What is Lymphedema?
The swelling that occurs when there is an accumulation of lymphatic fluid in the tissues is known as lymphedema. Primary lymphedema, which is hereditary and/or caused by gene abnormalities, is less common than secondary lymphedema, most often caused as a result of cancer treatment. During cancer treatment, a patient’s lymphatic system can become compromised, leading to the onset of lymphedema. Lymphedema is a progressive disease that can worsen over time if left untreated resulting in difficulty with movement, pain, increased risk for infections and challenges with daily activities.
Factors that may increase a person’s risk of acquiring lymphedema during or after treatment include:
- type of cancer surgery
- number of lymph nodes dissected
- extent of damage to the lymphatic system during radiation treatment
What does the lymphatic system do?
The lymphatic vessels are the transportation system that moves fluid, proteins, cellular waste and bacteria out of the tissues. The lymphatic system also contains white blood cells that aid in immune function. When a person undergoes cancer treatment, and the lymphatic system becomes damaged, it can no longer perform its job effectively. Fluid may accumulate in the tissues and lead to swelling, resulting in a lymphedema diagnosis.
What symptoms should I monitor?
If lymphedema is caught early and treatment is started quickly, symptoms can be significantly reduced, the disease is less likely to progress, and the risk of complications such as infections and pain are less likely.
Common warning signs:
- A heavy or achy feeling in the region near the cancer-treated area
- Noticeable swelling in the region near the cancer-treated area
To date, there is no cure for lymphedema. However, swelling may be reduced and tissue quality improved, resulting in increased comfort, mobility and quality of life while simultaneously preventing progression of the disease.
How is Lymphedema treated?
The gold standard for lymphedema treatment is called Complete Decongestive Therapy (CDT). CDT is a safe, reliable and non-invasive treatment that is performed by a certified lymphedema therapist.
Complete Decongestive Therapy (CDT) consists of:
- Manual Lymphatic Drainage - a manual technique that re-routes fluid to areas in which the lymphatic system has not been compromised and can be eliminated more effectively
- Compression Bandaging or Compression Garments - techniques that help eliminate fluid and soften fibrotic tissue
- Therapeutic Exercise - activities promoting lymphatic circulation
- Education - information regarding precautions and skin care
Other treatments that can be performed and/or utilized in addition to CDT include Low Level Laser Treatment, compression pumps, kinesiotaping, and Negative Pressure Treatment. These modalities do not take the place of CDT but can be a beneficial addition in many cases.
How will Lymphedema impact my life?
As mentioned previously, if lymphedema is left untreated, it can progress and significantly impact daily life. However, with treatment and a regular home management program, a patient can lead a normal life with few limitations in daily activities, physical mobility, hobbies and overall quality of life.
There are many myths regarding lymphedema.
- A person is no longer at risk for developing lymphedema after 5 years. Although the risk is reduced after 5 years, a person can develop lymphedema at any point after cancer treatment.
- A person with lymphedema, or at risk of developing it, should not exercise or lift weights. Exercise helps promote lymphatic circulation and weight training has been shown to decrease limb volume in patients with lymphedema. Exercise should be performed with gradual progressions and a person should perform strength training prior to lifting heavy items. There is no limit to the amount of weight a person can lift as long as they gradually progress their weight. Exercise should be something that is encouraged for lymphatic, cardiopulmonary, bone and psychological health.
- When a person has lymphedema, limbs are very large. Lymphedema is a progressive disease with stages ranging from 0 to III. The earlier it is detected and treated, the less likely it is to progress. A person can have lymphedema with little observable edema.
Anecdotal lymphedema risk reduction practices are based on the physiology, anatomy and function of the lymphatic system. However, basic research is lacking in regard to lymphedema prevention strategies. The lymphatic system’s anatomy varies significantly from person to person and lymphedema may be caused by many different compounding factors. The current National Lymphedema Network guidelines for risk reduction practices include maintaining a healthy body weight (obesity increases the risk for acquiring lymphedema), exercise and avoiding trauma to the area.
Lymphedema is a health issue deserving greater attention. Improvements in surveillance for earlier detection, earlier initiation of treatment intervention and a greater understanding of this disease - from both our medical and general community - will allow for improved quality of life for those impacted by cancer.
If you are in need of lymphedema treatment, you can find a certified lymphedema therapist in your area by searching the following directories:
Directory of LANA-certified therapists: https://www.clt-lana.org/search/therapists/
National Lymphedema Network therapist directory: http://www.lymphnet.org/find-treatment
Academy of Lymphatic Studies (ACOLS): ACOLS Directory
Dr. Vodder School International: http://vodderschool.com/contacts/therapist
Klose Training: http://klosetraining.com/therapist-directory/
Norton School of Lymphatic Therapy: http://www.nortonschool.com/therapistreferrals_form.html
Dr. Angela Wicker-Ramos PT, DPT, CLT-LANA
**Dr. Angela Wicker-Ramos PT, DPT, CLT-LANA is a certified lymphedema therapist, oncology physical therapist and Director of Rehab at Cancer Rehab and Integrative Medicine in Austin, TX.