Combined cancer surgery and radiation therapy to a lymph node region (such as the neck, armpit, groin, pelvis or abdomen).
• Radiation therapy to a lymph node region.

Lymphedema can occur within a few days, months, or years after surgery. A small amount of swelling is normal for the first four to six weeks after surgery.

What happens after my breast surgery?
Lymphedema develops after breast surgery because there is an alteration in the pathway that drains the fluids involved in the immune system. It can occur at any time after the surgery. If untreated, it can become worse. Following surgery, a physician will examine you and take arm measurements. Sometimes, there may be redness or pain in the arm, which may be a sign of inflammation. Depending on your symptoms, your physician will then consider the best treatment options for you.

What are the signs and symptoms of Lymphedema?
If you suspect any of the symptoms listed below, call your health care provider right away. Prompt treatment can help get the condition under control.

• Swelling in the arms, hands, fingers, shoulders, chest, or legs. The swelling may occur for the first time after a traumatic event (such as bruises, cuts, sunburn, and sports injuries), after an infection in the part of the body that was treated for cancer, or after an extended (more than three hours) airplane trip (due to the sudden change in cabin pressure).
• A "full" or heavy sensation in the arms or legs.
• Skin tightness.
• Decreased flexibility in the hand, wrist, or ankle.
• Difficulty fitting into clothing in one specific area.
• Tight-fitting bracelet, watch, or ring that wasn't tight before.

How is lymphedema diagnosed?
Lymphedema is diagnosed after a careful evaluation of your medical history, including past surgeries and treatments; an evaluation of current medications and symptoms; and a complete physical examination. Sometimes, additional tests may be needed.

How is lymphedema treated?
Lymphedema treatments vary, depending on the stage and cause of the illness. The most important aspect of treatment is learning how to care for your health. Your doctor or nurse will teach you and your family how to follow your prescribed treatment.

If the initial signs and symptoms of swelling are caused by infection, antibiotics may be prescribed. Other treatments may include bandaging, proper skin care and diet, compression garments, exercises, and manual lymphatic drainage, a gentle form of skin stretching/massage.

How can I help prevent lymphedema?
Lymphedema can be prevented or controlled (if it develops) by following the recommendations below.

•  Include at least two to four servings of fruits and three to five servings of vegetables in your daily meal plan.
•  Eat a variety of foods to get all the nutrients you need.
•  Use the package label information to help you to make the best selections for a healthy lifestyle.
•  Eat foods high in fiber such as whole-grain breads, cereals, pasta, rice, fresh fruits and vegetables.
•  Drink plenty of water