Lymphedema - Lymphoma

lymphedema

(lim″fi-dē′mă) [lymph + edema] An abnormal accumulation of tissue fluid in the interstitial spaces due to the removal of lymph nodes or to the blockage or destruction of lymphatics. Stagnant flow of tissue fluid through body structures may make them prone to infections that are difficult to treat; as a result lymphedematous limbs should be protected from cuts, scratches, burns, and blood drawing. SEE: illus.

LYMPHEDEMA OF THE LEG

SEE: lymphatic blockade; elephantiasis; lymphedema pump.

CAUSES: Common causes of lymphedema include neoplastic obstruction of lymphatic flow (as in the axilla, in metastatic breast cancer); postoperative interference with lymphatic flow (after axillary dissection); infectious blockade of lymphatics (in filariasis); radiation damage to lymphatics (after treatment of pelvic, breast, or lung cancers). All of these are secondary (acquired) lymphedemas. Rarely, lymphedema also may occur congenitally (Milroy disease), or develop at the onset of puberty or during adulthood from an unknown cause that may be related to vascular anomalies (primary lymphedema). In the U.S. and other developed countries, the leading cause of secondary lymphedema is surgical or radiation therapy for cancer, esp. if accompanied by lymph node dissection.

SYMPTOMS AND SIGNS: Symptoms of lymphedema include a feeling of heaviness, tiredness, aching, weakness, and fullness in a limb that impairs flexibility or interferes with the wearing of jewelry, watches, or clothing.

DIAGNOSIS: The clinical appearance of affected limbs is diagnostic.

Lymphedema occurs in four stages, 0 to 3: 0) the subclinical stage in which lymph transport is known to be im paired, but no signs or symptoms are obvious (this stage may last for years); 1) soft tissue with pitting edema; swelling decreases with elevation; 2) swollen tissue but firmer and thus may not show pitting; edema does not resolve completely with elevation; and 3) grossly enlarged and misshapen limb; skin breakdown and infection often occur.

PREVENTION: Surgical techniques that spare lymphatic drainage and the integrity of uninvolved lymph nodes reduce the incidence of postoperative lymphedema, e.g., in patients with breast cancer who undergo axillary dissection to remove tumor that has spread to neighboring lymph nodes.

TREATMENT: Postoperative physical therapy reduces the severity of lymphedema, as do lymphatic drainage techniques and bandages and clothes that compress the limb. Drugs such as antibiotics, anticoagulants or diuretics are not effective.

PATIENT CARE: A combination of manual lymphatic drainage, compression devices, and protection of the affected limb can make a positive difference in a patient's quality of life. Patient management by physiatrists, other physicians experienced in lymphedema care, certified nurses, and therapists is crucial. Careful measurement of the affected limb with comparison to its opposite and diagnostic testing help to rule out ...