Lymphedema Case Management

Lymphedema refers to swelling (edema) in the soft tissues of the body, most often in the extremities. It may occur in both arms and legs but typically in only one extremity. Symptoms range from mild discomfort to extreme pain and debilitation. Unfortunately, no cure exists for this condition, resulting from a blockage in the lymph portion of the circulatory system, but available treatments might significantly decrease the swelling and relieve the discomfort.

Lymphatic System

• The lymphatic system contains a network of vessels that flow through tissues and certain organs of the body, including the lymph nodes, tonsils, thymus, spleen and bone marrow. The clear fluid (lymph) running through the lymph vessels carries plasma, lymphocytes (white blood cells that fight infection) and waste products collected from all the organs in the body. When the system functions normally, the lymph vessels take the fluid through the lymph nodes. The nodes filter viruses, bacteria and cancerous cells from the fluid and return a cleaner version of lymph to the bloodstream, according to WebMD.

Causes of Lymphedema

• The swelling that marks lymphedema occurs when damage or rare congenital deformities block the circulatory path of the lymph vessels, causing the fluid to leak into surrounding tissue. Congenital causes include Milroy's disease, which occurs in infancy and results from malformed lymph nodes, according to the Mayo Clinic. Meige's disease, another inherited disorder that generally occurs in puberty and early adulthood, results when the valves that normally prevent lymph fluid from flowing backward and overflowing do not form. Other causes of lymphedema include surgery that damages lymph vessels or surgical removal of lymph nodes, such as with breast cancer or lymphoma. Infection of the lymph nodes or vessels, cancer and radiation during cancer treatment may also cause structural damage leading to lymphedema.

Symptoms and Complications

• Signs of lymphedema include aching discomfort or limited range of movement in the affected limb, skin infections or hardening of the skin and swelling that ranges from very mild to severe enough to increase the limb to many times its original size. The condition can cause serious infections of the skin (cellulitis) or lymphatic system and, according to the Mayo Clinic, the most severe cases may lead to a rare form of cancer, lymphangiosarcoma.

Management

• The keys to controlling this condition include managing the swelling and keeping the skin healthy. Doctors may enlist a physical therapist to massage the affected limb or teach patients gentle isotonic exercises that help get the fluid moving out of the extremity. They might prescribe bandaging the affected limb in a specific way to compress the tissue and move the fluid back toward the trunk of the body or have the patient wear specially fitted compression garments, such as stockings, that encourage the fluid to move out of the soft tissue. Because there is no cure, Mayo Clinic notes these treatments become routine for those suffering from lymphedema. In the most severe cases, doctors may try to remove excess tissue through surgery, but even this does not provide a cure.

Other Considerations

• Adequate rest, healthy diet, exercise and reducing stress can increase the odds of successfully controlling lymphedema. The Mayo Clinic recommends contacting a local or online support group to help cope with the lifelong management of this condition, which, according to the National Institutes of Health, affects 1 million to 2 million people in the United States.