Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Lymphedema is a condition characterized by swelling in one or more
extremities that results from impaired flow of the lymphatic system.
The lymphatic system is a network of specialized vessels (lymph vessels)
throughout the body whose purpose is to collect excess lymph fluid with
proteins, lipids, and waste products from the tissues. This fluid is then
carried to the lymph nodes, which filter waste products and contain
infection-fighting cells called lymphocytes. The excess fluid in the lymph
vessels is eventually returned to the bloodstream. When the
lymph vessels are
blocked or unable to carry lymph fluid away from the tissues, localized swelling
(lymphedema) is the result.
Lymphedema most often affects a single arm or leg, but in uncommon situations
both limbs are affected.
Primary lymphedema is the result of a design flaw of
the lymph vessels and is a rare, inherited condition.
Secondary lymphedema
results from an identifiable damage to or obstruction of normally-functioning
lymph vessels and nodes.
Worldwide, lymphedema is most commonly caused by
filariasis (a parasitic infection), but in the U.S., lymphedema most commonly
occurs in women who have had breast cancer surgery, particularly when followed
by radiation treatment.
It has been estimated that worldwide, there are 140-250 million people
affected by lymphedema.
What causes lymphedema?
Primary lymphedema causes
Primary lymphedema is an abnormality of an individual's lymphatic system and
is likely present at birth, although symptoms may not become apparent until
later in life. Depending upon the age at which symptoms develop, three forms of
primary lymphedema have been described. Most primary lymphedema occurs without
any known family history of the condition.
Congenital lymphedema is evident at birth, is more common in females, and
accounts for 10%-25% of all cases of primary lymphedema. A subgroup of people
with congenital lymphedema has a genetic inheritance (in medical genetics termed
"familial sex-linked pattern"), which is termed Milroy disease.
Lymphedema praecox is the most common form of primary lymphedema, making up
65%-80% of cases. It is defined as lymphedema that becomes apparent after birth
and before age 35 years and symptoms most often develop during
puberty.
Lymphedema praecox is four times more common in females as in males.
Primary lymphedema that becomes evident after 35 years of age is known as
Meige disease. It is less common than congenital lymphedema and lymphedema
praecox and accounts for 10% of cases of primary lymphedema.
Secondary lymphedema causes
Secondary lymphedema develops when a normally-functioning lymphatic system is
blocked or damaged. In the U.S., breast cancer surgery, particularly when
combined with radiation treatment, is the most common cause. This results in
one-sided (unilateral) lymphedema of the arm. Any type of surgical procedure
that requires removal of regional lymph nodes or lymph vessels can potentially
cause lymphedema. Surgical procedures that have been associated with lymphedema
include vein stripping,
lipectomy, burn scar excision, and
peripheral vascular
surgery.
Damage to lymph node and lymph vessels, leading to lymphedema, can also occur
due to trauma, burns, radiation, infections, or compression or invasion of lymph
nodes by tumors.
Worldwide, however, filariasis is the most common cause of lymphedema.
Filariasis is the direct infestation of lymph nodes by the parasite Wuchereria
bancrofti. The disease is spread among persons by mosquitoes, and affects
millions of people in the tropics and sub-tropics of Asia, Africa, Western
Pacific, and parts of Central and South America. Infestation by the parasite
damages the lymph system, leading to swelling in the arms, breasts, legs, and,
for men, the genital area. The entire leg, arm, or genital area may swell to
several times its normal size. Also, the swelling and the decreased function of
the lymph system make it difficult for the body to fight infections. Lymphatic
filariasis is a leading cause of permanent disability in the world.
Lymph nodes help the body's immune system fight infections. Causes of swollen lymph nodes (glands) may include infection (viral, bacterial, fungal, parasites). Symptoms of swollen lymph nodes vary greatly. They can sometimes be tender, painful or disfiguring. The treatment of swollen lymph nodes depends upon the cause.
Cellulitis is an acute spreading bacterial infection below the surface of the skin characterized by redness, warmth, inflammation, and pain. The most common cause of cellulitis is the bacteria Staph (Staphylococcus aureus).
Edema is the swelling of tissues as a result of excess water accumulations. Peripheral edema occurs in the feet and legs. There are two types of edema, non-pitting edema and pitting edema. Causes of pitting edema is caused by systemic diseases, most commonly involving the heart, liver, and kidneys. Local conditions that cause edema are thrombophlebitis and varicose veins. Edema is generally treated with medication.
Breast cancer is the most common cancer in women and the second most common cause of cancer death in women in the U.S. Symptoms include a lump in the breast or underarm area, nipple pain, change in breast size or shape, an inverted nipple, nipple discharge, and breast skin changes. Treatment may involve chemotherapy, radiation therapy, biological therapy, hormone therapy, or surgery.
Sepsis (blood poisoning) is a potentially deadly infection with signs and symptoms that include elevated heart rate, low or high temperature, rapid breathing and/or a white blood cell count that is too high or too low and has more than 10% band cells. Most cases of sepsis are caused by bacterial infections, and some cases are caused by fungal infections. Treatment requires hospitalization, IV antibiotics, and therapy to treat any organ dysfunction.
Peripheral vascular disease (PVD) refers to diseases of the blood vessels (arteries and veins) located outside the heart and brain. While there are many causes of peripheral vascular disease, doctors commonly use the term peripheral vascular disease to refer to peripheral artery disease (peripheral arterial disease, PAD), a condition that develops when the arteries that supply blood to the internal organs, arms, and legs become completely or partially blocked as a result of atherosclerosis. Peripheral artery disease symptoms include: intermittent claudication, rest pain, numbness in the extremities, and more. Treatment for peripheral artery disease include: lifestyle measures, medication, angioplasty, and surgery.
Burns are categorized by severity as first, second, or third degree. First degree burns are similar to a painful sunburn. The damage is more severe with second degree burns, leading to blistering and more intense pain. The skin turns white and loses sensation with third degree burns. Burn treatment depends upon the location, total burn area, and intensity of the burn.
Varicose vein: A dilated (widened) tortuous (twisting) vein, usually involving a superficial vein in the leg, often associated with incompetency of the valves in the vein. These visible and bulging veins are often associated with symptoms such as tired, heavy, or aching limbs. Spider veins are a group of widened veins that can be seen through the surface of the skin.
The time when boys and girls begin the process of sexual maturation is called puberty. During this time, both sexes undergo a series of biological changes that include a rapid increase in height, bone growth, weight increase, the growth of pubic hair, breast development and the onset of menstruation in girls, and testicle, penis, and muscle enlargement in boys.
Lymphedema is a common chronic, debilitating condition in which excess fluid called lymph collects in tissues and causes swelling in them. It is common after a mastectomy, lumpectomy or breast cancer surgery and radiation therapy.
Lymph nodes are an important component of the body's immune system and help
in fighting infections.
They are small, soft, round or oval structures that are found throughout the
body and are connected to each other in chain-like (lymphatic chains) fashion by
channels similar to blood vessels. Each individual lymph node is covered
by a capsule made up of connective tissue.
Within the capsule, lymph nodes contain certain kinds of
immune cells. These
cells are mainly lymphocytes, which produce proteins that capture and fight
viruses and other microbes, and macrophages, which destroy and remove the
captured material.
Where are the lymph nodes located in the body?
Lymph nodes are located throughout the body. Some are directly under the skin
while others are deep inside the body. Even the most superficial (close to the
skin) lymph nodes are usually not visible or palpable (felt by touchi...
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