What is Lymphoedema

What Is Lymphedema?

It is a clinical manifestation occurred as a result of the accumulation of a fluid being rich in protein due to the impairment in the lymphatic circulation system. Swelling, pressure feeling, feeling of firmness and tendency to infections signs reveal in the affected region. It influences unfavorably the quality of life of the patient. In the upcoming periods, it causes cosmetic deformities, limitations in the functions of arms and legs. Although it is rare, the development of malignant change in soft tissues in these areas may be in question.          

Which type of signs does the lymphedema demonstrate?

The diagnosis is difficult in the early stages of the disease. In this period, swelling, feeling of distension and feeling of pressure are observed in the affected area. Many patients does not regard at the beginning or he or she does not get a satisfactory result in terms of the diagnosis of the disease from the clinics that he or she admitted. Provided that no preventive precautions are taken by establishing the lymphedema diagnosis, the signs demonstrate increases more with time and they become to an irreversible situation. In this case, manifestations such as thickening of skin, hardening and lymph leakage in arms and legs and swelling in advanced degree in that will make difficult the motion     

 

How Is the Lymphedema diagnosed?

Swelling and increase in diameter in the area that is affected in the early stage are the most noticeable manifestations. The tightening of the used jewelry, the accessories, of cloth and that of the shoes may occur. Difference of diameter and the change in the viscosity of tissue are detected in the arm and in the leg when compared with the other side. Manifestations demonstrate an increase following the excessive exercise and the fatigue. The signs which appear in the evening at the beginning are observed in persistent character during the day. In the diagnosis and in the differential diagnosis of lymphedema, blood analyses, the assessment of the veins (venous Doppler Ultrasonography), lymphoscintigraphy and lymphatic Magnetic Resonance Imaging are beneficial.           

What are the types of lymphedema?

Lymphedema is classified into two main groups such as its cause such as primary and secondary.

What is Primary Lymphedema?

It is a type of lymphedema which emerges as a result of the impairment of the lymphatic structure without the presence of any significant cause. It occurs after that the lymphatic system in the arm region and in the leg region does not work sufficiently. Although its cause is not known, it can emerge after the birth (congenital lymphedema), in the adolescence period or in the adult period (tarda). It is seen more commonly in females. It is usually observed in the legs.      

What is Secondary Lymphedema?

It is the lymphedema type which is revealed as a result of the damage of the lymphatic vessels or lymphatic nodes due to the surgery, radiation treatment, infection or trauma. The lymphedema which is occurred due to these causes can either emerge in the early period or it can happen in weeks, in months or in years.  

Why is lymphedema developed in patients experienced cancer surgery?

The patients in which the lymphatic system is removed due to cancer constitute an important lymphedema group. Particularly in patients with breast cancer, melanoma, gynecologic cancer, prostate cancer, urinary bladder cancer, testicular cancer, colon cancer, lymphedema can be developed following the removal of the axillary and inguinal lymphatic nodes in which lymphatic ducts are collected. The application of radiotherapy after these types of surgical procedures increases considerably the risk of lymphedema development.     

What are the stages of lymphedema?

Lymphedema is classified in four stages; Stage 1: Swelling is in minimal level or it leaves no trace when it is pressed by the finger. The person has a feeling of weight due to the accumulation of fluid and fibrotic changes. Stage 2: There is a noticeable significant edema. The edema is reversible, it regresses with the application of pressure or when the limb is hold in higher level. Therefore, the patient sees that his or her swollen arm or leg returned to its normal situation when he or she wakes in the morning. A trough takes place when the skin is pressed by finger. Stage 3: The edema does not regresses spontaneously. There is a swelling in moderate degree. The tissue is hard and it was thickened. Stage 4: The skin is affected until the deeper layers and it is hard. Permanent structural changes and impairments are seen. This stage is called elephantiasis (lymphostatic elephantiasis). Chaps and wounds occur in the skin and the risk of infection reveals by the entrance of the bacteria through the chaps. Lymphatic fluid leaks outwards from the wounds.       .  

When Does the Necessity of Emergency Treatment Occur?

Provided that there are rash, sensitivity, and increase in heat and if the body temperature rises over 38 degrees Celsius in the affected arm or leg, it is necessary to refer a physician as soon as possible. These findings are frequently the signs of infection (lymphangitis, cellulitis). If it is not treated conveniently, it leads to worsen the lymphedema and to general poverty. This manifestation should be improved by means of medical treatment without losing time.    

What Is the Therapeutical Approach in Lymphedema?

Lymphedema is accepted as a chronic disease. Since there are few experienced healthcare professionals specialized in the field of lymphology, the patients cannot know who they could refer in terms of support and treatment. The most important issue to keep in mind is that provided that the lymphedema is not kept under the control, it is a chronic disease demonstrating change in progressive characteristic. There is no medical treatment which has an efficacy for lymphedema. Nowadays, it is aimed to regress the lymphedema and to take it under control non-surgical (physiotherapy) and surgical treatment. Complementary results for each other which increase the efficacy are obtained by the application of these two methods together. Scientific data reveal that long-term and efficient treatment is ensured in the patients in which both methods are applied together.    

What is the Surgical Treatment Approach in Lymphedema?

Nowadays, the promising surgical procedure is the lymphatic microsurgery. The lymphatic vessels which have very thin diameter are repaired by means of supermicrosurgery under the microscopy. The primary purpose of the applied procedures is intended to improve the impairment mechanisms. It is aimed to orient directly the accumulated lymphatic fluid as a result of the lymphatic obstruction or insufficient transport to other collecting systems. By orienting the lymphatic vessels to veins, the accumulated fluid is moved away from this environment by this way. In a manner of speaking, these procedures may be resembled to get away from a situation in which there is a traffic congestion in the main road by turning toward an alternative way. These procedures are labeled as ‘physiological procedures’.      

In which period the surgery should be performed? Should be expected as the final option?

The success that will be obtained from the surgery procedure which will be performed in the early period is higher too much compared to the procedure done in the late period. After the lymphatic microsurgery, lymphatic vessels which are structurally intact continue to function effectively. In long-term lymphedemas, frequent infection attacks cause impairments in the lymphatic vessels and in the subcutaneous tissues. So this influences unfavorably the success of the surgery to be applied. 

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