Lymphedema

The lymph fluid flows around the body via the lymph vessels. It contains proteins, salts and white blood corpuscles (lymphocytes), among others. The lymphocytes are important for the immune defense. The lymph system is also used for drainage and cleaning: excess fluids, metabolic waste products and harmful substances are flushed out of the body via the lymphs. 

One talks of a lymphedema when the lymph fluid accumulates at a particular place in the body and a swelling (edema) occurs. This can happen when lymph vessels or lymph nodes are damaged.

A lymphedema is a chronic illness that can occur at any age. Doctors distinguish between congenital (primary) and acquired (secondary) lymphedemas. The latter occur as a consequence of injuries, therapies, or illnesses such as cancer.

Lymphedema is often accompanied by these symptoms:

• swellings
• pain
• feeling of pressure
• feeling of heaviness
• changes to skin
• mobility restrictions

These symptoms can occur singly or in combination. Lymphedemas may occur at one or more sites in the body.

In general, any part of the body may be affected, but lymphedemas are often found in arms or legs.

A primary lymphedema has genetic causes. 

A secondary lymphedema can occur because of various conditions or injuries, but it may also be triggered by certain therapies. The most common causes are cancers and cancer treatments. These include, for example, the removal of lymph nodes and radiotherapy.

Factors that favor lymphedema are being overweight (obesity) and certain inflammatory illnesses such as arthritis and dermatitis.

Lymphedema can occur at any age. Children mainly get primary (genetic) lymphedemas.

Primary lymphedema occurs in around 1 out of 6,000 babies. It is ten times more common in girls than in boys. 

Secondary lymphedema is far more common than primary. In industrialized countries it occurs in approximately 0.1 to 2 percent of people. 

Lymphedema is a chronic condition, i.e. it stays with the sufferer for life. Depending on the nature of the condition, doctors categorize it as stages 0 (very mild) to 3 (very severe).

Adequate treatment can prevent it from getting worse. Even a severe lymphedema can then regress.

People with a higher risk of developing a lymphedema can help their lymph system through sporting activities. A healthy diet is also recommended.

The doctor will particularly ask whether

• there is any lymphedema or vascular disease in the family
• the person has been operated on
• there are any pre-existing conditions
• there is or has been any cancer
• the skin has changed

The doctor will then check:

• where the swelling is
• whether the skin has changed
• whether the person is short of breath or sweating
• how mobile the person is in general
• how big the lymph nodes are and how they feel
• the nature of the edema
• the condition of the blood vessels
• the skin temperature
• joint mobility

If these tests do not result in a definite diagnosis, other methods can be used. These are, in particular, imaging methods such as ultrasound, magnetic resonance tomography (MRT), and an image of the lymph vessels (lymphangiogram).

Functional lymphoscintigraphy is used to assess lymph fluid transport. This involves injecting a weak, radioactive substance that is carried off through the lymph vessels.

If a primary lymphedema is suspected, certain genetic tests can provide further information.

Lymphedema is usually treated with Complex Physical Drainage (CPD) therapy. This aims to help the accumulated fluid to drain away. It includes:

• manual lymph drainage 
• compression therapy, for example with compression stockings
• exercise and activity, particularly group exercises and rehabilitation activities
• information and training for self-treatment
• skincare and skin protection, for example with moisturizing creams
• immediate treatment for skin damage, for example disinfecting wounds

The initial treatment phase usually takes place in hospital. As the therapy continues, decisions as to which measures to employ and how often are taken on an individual basis.

Weight loss, along with exercise for stamina, flexibility and strength, may be beneficial to overweight people with lymphedema, in particular.

Surgical therapy will only be considered if the conservative therapy has not yet resulted in a significant improvement after 6 months.

Depending on the nature of the illness, the restricted mobility and the appearance of the affected part of the body may badly affect the patient mentally. The extensive therapy takes time, and everyday tasks have to be adapted to the situation.

Additional psychological support helps some people with a lymphedema. This often also results in an improvement of the physical symptoms.