Lymphedema

The role of the lymphatic system is to drain excess fluids and waste substances from the tissues. This is carried out by the lymphatic vessels, which contain lymph nodes that act as filters and capture points for toxins. Many immune system processes also take place within the lymph nodes.

Malfunction of the lymphatic system leads to the accumulation of fluids and proteins in the tissues. This results in the development of edema and, in prolonged cases, can also cause inflammation.

Lymphedema can appear in any area near the vessels and lymph nodes, but the most common types are upper limb lymphedema and lower limb lymphedema. The most frequent cause of arm swelling is surgery for breast cancer, during which lymph nodes may be damaged or removed. Up to 42% of women who undergo breast surgery can develop lymphedema.

Causes of Lymphedema

Causes of lymphedema can be congenital (primary) or acquired during life (secondary).

Primary lymphedema is rare and results from a congenital defect in the lymphatic system or other developmental abnormalities. The first signs of lymphedema can appear at birth or manifest later in adulthood.

Secondary lymphedema is caused by an obstruction in the lymphatic vessels or lymph nodes. The most common causes are:

• • Tumors – a growing tumor near lymph nodes or lymphatic vessels can block lymph flow.

  • Oncological radiotherapy – radiation therapy causes scarring and inflammation of lymph nodes or lymphatic vessels.

  • Oncological surgery – surgical removal of a tumor often also involves removal of nearby lymph nodes.

  • Trauma – a severe injury can also affect the lymphatic system.

  • Infectious and inflammatory diseases – these cause a strong overload of the lymphatic system (reactions after insect bites, parasitic or fungal infections).

  • Obesity – an increased volume of subcutaneous fat compresses the lymphatic vessels.

  • Heart, vascular, or kidney diseases – these conditions regulate the distribution of fluids in the body; if impaired, they also worsen lymphatic function.

Diagnosis of Lymphedema

The diagnosis of lymphedema is based on modern imaging techniques such as magnetic resonance imaging (MRI), computed tomography (CT), or ultrasound. For a precise evaluation of the lymphatic system’s function, lymphoscintigraphy is used, during which a contrast agent is injected and the pathway and speed of lymph flow are monitored, highlighting any obstructions.

Lymphedema and Treatment

Treatment of lymphedema is based on complex decongestive therapy (CDT), which includes the following methods:

Manual and Instrumental Lymphatic Drainage
A very gentle massage is performed. The goal is to direct fluid from the edematous areas toward the nearest healthy lymph nodes.

Compression Therapy
Bandages and compression devices are used. Bandages should be short-stretch and applied to the affected areas during the day and night. It is recommended to wear elastic compression stockings or sleeves, which can be custom-made.

Respiratory and Motor Exercises
A set of targeted exercises for the arms and legs is sometimes called anti-edema gymnastics. Exercises are performed with applied compression and alternated with breathing techniques.

Other Measures
These include proper hygiene, drying skin folds and spaces between the fingers or toes, and adequate skin hydration to prevent infections. Proper care of compression devices is also important.