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Although lymphedema has afflicted children and adults for centuries, little understanding about diseases of the lymphatic system has existed until relatively recently. Not until 1934 was primary lymphedema described as a clinical entity, and only in the past 10 to 15 years have therapists and clinicians begun to focus more vigorously on its treatment. According to the World Health Organization, lymphedema affects 250 million people worldwide. Others estimate that 1 in every 25 will suffer from some form of lymphedema during their lifetime. In the industrialized world, as venous disease and cancer rates increase, so too, will the incidence of lymphedema.
LYMPHEDEMA occurs when an interruption in the lymphatic flow results in the accumulation of lymph fluid in the tissue spaces of an extremity (arm or leg). When the lymphatic system is damaged or blocked, edema (swelling) occurs over a period of time and thickens the tissue with fibrosis (hardening of tissues).
Limb heaviness is an important and common symptom that must be acknowledged. Lymph fluid, a thick fluid rich in protein, accumulates within the tissues of the extremity. Even though a great amount of swelling may not be evident, the abundance of fluid that lies within the tissues can be compared to that of a wet sponge. The accumulation of protein rich fluid creates a favorable environment for the growth of bacteria, and ultimately, infection. Recurrent infection (cellulitis, lymphangitis) of the lymphedematous (swollen) extremity can lead to deterioration of the limb over time.
Chronic lymphedema is a permanent, progressive condition. There is no cure for lymphedema, only "palliative" treatment. Palliative means to treat the symptoms as they exist. Lymphedema can be managed. Patients who are educated about their lymphatic deficiencies can lead normal lives.
Causes:
- Cancer surgery/lymph node dissection
- Radiation
- Chronic venous insufficiency
- Congenital abnormalities
- Surgery
- Trauma
Lymphedema is occasionally seen as a result of cancer surgery and/or radiation. It can be acquired from axillary node dissection (seen in breast and melanoma cases) or groin dissection (seen in various types of cancer such as: melanoma, cervical, vulvar and prostate).
Radiation can also destroy lymphatic tissue and result in lymphedema. Lymphedema can occur as soon as 3 months or as late as 30 after surgery and/or radiation therapy.
ACUTE LYMPHEDEMA is a temporary condition in the post-operative phase (after surgery), that lasts less then 3-6 months and exhibits pitting edema to the touch and no skin changes.
CHRONIC LYMPHEDEMA generally lasts longer than 3 months with noticeable changes in the quality of the skin and less pitting edema than acute lymphedema.
Lymphedema most often begins with swelling of the hands or feet. If you notice persistent swelling in an extremity, it is very important that you seek medical advice, as early diagnosis and treatment improves both the prognosis and condition. All patients who undergo lymph node dissection or radiation of the lymph nodes are at risk of developing lymphedema. Regeneration of the lymphatics does NOT occur and the RISK is LIFELONG. |
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