Understanding Lymphedema
Lymphedema is a chronic and debilitating condition that is under-detected and untreated in our country. However, the physical, mental, and emotional toll on patients is very real. Think of the lymphatic system as a highway for fluids in your body. In a normal person, this highway runs smoothly with no traffic congestions. What happens when this highway gets blocked or damaged?
What is Lymphedema?
When this lymphatic highway becomes blocked or damaged, the lymph fluid cannot flow properly. As a result, the fluid accumulates in one area, spreading into the surrounding tissues and causing swelling. This condition is known as lymphedema.
Lymphedema occurs when part of the body, typically an arm or leg, swells due to the buildup of lymph fluid, which normally flows through the lymphatic system.
Clearing things Up.
- Lymph Fluid: This is a clear, watery fluid that travels through your body in the lymphatic system. It carries cells that help fight infections.
- Swelling: In lymphedema, the lymph fluid can’t drain well, and it builds up in a part of the body, causing swelling. This is often in an arm or leg, but it can also be in other body parts such as the face and breast.
- Chronic Condition: Lymphedema is usually a long-term (chronic) condition that doesn’t completely disappear. However, with proper treatment, the swelling can be reduced and managed.
- Not Just About Fluid: Lymphedema isn’t just extra fluid; it can also affect how nutrients are delivered to tissues and how waste is removed. The immune system is often impaired leading to episodes of infection called cellulitis.
Why Does Lymphedema Happen?
There are two main reasons why lymphedema occurs.
Primary Lymphedema:
A patient is born with a lymphatic abnormality known as Primary Lymphedema. This is rare, but your doctor may suspect if there is no cause to attribute your lymphedema to.
Secondary Lymphedema:
A patient develops a blockage in their lymphatic system due to infection, cancer treatment, surgery, or even traumatic accidents. This is known as Secondary Lymphedema. This is by far the most common cause in the world. In developing countries, a type of parasitic infection called Filariasis is most common. In developed countries like Singapore, lymphedema is usually caused by cancer treatment and surgery. Breast cancer-related lymphedema of the arm happens approximately 20% of the time when lymph nodes in the armpit are removed.
Symptoms
- Swelling: The most common sign is swelling in one part of the body, usually in an arm or leg. This swelling might make your jewelry feel tight or your shoes not fit as they used to.
- Feeling of Heaviness: The swollen area might feel heavy or hard to move. It’s like trying to walk in deep water.
- Skin Changes: The skin over the swollen area might feel tight, look shiny, or appear thicker. Sometimes, the skin might even take on a rough texture, almost like an orange peel.
- Aching or Discomfort: The swollen area might feel sore or uncomfortable, especially by the end of the day.
- Repeated Infections: If you notice that you’re getting infections more often in the swollen area, it could be a sign of lymphedema.
Diagonosis
Lymphedema diagnostic scans are:
- Lymphoscintigraphy: This test involves injecting a radioactive substance into the skin. This radioactive substance travels within the lymphatic system and provides a lymphatic map when a special camera takes pictures at regular intervals. The injection may be painful, and the test typically takes 1-3 hours.
- Indocyanine Green (ICG) lymphography: ICG is injected into various parts of the affected limb. A special near-infrared camera detects dye moving through the superficial lymph vessels in real-time. The injections tend to be less painful, and the test typically takes 20-30 minutes. This is regarded as one of the most sensitive ways of detecting lymphedema.
- Magnetic Resonance Lymphangiography (MRL): MRL uses magnetic and radio waves to provide a detailed look at the lymphatic system. The advantage is that doctors are able to see the deeper lymphatics. MRL is an expensive test and typically takes about an hour to complete.
ICG lymphography: Normal linear patterns seen in patients without lymphedema
ICG lymphography: the pattern seen is indicative of lymphedema
Find the right specialist
A combination of tests is usually ordered and performed for the first consultation. Subsequently, ICG lymphography is one of the more cost-effective ways to monitor the disease.
Finding a doctor who can perform regular ICG lymphography for monitoring and surveillance is prudent.
Plastic Surgeons are the main specialist trained in lymphedema surgery.