Podcast: Understanding lymphedema
Lymphedema is a collection of fluid, usually in the arm or leg, which often develops due to surgery, radiation, infection or trauma. The protein in the fluid acts as a magnet for more swelling and serves as a food source for infections, making it difficult to treat.
Normally, the amount of lymphatic fluid going into the arm or leg is equal to the fluid that is going out. With lymphedema, the amount of fluid going in is greater than the amount that can go out because of the damage to the “transport system.”
Lymphedema occurs most commonly in women who have had breast surgery with removal of lymph nodes, followed by radiation therapy. It can appear weeks, months or even years after the initial surgery. It also may occur following injury or infection. In each case, normal drainage of the lymphatic fluid is interrupted.
Although there are cases when lymphedema has spontaneously resolved and never recurred, for most patients it is a chronic problem requiring an ongoing effort to control.
A treatment plan is based on evaluation by the therapist. It may include one or more of the following elements:
- Skin care: To avoid injury and infection, good hygiene and proper moisturization is very important.
- Massage: Two basic types of massage are used to treat lymphedema.
- Manual lymph draining is a precise and gentle form of massage that helps mobilize the fluid and direct it to other pathways.
- Soft tissue mobilization is a type of massage used to release scar tissue and other tightness that might be contributing to the swelling. Sometimes massage is taught to patients or family members to carry out at home.
- Exercise: You may be instructed in stretching exercises to loosen up the tissues in the region or specialized exercises to help move the fluid out. You will be given written instructions for these exercises.
- Bandaging: This is a precise technique which uses cotton low-stretch bandages to apply constant pressure on the limb. Bandaging is usually done in combination with other methods.
- Compression Garments: These are elastic fabric garments similar to a girdle or support stocking that apply pressure to the arm or leg to help move fluid out and keep new fluid from collecting.
- Medicine: Sometimes antibiotics or other medications are prescribed as part of your lymphedema treatment plan.
Lymphedema often can be managed with therapy and self-care. However, for many patients, surgery may help reduce the severity and symptoms of lymphedema. Surgical procedures bypass the lymphatic system to drain excess fluid and relieve swelling.
At MD Anderson, surgeons perform a lymphaticovenular bypass, a variation of lymphovenous bypass. Two to five small incisions measuring an inch or less are made in the arm or leg using tiny microsurgical tools. The surgeons redirect the lymphatic fluid to small veins (venules) to allow for drainage, thus alleviating lymphedema. The procedure takes about 2-4 hours under general anesthesia. The hospital stay is less than 24 hours.
Most patients suffering from lymphedema of the arm or leg are candidates for bypass surgery. However, those who have had the condition for a shorter time tend to have better results. Results will vary from patient to patient. Some will see a significant improvement in their lymphedema symptoms, while others may experience no improvement at all. A complete cure from lymphedema should not be expected.
While the surgery may result in significant improvement of the lymphedema, continued therapy such as wearing of the compression garment, massage, skin care and exercise is recommended to obtain the best result. Lymphedema therapy should be resumed four weeks after the surgery.
When Paula Bell was diagnosed with stage III breast cancer in her left breast in 2007, she had chemotherapy prior to undergoing a mastectomy, and then radiation and drug treatment. But eventually, Paula’s arm began to swell due to lymphedema, localized fluid retention and tissue swelling that can result from treating breast cancer, as well as melanoma, sarcoma and pelvic cancer.
Her surgeon recommended she see Edward Chang, M.D...