What is lymphedema?
As blood flows through our arteries supplying essential oxygen and nutrients throughout the body, it flows through smaller and smaller channels, and finally bathing the cells in the tissue fluid. This tissue fluid returns to the larger circulatory system by the venous system and lymphatics. If the architecture of the lymphatics is disrupted, the flow of tissue fluid back is hampered. This leads to a back up in the end organ causing swelling.
This is commonly seen in women who have had breast cancer surgery. A curative operation requires sampling of lymph nodes from the armpit. This disrupts the lymphatic channels flowing back from the arm, and fluid backs up, causing swelling from the arm. Doing the minimal possible dissection, by identifying the “sentinel lymph node”, has minimized this side effect. This is achieved by injecting a dye into the breast tumor, and tracing where it drains. This minimizes the disruption of lymphatic channels, and decreases the risk of lymphedema.
Lymphedema can be seen in the neck when patients with cancer in the head and neck region receive radiation to the region. This can cause scar tissue locally, which blocks the lymphatic channels. The same can occur in the lower extremities when the lymph nodes in the groin are radiated for uterine, rectal or prostate cancer.
Lymphedema can also result from other non-malignant causes. There are areas of the world, which suffer from a parasitic infection, called filariasis. This parasite is transmitted by mosquito bites, and populates the lymph nodes, and blocks the drainage of the lymph from the lower legs. This results in an irreversible condition commonly called “elephantiasis”.
Lymphedema related to cancer treatment, can be anticipated, and managed early, to minimize permanent problems.
Preventive management would be using surgical procedures to minimize disruption, e.g. sentinel node biopsy instead of a full axillary dissection.
Early intervention requires careful monitoring, and watching for early signs of swelling or discomfort. Physical therapy involved massage therapy and a “milking” action, pushing the fluid back towards the body.
Once lymphedema sets in, a tight elastic sleeve is fitted to prevent further swelling and discomfort. This sleeve is generally needed indefinitely, as the condition does not reverse.