Doctor's Notes on Lymphedema
Lymphedema is defined as swelling in one or more of the arms or legs due to damage or inadequate function of the lymphatic system to move lymph fluid. Signs and symptoms include swelling of one or more extremities that can range from mild to severe. The skin is firm and does not pit when the skin is compressed by a finger. The skin may become scaly, cracked and may resemble an orange peel; the skin can become tender and sore. Severe lymphedema can be disfiguring and limit limb mobility.
There are two general causes of lymphedema, primary (due to an intrinsic defect in the lymph system) and secondary (due to damage or destruction of an otherwise normal lymph system). Primary causes are uncommon and are genetically caused like congenital lymphedema or Milroy disease (genetic, sex-linked). Secondary causes are common and are caused by surgeries like breast cancer surgery, infections like filariasis, trauma, cancer cells that block lymphatics, burns, scars and radiation exposure.
The swelling of lymphedema may be so slight as to barely be noticed, or the swelling may be severe and disfiguring. Pronounced swelling can be accompanied by fatigue when moving the involved extremity, as well as embarrassment.
Over the long-term, the excess fluid and proteins in the tissues cause chronic inflammation and scarring. The swelling is firm and does not retain an indentation (pit) when the skin is compressed by a finger (non-pitting edema). The skin in the involved area can become scaly or cracked, or may develop an orange-peel appearance (peau d'orange). Tenderness and soreness can accompany the swelling and skin changes. Loss of mobility may also occur.
Lymphedema also increases the susceptibility to infection in the affected area. Bacterial infections of the skin and of the subcutaneous tissues (the tissues underlying the skin) are the most common type of infections that occur in affected areas.
- Lymphedema can occur due to a defect in the function of the lymphatic system, although this is not common. In this situation, the lymphedema is referred to as primary lymphedema.
- Depending upon when in life the signs and symptoms develop, primary lymphedema is termed congenital lymphedema (present from the time of birth), lymphedema praecox, or Meige disease.
- Milroy disease is a one specific type of primary lymphedema that is inherited in a sex-linked genetic pattern.
- Much more commonly, lymphedema occurs because of damage or destruction of a lymphatic system that was previously functioning normally (secondary lymphedema).
- The most common cause of lymphedema in the U.S. is breast cancer surgery, especially in combination with radiation therapy, which can cause lymphedema of the arm on the side of the body affected by the cancer. '
- Other surgeries, such as vein stripping, peripheral vascular surgery, scar excisions, or any procedure that potentially damages lymph nodes and vessels can result in lymphedema.
- Worldwide, filariasis is the most common cause of lymphedema.
- Filariasis is infestation of lymph nodes by the parasite Wuchereria bancrofti, which is transmitted among humans by mosquitoes.
- Filariasis is a significant public health problem affecting millions in tropical and subtropical regions of Asia, Africa, the Western Pacific, and parts of Central and South America. In people suffering with filariasis, the entire leg, arm, or genital area may swell to several times its normal size, causing long-term disability.
- Other conditions characterized by damage to lymph nodes can also cause lymphedema, including infiltration of lymph nodes by cancer or damage due to trauma, burns, radiation, compression, or infection.
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Breast Cancer : Symptoms & Signs QuizQuestion
A lump in the breast is almost always cancer.See Answer
Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.