What Is Lymphedema?
Lymphedema is an accumulation of lymphatic fluid in the interstitial tissue
that may causes swelling in an extremity such as arm, legs, face abdomen or genitals.  Lymphedema can develop when lymphatic vessels are missing or impaired (primary), or when lymph vessels
are damaged or removed (secondary).  The most common cause of Lymphedema is the result of surgery, lymph node removal and the side effects of radiation treatment.
When lymphedema remains untreated, protein-rich fluid continues to accumulate, leading to an increase of swelling and a hardening or fibrosis of the tissue.  In this state, the swollen limb(s) becomes a perfect culture medium for bacteria and subsequent recurrent lymphangitis (infections).  Moreover, untreated lymphedema can lead into a decrease or loss of functioning of the limb(s), skin breakdown, chronic infections and, sometimes, irreversible complications.
Lymphedema should not be confused with edema resulting from venous insufficiency.  However, untreated venous insufficiency can progress into a combined venous/lymphatic disorder which is treated in the same way as lymphedema.
What Causes Lymphedema?
Primary lymphedema, which can affect from one to as many as four limbs
and/or other parts of the body, can be present at birth, develop at the
onset of puberty (praecox) or in adulthood (tarda), all from unknown causes,
or associated with vascular anomolies such as hemangioma, lymphangioma,
Port Wine Stain, Klippel Trenaury.
Secondary lymphedema, or acquired lymphedema, can develop as a result of
surgery, radiation, infection or trauma.  Specific surgeries, such as
surgery for melanoma or breast, gynecological, head and neck, prostate or
testicular, bladder or colon cancer, all of which currently require removal
of lymph nodes, put patients at risk of developing secondary lymphedema.  If
lymph nodes are removed, there is always a risk of developing lymphedema.
Secondary lymphedema can develop immediately post-operatively, or weeks,
months, even years later.  It can also develop when chemotherapy is unwisely
administered to the already affected area (the side on which the surgery was
performed) or after repeated aspirations of a seroma (a pocket of fluid
which occurs commonly post-operatively) in the axilla, around the breast
incision, or groin area.  This often causes infection and, subsequently,
Aircraft flight may also be linked to the onset of lymphedema in patients
post-cancer surgery (likely due to the decreased cabin pressure).  It is advisable to wear a compression garment (sleeve, stocking) when you fly, even if you do not have lymphedema.
Another cause of lower extremity lymphedema is that resulting from the use
of Tamoxifen. This medication can cause blood clots and subsequent DVT
(deep venous thrombosis).
Radiation therapy, used in the treatment of various cancers and some
AIDS-related diseases (such as Kaposi-Sarcoma), can damage otherwise
healthy lymph nodes and vessels, causing scar tissue to form which
interrupts the normal flow of the lymphatic fluid.  Radiation can also cause
skin dermatitis or a burn similar to sunburn.  It is important to closely
monitor the radiated area for any skin changes, such as increased
temperature, discoloration (erythema) or blistering which can lead into the
development of lymphedema.  Be sure to keep the area soft with lotion
recommended by your radiation oncologist.
Symptoms of Lymphedema
Lymphedema can develop in any part of the body or limb(s).  Signs or symptoms
of lymphedema to watch out for include: a full sensation in the limb(s),
skin feeling tight, decreased flexibility in the hand, wrist or ankle,
difficulty fitting into clothing in one specific area, or ring/wristwatch/bracelet
tightness. If you notice persistent swelling, it is very important that you seek
immediate medical advice (and get at least one second opinion) as early diagnosis
and treatment improves both the prognosis and the condition.
- Post-cancer surgery lymphedema patients who experience a sudden marked increase
of swelling should immediately cease treatment and be checked by their physician.  Many lymphedema specialists believe that patients with recurrent or metastatic disease should not undergo Complete Decongestive Therapy (CDT) in order not to
promote the spreading of the cancer.  Be sure to discuss this treatment with your
- Patients with a sudden onset of lymphangitis (infection) should
immediately discontinue treatment (see page 4) until the infection is
cleared. Patients with histories of vascular disease and who are
taking anticoagulants, should have a Doppler and ultra-sound to rule out
deep-venous thrombosis before being treated. During treatment, these
patients should be followed closely and regular laboratory tests should
be performed (prothrombentime).
- Patients who have congestive heart failure must be monitored closely to
avoid moving too much fluid too quickly, for which the heart may not be able
- If pain is present, discontinue all treatment until the pain subsides or
the underlying cause has been determined.