Understanding Lymphedema: Causes, Symptoms, and Treatment
In daily life, it is not uncommon to experience swelling in the face or legs. However, it is important not to dismiss these symptoms, as the causes of swelling can vary greatly. If there are accompanying symptoms such as severe pain in the swollen area or non-responsive symptoms upon exerting pressure, it may be indicative of lymphedema.
What is Lymphedema?
Lymphedema primarily affects the arms and legs. It occurs when there is an imbalance in the distribution of intracellular and extracellular fluids in the body, causing a concentration of fluids and subsequent swelling in a specific area. Lymphedema specifically occurs when the lymphatic system, responsible for fluid movement, fails to function properly. While it most commonly affects the arms and legs, it can manifest anywhere in the body.
Our blood vessels supply oxygen, moisture, and nutrients to all tissues, with approximately 10% of the blood flowing into the lymphatic vessels as proteins, bacteria, and waste products. This fluid, known as lymph, is cleansed in lymph nodes located in various parts of the body. However, if this process is hindered, lymph fluid cannot escape and builds up in the lymph nodes, leading to swelling in the affected area.
Statistics from the National Health Insurance Corporation reveal a gradual increase in the number of lymphedema patients in Korea. The number rose from approximately 18,000 in 2016 to around 28,000 in 2020, indicating an average annual increase of 10%. This rise is particularly significant among individuals who have undergone cancer surgery, especially breast and gynecological cancer patients.
Lymphedema is divided into primary and secondary forms. Primary lymphedema occurs due to congenital causes, such as the FLT4 gene mutation seen in Milroy’s disease. These primary forms can be classified based on the time of occurrence, namely congenital lymphedema (present at birth or within the first year), premature lymphedema (occurring between the ages of 1 and 35), and delayed lymphedema (appearing after the age of 35).
Secondary lymphedema, which accounts for over 90% of cases, is caused by damage to the lymphatic system due to surgery, tumors, radiation treatment, or trauma. It is commonly associated with the presence of cancer. Patients who have undergone lymph node removal surgery, experienced lymph node damage due to radiation therapy, or have blocked lymphatic vessels due to tumors are at a higher risk of developing secondary lymphedema. Other factors such as obesity, chronic diseases, extensive soft tissue damage, venous disease, and limited exercise can also contribute.
If left untreated, lymphedema can result in fibrosis, or tissue thickening, and ongoing treatment and maintenance are crucial. Early-stage lymphedema may go unnoticed, but over time, the swelling becomes more apparent. Initially, there may be mild symptoms, such as a sensation of slow reduction in swelling or a pricking sensation due to nerve stimulation. As the condition progresses, the affected area may not heal well, feel heavy, and exhibit signs of bacterial infection, such as fever and skin rashes.
The treatment of lymphedema occurs in stages. Stage 1 lymphedema is characterized by easily reducible swelling that improves with elevation. In this stage, conservative treatments are typically administered for a minimum of 3 to 6 months. If there is no improvement, surgical intervention may be considered. However, it is important to note that lymphedema cannot be cured completely, and ongoing management, including lymphatic massage, compression therapy, and exercise, is necessary even after surgical intervention.
Dr. Ban Dong-gyu, a thoracic surgery specialist at Vennon Hospital, emphasizes the importance of exercise in treating lymphedema. By strengthening the muscles, blood flow can be facilitated, aiding in the transport of lymphatic fluid. Additionally, he recommends elevating the legs above the heart and regularly wearing compression stockings to alleviate symptoms.
Disclaimer: This article was written by Haidak Thoracic Surgery Consulting Doctor Ban Dong-gyu (Poison Clinic) and is protected by copyright laws. Unauthorized reproduction or redistribution is strictly prohibited.
In everyday life, swelling of the face or legs is common. However, the causes of swelling are very varied and should never be taken lightly. If there are symptoms such as severe pain in the swollen area or symptoms that do not come out when pressed, lymphedema should be suspected.
Lymphedema｜Source: Getty Image Bank
It occurs mainly in the arms and legs … Lymphedema patients increase by an average of 10% per year
Water, which makes up 70% of our body, is present in cells, 2/3 of which consists of blood plasma, and 1/3 between cells. Edema refers to swelling of the affected area as the evenly distributed intracellular and extracellular fluids lose their balance for some reason and are concentrated in one place. In particular, lymphedema occurs when the lymphatic system does not work properly and the lymph fluid cannot move normally. It occurs mainly on the arms and legs, but can appear anywhere on the body.
Blood from the heart supplies oxygen, moisture and nutrients to all tissues through the blood vessels. The supplied blood is reabsorbed through the veins and transported back to the heart. At this stage, approximately 10% of the blood flows into the lymphatic vessels as proteins, bacteria and waste products. This is the lymph fluid. Lymph fluid moves through the lymphatic vessels and is made clean in the lymph nodes located in the armpits, groin, breast and neck areas of the body. However, if this process does not go smoothly for some reason, the lymph fluid cannot escape and collects in the lymph node, causing swelling in the affected area.
According to the statistics of the National Health Insurance Corporation, the number of lymphedema patients in Korea is gradually increasing. Around 10,000 increased from around 18,000 in 2016 to around 28,000 in 2020. This means that the number of patients increases by around 10% per year on average. In particular, in Korea, the number of patients suffering from secondary lymphedema after undergoing cancer surgery, especially breast cancer and gynecological cancer, has increased.
Increased risk of developing lymphedema after cancer surgery It is also common in patients with obesity and chronic diseases.
Lymphedema is divided into primary and secondary depending on the cause. Primary lymphoma occurs when the lymphatic system does not function normally due to congenital causes. Milroy’s disease caused by FLT4 gene mutation is representative. ‘Primary lymphoedema’ which occurs without a specific cause is △congenital lymphoedemawhich occurs at birth or less than 1 year depending on the time of occurrence △premature lymphedema which occurs between the ages of 1 and 35 and △lymphedema delayed lymphedema that occurs after. 35 years old Classify.
‘Secondary lymphedema’ accounts for more than 90% of patients with lymphedema and is caused by damage to the lymphatic system due to surgery, tumor, radiation treatment, or trauma. It often occurs after cancer has started. Representative cases are when lymph nodes are removed by cancer surgery or when the lymphatic system is damaged during radiation therapy, or when cancer has metastasized due to cancer progression or recurrence. Rarely, it is caused by trauma or a parasitic infection. The high risk group for secondary lymphedema is △ patients who have had lymph node removal surgery along with surgery for cancer such as breast cancer, skin cancer, cervical cancer, or prostate cancer △ patients with lymph node damage due to therapy radiation △ patients whose lymphatic vessels are blocked due to the tumor itself. . In addition, patients with limited exercise for a long time for various reasons such as obesity and chronic diseases, patients with extensive soft tissue damage after burns or trauma, and patients with venous disease are also very likely to develop it.
If left untreated, fibrosis develops … Ongoing treatment and maintenance is important.
In the early stages of lymphedema, the swelling is hard to see with the naked eye, but it gets worse. At first, there are no major symptoms, and the swelling feels like it is not going down well. Over time, some patients feel a sensation of being pricked by a needle as the peripheral nerves in the area of edema are stimulated. When lymphedema develops over time, the skin does not heal well when pressed on the legs or arms, and the arms and legs feel strangely heavy.
The body fluid in the area where the edema has occurred is rich in protein, so it becomes a good environment for bacteria to grow. If lymphedema is not treated, a bacterial infection can cause fever and skin rashes. In addition, bacterial infection causes redness and swelling of the limbs, fever, cellulitis, and poor oxygen supply due to swelling, which makes the wound difficult to heal. Recurrent eczematous dermatitis and peeling of the skin also occur, and eventually fibrosis, which stiffens the tissue, progresses, so that the swelling does not go away and can harden as it is.
Lymphedema can be treated in stages 1 to 3. If the edema improves by elevating the site of the edema above the heart, or if only body fluid builds up and the skin is soft and there is pitting edema that does not improve when the skin is pressed with a finger, it is judged as stage 1 lymphedema. If the tissue is weakened and fibrotic, and edema and pitting edema are not easily cured, it is judged as stage 2, and if fibrosis intensifies, as the skin becomes thicker and harder through chronic inflammation, or if subcutaneous fat tissue accumulates and deforms. , it is judged as stage 3.
In the first stage, progress can be stopped and improvement can only be expected through elevation, which raises the edematous area high. Although there are differences depending on the degree of progression, in general, conservative treatment is performed for at least 3 to 6 months after diagnosis of lymphedema, and if there is no improvement after that, surgery can be decided. Of course, since lymphedema is difficult to cure 100%, it is necessary to reduce swelling through constant management such as lymphatic massage, compression therapy, and exercise therapy even after surgery.
Haidak Thoracic Surgery Consulting Doctor Ban Dong-gyu (Poison Clinic) said, “To cure lymphedema, it is crucial to strengthen muscle strength through exercise. This is because this vein is compressed and the pressure produced at the time gives the blood a driving force to go up to the heart. Therefore, it is necessary to strengthen muscle strength through regular exercise,” he said, “When sleeping, raise the legs higher than the heart and stretch. It is also useful to wear compression stockings on regularly.”
Support = Haidaq Counseling Doctor, Director Ban Dong-gyu (Thoracic Surgery Specialist of Vennon Hospital)
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