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Lymphedema
 
Lymphedema is a swelling that’s caused by a collection of too much lymph fluid. Lymph is aprotein-rich fluid that moves throughout your body in lymph vessels. It scoops up things like bacteria, viruses, and waste, and carries them to your lymph nodes. Your lymph nodes then filter the fluid to get the impurities out of your body.
Lymphedema occurs when your lymph vessels are unable to adequately drain lymph fluid. This swelling may cause pain and limit how well the affected area moves. Lymphedema can be either primary or secondary. This means it can occur on its own (primary lymphedema), or it can be caused by another disease or condition (secondary lymphedema). It usually happens in your arms and legs, but it can happen in other parts of your body, as well.

Secondary lymphedema is far more common than primary lymphedema. Some of the major causes include:
Surgery - Removal of or injury to lymph nodes and lymph vessels may result in lymphedema. For example, lymph nodes may be removed to check for spread of breast cancer, and lymph nodes may be injured in surgery that involves blood vessels in your limbs.

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

Cancer - If cancer cells block lymphatic 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. The types of cancer that are most associated with lymphedema are those that require the removal of large numbers of lymph nodes for staging or other purposes. The most common ones are breast cancer; gynaecologic malignancies, including ovarian, cervical, and uterine cancers; prostate cancer; and malignant melanoma and sarcomas of various types.
Infection - An infection of the lymph nodes or parasites can restrict the flow of lymph fluid. Infection-related lymphedema is most common in tropical and subtropical regions and is more likely to occur in developing countries.

Signs and symptoms

The patients are often admitted with signs and symptoms of lymphoedema including limb swelling, non-pitting oedema, skin changes such as hyperkeratosis, lymphangioma, lymphorrhea, dermatitis red skin discoloration, ulceration, lymph vesicles, peaud’orange or nail abnormalities. Stemmer sign (squaring of the toes) or puffiness of the forefoot (buffalo hump) canal.

Treatment

While there is presently no cure for lymphedema, it can be managed with early diagnosis and diligent care of your affected limb. Your doctor may recommend:
Compression garments:These fabric sleeves apply pressure to the affected limb to help lymph fluid circulate.

Compression devices:These compression sleeves are attached to a pump that automatically applies and removes pressure on your limb on a timed schedule to prevent lymph buildup.
Exercise:Gentle exercises may promote lymph drainage and strengthen your affected limb.

Bandages:Wrapped in just the right way, these may help push lymph fluid toward the trunk of your body. You may also wear them to help prevent lymph fluid from going back into your affected limb.
Massage:A specially trained professional can do light massage to help move fluid from areas of swelling to other areas where working lymph vessels may carry it away. You can even learn how to use these massage techniques on yourself.

Daily skin and general health: Protect the limb against trauma. Avoid sun burn. Avoid injections/blood sampling in the affected limb, Keep the limb clean. Moisturize the skin daily to avoid dryness. Avoid standing for long periods if leg is swollen. Wear loose clothing to prevent further restriction. Keep weight within normal limits, Use the swollen limb normally-avoid strenuous exercise, do not ignore a slight increase in swelling size. Hosiery is an important element in the maintenance phase of lymphoedema management.

Prevention

If you have had or you are going to have cancer surgery, ask your doctor whether your procedure will involve your lymph nodes or lymph vessels. Ask if your radiation treatment will be aimed at lymph nodes, so you'll be aware of the possible risks.

To reduce your risk of lymphedema, try to:
Protect your arm or leg. Avoid injury to your affected limb. Cuts, scrapes and burns can invite infection. Protect yourself from sharp objects. For example, shave with an electric razor, wear gloves when you garden or cook, and use a thimble when you sew. If possible, avoid medical procedures, such as blood draws and vaccinations, in your affected limb.

Rest your arm or leg while recovering. After cancer treatment, exercise and stretching are encouraged. But avoid strenuous activity until you've recovered from surgery or radiation.
Avoid heat on your arm or leg.Don't apply ice or heat, such as with a heating pad, to your affected limb. Also, protect your affected limb from extreme cold.
Elevate your arm or leg.Whenever possible, elevate your affected limb above the level of your heart.

Avoid tight clothing. Avoid anything that could constrict your arm or leg, such as tightfitting clothing and, in the case of your arm, blood pressure cuffs. Ask that your blood pressure be taken in your other arm.

Keep your arm or leg clean.Make skin and nail care high priorities. Inspect the skin on your arm or leg daily, watching for changes or breaks in your skin that could lead to infection. Don't go barefoot.
Although there is no cure for lymphedema, patients are encouraged to seek treatment at the first signs, because early diagnosis and treatment improves both the prognosis and the condition. The goal of care should focus more on improving/maintaining the patient’s quality of life, rather than fully reducing swelling. All four cornerstone methods, including skin care, compression, massage, and exercise, should be applied carefully.

Dr Shali S Nair
Pain & Palliative Medicine
KIMSHEALTH Cancer Centre


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