Lymphedema is a condition that develops when lymphatic fluid fails to drain properly through the body’s network of lymphatic vessels, accumulating instead in various tissues, such as the arms or legs. Common sites of lymph fluid buildup include the lower legs, ankles and feet. But lymphedema can occur in any part of the body where fluid circulation has been compromised due to radiation, surgery, trauma, or some other cause.

Local tissues typically swell, become tender, and are at greater risk of infection than healthier tissues. If the condition is left untreated, the skin above such tissues may become unsightly and discolored, become susceptible to infections, and may even weep fluid.

A Parallel Circulatory System

The lymphatic system is a sort of parallel circulatory system that circulates a clear, protein-rich fluid called lymph. This network of vessels, valves and “nodes” more of less mirrors the better-known blood circulatory system. And like the circulatory system, the lymphatic system carries fluid away from the extremities and towards the heart. Lymph, or lymphatic fluid, is essentially interstitial fluid. Interstitial fluid is a clear fluid that bathes the spaces between cells and derives from blood plasma.

It is primarily made up of water, but it also contains sugars, salts, fatty acids, white blood cells, wastes, hormones, and other biologically relevant molecules. In the interstitial spaces, it facilitates nourishment, waste removal, and even communication among cells.

Although some forms of lymphedema can be inherited (primary lymphedema), in most cases, it arises after local lymphatic vessels have been damaged or otherwise compromised (secondary lymphedema). Treatments for cancer are among the most likely causes of lymphedema. Radiation, surgery, and lymph node removal can all compromise lymphatic system function. Infection with a tropical parasite—a condition known as filariasis—is another not-uncommon cause of lymphedema, at least in tropical countries.

Research indicates that from one-third up to about 80% of breast cancer patients will eventually experience some degree of lymphedema, related to damage to the axillary lymph nodes, located in the armpits. The use of radiation, and a history of prior infections in the affected arm, have been identified as two strong predictors that a patient may experience swelling in the upper arm(s) following breast cancer therapy. Unfortunately, this form of lymphedema can occur years after treatment has been completed. Obesity has been identified as another risk factor for the development of postoperative lymphedema

Treatment

Lymphedema is typically treated using compression devices, or graduated compression wear. Garments designed to squeeze the tissues tightly at a distal point (farthest from the heart) and less tightly more proximally (closest to the heart) are usually prescribed to assist the body in eliminating and draining excess lymph buildup in affected tissues.

People with lower leg or ankle lymphedema, for instance, can wear medical-grade compression stockings that hug the skin tightly at the ankle, and become gradually less compressive further up the leg. This helps massage fluid back into lymphatic vessels and encourages the fluid to drain back towards the heart.

References

Berrington JE, Barge D, Fenton AC, Cant AJ, Spickett GP. Lymphocyte subsets in term and significantly preterm UK infants in the first year of life analysed by single platform flow cytometry. Clinical and Experimental Immunology. 2005;140(2):289-292. doi:10.1111/j.1365-2249.2005.02767.x.

Helyer LK1, Varnic M, Le LW, Leong W, McCready D. Obesity is a risk factor for developing postoperative lymphedema in breast cancer patients. Breast J. 2010 Jan-Feb;16(1):48-54. doi: 10.1111/j.1524-4741.2009.00855.x. Epub 2009 Nov 2.

Mehrara BJ, Greene AK. Lymphedema and Obesity: Is There a Link? Plastic and reconstructive surgery. 2014;134(1):154e-160e. doi:10.1097/PRS.0000000000000268.

Rebegea L, Firescu D, Dumitru M, Anghel R. The incidence and risk factors for occurrence of arm lymphedema after treatment of breast cancer. Chirurgia (Bucur). 2015 Jan-Feb;110(1):33-7.