Lymphedema describes the tissue swelling resulting from an accumulation of protein-rich fluid, typically discharged through the body's lymphatic system, it commonly affects the arms or legs, although it can also affect the genitalia, chest wall, belly, and neck.

Lymph nodes are a crucial part of your lymphatic system. Cancer treatments that harm or remove your lymph nodes might result in lymphedema. Lymphedema can be due to any issue that prevents the lymph fluid from draining.

Severe lymphedema can impair motion in the affected limb, raise the risk of sepsis and skin infections, and cause skin abnormalities and disintegration. Treatment may include massage, compression bandages, sequential pneumatic pumping, compression stockings, careful skin care, and surgery to remove swollen tissue or to create new drainage routes.

Also Read: Top 4 Ways to Prevent Lymphedema

What is the lymph system?

The lymph is part of your body's immune system. A network of lymph nodes, ducts, and organs plays a role in gathering and transporting clear lymph fluid through the bodily tissues and into the blood. This is similar to how veins bring blood back to the heart from far-flung areas of the body (such as the hands and arms).

White blood cells, proteins, salts, and water are all found in the lymph fluid that travels throughout the body and aid in the body's ability to fight illness.

Lymph vessels or ducts have one-way valves that work with body muscles. It helps in controlling the flow and moving the fluid through the body.

Small, bean-sized glands called lymph nodes are along the lymph channels and function to assist foreign filter material like tumour cells and pathogens. There are lymph nodes throughout the body, including the groin, armpit, chest, abdomen, and armpit.

The lymph system also includes the tonsils, adenoids, spleen, and thymus.

Symptoms of lymphedema

• Swelling of the entire or just a part of the arm, leg, fingers, or toes
• a sensation of weight or constriction
• Limitation of movement
• persistent infections
• Skin that is hardening and becoming thicker (fibrosis)
• Mild to severe signs and symptoms are possible in lymphedema.
• Cancer-related lymphedema may not manifest for months or even years after treatment.
• When surgery or other treatments damage the arms or legs, lymphedema frequently occurs there, but it can also occur in different places of the body.
• If lymphedema occurs after treatment for breast cancer, it may affect the arm closest to the operation and the breast, chest, and underarms.
• Lymphedema may manifest as swelling of the abdomen, genitalia, or one or both legs following treatment for cancer of the abdomen (belly) or pelvis.
• Lymphedema in the face and neck could result from treating malignancies in the head and neck region.

What are the stages of lymphedema?

The severity of lymphedema is understandable through its stages:

• Stage 0: No swelling, but minor symptoms such as a feeling of fullness or heaviness in the affected area or tight skin.
• Stage 1: The affected area begins to swell. The arm, leg, or affected part has grown larger or more stiff. Swelling in the arms or legs gets better when you lift them.
• Stage 2: Greater edema than stage 1,raising the arm or leg isn't helpful. More significant in size than stage 1, the afflicted region is hard.
• Stage 3: Stage 2 swelling is significantly worse, you can have such severe swelling that you cannot lift or move the arm or leg by yourself.

Know the signs of cellulitis in lymphedema

An infection in the tissues directly below your skin is known as cellulitis. It might result in lymphedema. You need to consult your doctor immediately if you have cellulitis, or an urgent medical problem.

Cellulitis symptoms and signs include redness, warmth, pain, and potentially peeling or breaking the skin in the affected area and there may also be symptoms of the flu and fever. Antibiotics may be required to keep it under control if it develops into a recurrent issue.

Tests and diagnosis for lymphedema

A doctor will rule out a blood clot or an infection unrelated to the lymph nodes, along with other potential reasons for swelling.

Suppose the patient is at risk of lymphedema, for instance. In that case, the doctor may diagnose lymphedema based on the symptoms if they recently had cancer surgery or treatment related to the lymph nodes.

If a cause for the lymphedema is not immediately apparent, several imaging tests may be prescribed. The lymphatic system can be examined in-depth using the following imaging methods.

• MRI scan
• CT scan
• Doppler ultrasound scan
• Lymphoscintigraphy may also be used a radioactive dye is injected into the lymphatic system, while the nuclear scanner shows the dye's movement through the lymphatic system and identifies any blockages.
• Lymphedema can also lead to cellulitis, so watching for signs and symptoms is essential.

Treatment of lymphedema

Lymphedema cannot be cured, but treatment, however, can lessen pain and swelling.

Complex decongestive therapy (CDT) involves daily treatment and instruction for the patient during an intensive therapy phase. The maintenance phase comes next, during which the patient is urged to manage their treatment using the methods they have been taught.

The four parts of CDT are as follows:

Remedial exercises: These are light exercises designed to promote the movement of the lymph fluid out of the limb.

Skincare: Skin infections like cellulitis are less likely to occur with good skincare practices.

Manual lymphatic drainage (MLD): The lymphedema therapist uses special massage techniques to move fluid into working lymph nodes, where they are drained. The lymphedema therapist also teaches several massage techniques that can be used during the maintenance phase.

Multilayer lymphedema bandaging (MLLB): Wrapped over muscles surrounding lymph vessels and nodes to help the fluid move through the lymphatic system.

Unlike blood circulation, there is no central pump (heart). The aim is to use bandages and compression garments to support the muscles and encourage them to move fluid out of the affected body. Patients will also be taught how to apply their bandages and compression garments correctly so that MLLB can continue during maintenance. A range of compression stockings is available for purchase online.

Surgery has historically had disappointing results compared with non-surgical therapies for lymphedema. However, a new surgical technique using liposuction has proved more successful. It removes fat from the affected limb, resulting in less swelling.

Exercises

People with lymphedema are advised to lead healthy lifestyles that include regular movement and exercise.

Exercising safely and successfully, though, may occasionally require professional assistance.

According to a study, women who engage in light lifting activities after undergoing breast cancer do not increase their chance of developing lymphedema in the arm. According to experts, such exercise may lower the risk of lymphedema.

The forms of exercise that might be advantageous include:

• increase adaptability
• exercising stretching
• develop power
• Aerobic activity that emphasizes the upper body aids in weight loss and promotes deep breathing is also advised.
• The limb should be monitored for any stiffness, texture abnormalities, or other changes.

Prevention

The patient's risk of developing the following diseases may be considerably decreased if they take steps to lower their risk of skin grazes and cuts. The damaged limb is more susceptible to skin infections because the supply of lymphocytes (which fight infection) is diminished.

Also Read: Yoga and Physiotherapy Techniques for Cancer Patients

These actions could be helpful:

• Avoid strenuous activities with the damaged leg after cancer treatment; let it rest while it heals.
• Avoid taking really hot showers or baths.
• Steer clear of saunas, steam rooms, and sunbeds.
• Avoid tight-fitting clothes.
• Wear loose-fitting jewellery.
• Avoid going barefoot outside.
• Check the skin for alterations or breaks.
• Applying moisturizer to your skin daily will keep it soft.
• Make sure your shoes fit comfortably.
• Use a foot powder that fights fungus to prevent an athlete's foot from developing.
• Wear gardening gloves.
• Maintain short nails.
• Use insect repellent while going outside in an area where there may be insects.
• Use a high-factor sunblock when you're outside in the sun.
• Apply an antibiotic cream very away to any cuts you may have. Likewise, keep the area tidy.

Conclusion

The condition of lymphedema is progressive and has no known treatment. The intensity of the symptoms will have some bearing on the prognosis.

A healthy lifestyle can help decrease fluid retention and promote lymph flow. This includes eating a balanced diet and getting some exercise. Follow your doctor's recommendations for the best course of action.

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Reference:

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2. Avancini A, Sartori G, Gkountakos A, Casali M, Trestini I, Tregnago D, Bria E, Jones LW, Milella M, Lanza M, Pilotto S. Physical Activity and Exercise in Lung Cancer Care: Will Promises Be Fulfilled? Oncologist. 2020 Mar;25(3):e555-e569. doi: 10.1634/theoncologist.2019-0463. Epub 2019 Nov 26. PMID: 32162811; PMCID: PMC7066706.