What is lymphedema?
Lymphedema is a failure of the lymphatic system whereby inadequate drainage of fluid and proteins results in the swelling of tissues. This swelling is typically in the arms or legs, however, other areas such as the breast, genitals or head and neck, can be affected as well.
Who can get lymphedema?
Lymphedema is common in patients who have undergone surgical procedures, removal of lymph nodes or radiation therapy, for the treatment of various cancers such as breast, ovarian, prostate, testicular, bladder, colon, and head and neck cancer, as well as melanomas.
What are the symptoms?
As a result of swelling, the affected limb might feel tight and heavy, and there may be pain due to associated nerve injuries, obstruction of veins, and strain on ligaments from the increased limb weight.
What happens if lymphedema is left untreated?
If left untreated, there is a risk of loss of limb function as well as chronic infections.
Psychological and social effects of lymphedema
In addition to the physical effects, lymphedema also causes psychological distress on the patient, which can have a profound effect on quality of life. Disfigurement, embarrassment and depression may result in the patient minimizing social interactions with others. Moreover, the physical effects of lymphedema may necessitate a change in lifestyle and activities, further affecting the psychological well-being of the patient.
The current recommended management of chronic lymphedema is Decongestive Lymphatic Therapy (DLT). DLT is a multi-modal treatment that aims to improve lymph drainage through existing lymphatic vessels, to encourage collateral circulation and to maintain volume reduction. DLT is provided by specialized trained lymphedema therapists and is divided into two treatment phases:
1) An edema reduction phase, approximately 2 to 6 weeks, involving manual therapy (e.g. manual lymph drainage, scar release), application of non-elasticized compression for 24 hours per day, skin care, exercise, and education provided by the lymphedema therapist. Compression pneumatic pump may be used in complement.
2) A maintenance phase where, under the guidance of their lymphedema therapist, patients take charge of their own care. During the day compressive garments are worn to maintain volume reduction. Exercise specific to lymphedema and general overall activity and exercise are recommended. Additional manual therapy and bandaging may be required by those with a more severe stage of lymphedema. Compression pneumatic pump may also be used in this stage of treatment.
Research has focused on physical treatments and methods of self-management for this chronic life-long condition. There are some exciting developments on the horizon with scientists investigating possibilities of treatment through medication. Surgical treatments are also available in specialized centers around the world.