What is Lymphedema?

Lymphedema is an abnormal buildup of fluid, most often in the arms or legs, that develops when lymph vessels or lymph nodes are missing, impaired, damaged or removed. It can also result from a blockage in your lymphatic system, preventing lymph fluid from draining well, causing fluid buildup, leading to swelling.

Causes
The lymphatic system is crucial to keeping the body healthy. It circulates protein-rich lymph fluid throughout the body, collecting bacteria, viruses and other waste products. It then carries this fluid, and other harmful substances, through your lymph vessels, which lead to lymph nodes. The waste is then filtered out by lymphocytes — infection-fighting cells that live in the lymph nodes — and is ultimately flushed from the body. Lymphedema occurs when your lymph vessels are unable to adequately drain lymph fluid, usually from an arm or leg. 

Symptoms
Symptoms of lymphedema include swelling in the arms, hands, fingers, shoulders and legs. The swelling may occur for the first time after a traumatic event (such as bruises, cuts, sunburn and sports injuries), after an infection or in the part of the body that was treated for cancer. If you have any of these symptoms, contact your doctor as they could be signs of lymphedema:

• Swelling of part or all of your arm or leg, including fingers and toes
• A feeling of heaviness or tightness
• Restricted range of motion
• Aching or discomfort
• Recurring infections
• Hardening and thickening of the skin (fibrosis)

Swelling can range from mild, hardly noticeable changes in the size of your arm or leg to extreme changes that make the limb hard to use.

Secondary Lymphedema
Any condition or procedure that damages your lymph nodes or lymph vessels can cause lymphedema. Secondary lymphedema is far more common than primary lymphedema. Causes include:

Surgery: Removal of or injury to lymph nodes and lymph vessels may result in lymphedema.

Radiation treatment for cancer: Radiation can cause scarring and inflammation of your lymph nodes or lymph vessels.

Cancer: If cancer cells block lymphatic vessels, lymphedema may result. For instance, a tumor growing near a lymph node or lymph vessels could enlarge enough to block the flow of the lymph fluid.

Infection: An infection of the lymph nodes or parasites can restrict the flow of lymph fluid. Infection-related lymphedema is most common in tropical and subtropical regions and is more likely to occur in developing countries.

Primary Lymphedema
Primary lymphedema is a rare, inherited condition caused by the absence of certain lymph vessels at birth, or abnormalities in the lymphatic vessels. Causes include: 

Milroy’s disease (congenital lymphedema): This disorder begins in infancy and causes lymph nodes to form abnormally.

Meige’s disease (lymphedema praecox): This disorder often causes lymphedema around puberty or during pregnancy, though it can occur later, until the age of 35.

Late-onset lymphedema (lymphedema tarda): This occurs rarely and usually begins after age 35.

Risk Factors
Factors that may increase the risk of developing lymphedema after cancer, from cancer treatment or from other secondary causes include:

• Older age
• Excess weight or obesity
• Rheumatoid or psoriatic arthritis 

Complications
Lymphedema in your arm or leg can lead to serious complications, such as infections or the development of lymphangiosarcoma — a rare form of soft tissue cancer and can result from the most severe cases of untreated lymphedema. Possible signs of lymphangiosarcoma include blue-red or purple marks on the skin.

When to see a doctor
See your doctor if you notice persistent swelling in your arm or leg. If you already have lymphedema in a limb, see your doctor if there is a sudden dramatic increase in the size of the involved limb, as it may suggest a new process is occurring.

Prevention
To the reduce your risk of lymphedema, try to:

• Protect your arm or leg
• Rest your arm or leg while recovering
• Avoid heat on your arm or leg
• Elevate your arm or leg
• Avoid tight clothing
• Keep your arm or leg clean

There is currently no cure for lymphedema, but it can be easily managed with early diagnosis and diligent care of the affected limb.