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Home News What If I Have Lymphedema? – Part I

What If I Have Lymphedema? – Part I

Published: Wednesday, January 3, 2007

The following article is Part I of a two-part series on Lymphedema.

 

Lymphedema is the chronic swelling of a body part, usually an arm or leg. There are many causes of lymphedema such as certain infections (for example, chronic cellulitis or parasitic infections such as filariasis), trauma, tumors, certain surgeries and radiation therapy. The most common cause of lymphedema in women is axillary lymph node removal, mastectomy, radiation or all three.

Lymphedema is a side effect that can begin during or after cancer treatment. It isn’t life threatening, but can last over a long period of time. This condition generally involves swelling of the soft tissues of the arm and/or hand. The swelling may be accompanied by numbness, discomfort and sometimes infection.

There is no reliable way to find out your level of risk for lymphedema, but by taking proper precautions, you can greatly reduce your chances of developing the condition.

What Causes Lymphedema?

Lymphedema is an accumulation of lymph fluid in the soft tissues (generally in the arm/hand) with accompanying swelling (also called edema). To understand how it happens, you have to know a little bit about how blood and lymphatic fluid move around the body.

To keep from getting backed up, fluid has to keep moving within networks of vessels and channels. Blood travels from your heart to your arm in arteries and small blood vessels that connect arteries to veins (capillaries). As the blood moves thorough these vessels, it drops off important supplies to the cells in your arm: oxygen, nutrients and clear, colorless fluid called lymphatic fluid. The used blood keeps moving and travels back to the heart and lungs where it is refreshed. With every beat of your heart, fresh blood returns to your arm with fresh supplies.

Lymph fluid also has to keep moving through the tissues of the arm back into the bloodstream. This fluid flows in another type of vessel, called the lymphatics. The muscles in your arm and contractions in the walls of the lymphatic channels push lymphatic fluid up your arm. The lymphatic channels pass through bean-shaped structures called lymph nodes, which are under the arm, neck, groin and throughout the body. Lymph nodes filter out bacteria, waste products and toxic substances from lymphatic fluid. Eventually the lymphatic fluid leaves the arm, joins back with the blood and re-circulates through the body.

Lymphatic fluid contains lots of nutrients. It is an easy target for bacteria that may find their way through the protection of the skin. Bacteria can get in even through something as simple as a torn cuticle or a splinter. If bacteria do get in, they can cause infection. As a result, there is increased blood flow to fight the bacteria—and more lymphatic fluid accumulating and needing to be drained away.

Simply stated, lymphedema is a plumbing problem: Veins and lymphatic channels are like pipes and drains that can handle the normal load of lymphatic fluid. If lymph nodes and channels are removed, there may not be enough pipes and drains to handle all of the fluid. This can become a real problem when blood flow to your arm increases because of an infection, burn, overusing the muscles of the arm or even a bug bite. In these situations, the increased amount of lymphatic fluid flowing in can sometimes be too much for the arm’s lymphatic vessels. If the fluid channels cannot keep up with all the extra fluid, it begins to back up and gather in the spaces between the cells of your arm’s soft tissues. These tissues include the skin, fat, muscle, blood and lymphatic vessels, nerves and connective tissue. The swelling resulting from this buildup of lymphatic fluid is called lymphedema.

Lymphedema can affect the whole arm or only a limited portion such as the hand, wrist area, area below the elbow or, much less often, only the area above the elbow. Lymphedema also can affect the breast area, because the fluid from that area also needs to drain through the underarm to get back into circulation.

Some women have mild lymphedema, which is hardly noticeable. Some develop moderate lymphedema that may be noticeable, tends to persist and worsens when aggravated. Others have severe lymphedema that is very uncomfortable and even disabling. For all these cases, there are treatments that can help ease the discomfort and lower the swelling.

Who is at Risk?

If you have had an underarm (axillary) lymph node dissection (with mastectomy or lumpectomy), you are at risk for developing lymphedema. Radiation treatment and chemotherapy can add to the risk.

There is no clear consensus on the actual risk for any given person following these treatments and surgeries, but the general figure is between 5 percent and 10 percent (5 or 10 people out of 100). It is clear that the more treatment you have had, the higher your risk of developing lymphedema.

Surgeons have been performing a relatively newer technique called sentinel node dissection, which aims to identify and remove only the lymph nodes most likely to contain cancer cells that could have spread beyond the breast. This technique may lower the risk because fewer lymph nodes are removed, leaving more lymph fluid drainage channels in tact.

Additional factors that may increase the risk include the following.

• Being very overweight; may limit the flow of blood and lymph fluid in and around the arm
• Smoking
• Diabetes
• Other conditions that can affect the circulation of blood and lymph fluid in and around the arm
• Previous surgeries in the armpit area or on the arm

Lymphedema Symptoms

The following are the most common symptoms related to lymphedema.

• Arm feels full or heavy
• Skin feels tight
• Less movement or flexibility in the hand or wrist
• Difficulty fitting the arm into jacket or shirt sleeves
• Ring, watch and/or bracelet feels tight, but you have not gained weight

If you have had lymph nodes removed or radiation treatment, you may want to examine your upper body in front of a mirror. If you notice any of the signs listed above and they last for one or two weeks, call your doctor or healthcare provider.

It also is important to speak with an expert regarding your symptoms if any of the following occur.

• Any part of your affected arm or underarm area feels hot, is red or has sudden swelling.
• You have a temperature above 100.5 degrees Fahrenheit that is not related to cold or flu.

Call your doctor or toll free 1.877.UT.CARES (1.877.882.2737) to request an appointment. 

For more information, visit the Brain and Spine Institute or Rehabilitation Services.

 

Part II of this article, covering Lymphedema prevention and treatment, will appear in the March / April 2007 issue of Healthy Living.