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Lymphedema

Medical Author: Melissa Conrad Stöppler, MD
Medical Editor: William C. Shiel, Jr., MD, FACP, FACR

Lymphedema and Breast Cancer Treatment

Therapy May Relieve Breast Cancer Surgery Complication

Secondary lymphedema is a complication of breast cancer treatment

WEDNESDAY, Jan. 13 (HealthDay News) -- A common complication of breast cancer surgery can be prevented or reduced if patients receive physical therapy, including massage and shoulder exercises, soon after their operation, a new study suggests.

Secondary lymphedema -- caused by damage to the lymphatic system during treatment -- results in fluid retention and arm swelling. It affects 71% of patients within 12 months of breast cancer surgery and can cause disfigurement, anxiety, depression and emotional distress.

Maria Torres Lacomba, a professor of physiotherapy at Alcala de Henares University in Madrid, Spain, and colleagues selected 120 women who had breast cancer surgery involving removal of lymph nodes and divided them into two groups -- an intervention group that received early physiotherapy and education, and a control group that received education only. Both programs lasted three weeks and the patients were followed up four weeks after surgery and again three, six and 12 months after surgery.

Read more on lymphedema and breast cancer treatment »

SOURCE: HealthDay News

What is lymphedema?

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.



Next: What are the symptoms of lymphedema? »

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Lymphedema

Introduction to Lymphedema

The lymphatic system helps coordinate the immune system's function to protect the body from foreign substances and includes an extensive network of lymph vessels and lymph nodes. Here's how the lymphatic system works:

Excess fluid is collected from the space between tissues in the body and moves through the lymph vessels. The fluid (now called lymph) isn't pumped through the body like blood, but instead is "pushed" through the lymph system as the vessels are compressed by surrounding muscles.

Filters called lymph nodes remove certain harmful substances from the lymph fluid, such as bacteria and debris. The fluid from most tissues or organs is filtered through one or more lymph nodes before draining into the bloodstream.

What Is Lymphedema?

Lymphedema is an abnormal buildup of fluid that causes swelling, most often in the arms or legs. The condition develops when lymph vessels or lymph nodes ...

Read the Breast Cancer and Lymphedema article »











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