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What is Lymphedema?


Lymphedema develops when the lymph system is unable to remove the lymph fluid from an area of the body, and the protein rich lymph fluid is left behind to accumulate in the tissues, and this stagnant tissue causes damage. It’s not “just swelling”.

The lymphatic system is a crucial, yet poorly studied, entire body system of lymph nodes and collecting tubes that captures the protein rich fluid that leaves our arteries and veins and is a crucial component of our immune system. You can see an illustration of it here:

Although the lymphatic system runs nearby the blood vessels, unlike our circulatory system, it doesn’t have a heart to pump the fluid and it relies on the actions of our surrounding muscles and some contractions of the lymph vessels to move this important lymph fluid back into the circulatory system. The lymph system is in “quadrants”: right and left upper quadrants and right and left lower quadrants and each has pathways back to our venous system. It’s a fragile system, nearly impossible to see and easy to damage. Lymphatics run throughout our intestines and along our bones as well.

Edema is swelling, and “lymphedema” is swelling due to excess lymphatic fluid. But, it’s not so simple.

· Lymphedema can exist without obvious swelling, but the tissue is still being damaged by the inflammation caused by the fluid. Often, before there is swelling, there are symptoms of heaviness, tingling, warmth, numbness and/or pain.

 · Over time, extra lymph fluid in the tissue causes changes in the skin, the “subcutaneous tissues,” with extra fat being deposited and fibrosis (hardening) of the tissues.

Lumphatic fluid is part of the body’s immune system so a damaged lymphatic system, with lymphedema, both decreases the body’s protective defenses and is prone to infection. 

The lymphatic system can be damaged by surgery, radiation, chemotherapy or trauma. Some people have lymphatic systems that are genetically predisposed to fail. They may have a condition called “primary lymphedema”, which can occur at birth or later in life, or they may more easily acquire lymphedema after damage to the lymphatic system—called “secondary lymphedema”.

Most people who get lymphedema after cancer treatments develop it within three years of treatment, but the risk is life-long. Our lymphatic system is also prone to aging, so the onset can be at any point after the damage has occurred. There can be triggering events that overwhelm a fragile system: infection, overuse, extreme heat, air travel, medical trauma—such as IV’s, injections or excess pressure on the body.

 Unfortunately, there’s no single agreed upon scientific definition of lymphedema, so it’s a “clinical” diagnosis. It’s important to look at the whole picture: not just size and volume measurements, but the appearance of the limb or other body part. As Andrea Cheville, MD of Mayo Clinic has written:

"There is no one value or standard you can use to say, ‘OK, if you meet that you have lymphedema, and if you don’t, well then you don’t have it,’” says Dr. Cheville. “For example, there may be no size or volume changes in the arm, but you could have subtle hand swelling or pitting on the arm. So it’s important not to be too locked into arm measurements alone, as that can create a false sense of security. You also need to be watching the arm and looking for the loss of what we call ‘anatomic architecture’ — an inability to see the veins and tendons in the arm as clearly, or less pronounced knuckles, or skin that is less wrinkled and therefore looks younger.”

 Lymphedema is defined as stages:

· Stage 0: Latent lymphedema: an at risk-area that may have excess tissue but no lingering swelling

· Stage 1: swelling that pits—indents when pushed, but can be reduced with treatment

· Stage 2: swelling that persists, even with treatment, causing the skin to harden

· Stage 3: advanced swelling with extensive tissue changes, some changes irreversible

 Please look at these images of hand and arm lymphedema:

Page Last Modified 11/17/2014