Lymphedema - treatment and therapy
What is Lymphedema and Definition
Lymphedema - swelling and often discomfort arising from inadequate LYMPH drainage and flow that allows interstitial fluid (fluid between the cells) to accumulate. Lymphedema most often occurs when INFECTION or CANCER that extensively engages the lymphatic system, or when surgery disrupts the LYMPH VESSELS and lymph nodes. Lymphedema is a common consequence of surgery and RADIATION THERAPY as treatments for cancer. Surgeons typically remove adjacent or sentinel lymph nodes, which are most likely to be affected by the cancer, during surgery to remove cancerous tumors to determine the extent to which the cancer has penetrated the tissues or metastasized (spread) to other tissues. Lymphedema can be debilitating when the swelling becomes substantial. Recurrent, progressive lymphedema often develops into fibrosclerosis (scarring and hardening) of the involved tissues.
It is important to distinguish lymphedema from other causes of swelling, such as edema (simple fluid retention) and ASCITES, because though the appearance of the affected area may be similar the treatment approaches differ. In chronic lymphedema the SKIN over the swollen area acquires a characteristic “orange peel” texture, which indicates damage to the underlying tissue. Tissue in the damaged area becomes susceptible to infection and ulceration, as the lymphedema compromises its BLOOD circulation and immune response. While conventional edema improves with diuretic medications, lymphedema does not.
Lymphedema Treatment
For lymphedema, treatment focuses on improving the flow of fluid into and through the lymph vessels. Compression sleeves and stockings provide gentle, consistent pressure against the affected arm or leg, helping prevent interstitial fluid from accumulating. Some people with severe lymphedema benefit from compression pump therapy, in which a pump gently inflates and deflates pressure cuffs wrapped around the arms or legs, to help squeeze interstitial fluid into the lymph capillaries. Surgery to remove damaged portions of tissue and lymphatic structures is a treatment of end resort that may improve very severe lymphedema when other methods have failed, though itself can cause further or more extensive damage.
Lymphedema is a lifelong concern for most people who develop it, regardless of its cause though particularly after extensive surgery that disrupts the lymphatic structures or in which the surgeon removes lymph nodes. Many people can manage their symptoms and discomfort through preventive measures such as frequent movement or self-massage of involved areas and prompt therapeutic response when swelling begins.
See also HEART FAILURE; LYMPH NODE; SENTINEL LYMPH NODE DISSECTION; SURGERY BENEFIT AND RISK ASSESSMENT.
