Lymphedema

Key points

Lymphedema is a lymph stagnation in various parts of the body, an expression of impaired lymphatic system.

Lymphedema: causes

Primary lymphedema is caused by congenital anomalies affecting the lymphatic system.

Secondary lymphedema can follow pathologies (adenopathies, diabetes, lymphangitis, bacterial cellulitis, erysipelas, lymphatic filariasis) or derive from surgical removal of lymph nodes (performed, for example, to remove tumor masses).

The most common symptom of lymphedema is swelling of an arm or leg. Other symptoms include alteration of skin color, difficulty moving the affected limb, skin susceptible to infection, itching and skin tension.

Lymphedema: therapy

There is no completely conclusive therapy. Complex decongestive therapy is recommended to improve the symptoms of lymphedema (Lymphatic drainage, Bandage, Pressotherapy, Elastic Tutors). Surgery is reserved for extremely serious cases.

Definition of lymphedema

Synonymous with lymphatic obstruction, lymphedema represents an abnormal and exaggerated accumulation of lymphatic fluid in the various districts of the body. More simply, lymphedema is defined as any stagnation of fluid in the tissues, expression of a blockage or impairment of the lymphatic system.

Lymphatic obstruction is a typical condition of the lower or upper limbs.

• As we know, the lymphatic circulation is a very important natural defense system of the organism against infections, therefore essential to remove toxic substances and liquids that filter from the blood capillaries. The lymph, flowing along the lymphatic vessels, is conveyed into the lymph nodes, which are specific filtering centers used for purifying it.

When the normal lymphatic flow is obstructed, the liquid accumulates, giving rise to the typical swelling that characterizes the lymphedema. Lymphatic obstruction is a debilitating chronic condition, which is constantly growing in the Italian population.

Unfortunately, there is no specific and totally decisive cure for lymphedema: however, lymphedema can be managed through specific exercises aimed at controlling swelling, including manual lymphatic drainage.

Causes

We analyzed that lymphedema occurs when the lymphatic vessels are unable to adequately drain the lymph. But what are the triggers? Why does this anomalous accumulation of interstitial fluid occur? Under what circumstances?

Depending on the cause triggered, lymphedema is classified in primary and secondary.

Primary lymphedema

The triggering cause of the primary lindefema lies in congenital anomalies affecting the lymphatic system. This variant of lymphedema occurs more frequently in women. Several variants are distinguished, based on the age at which the symptoms of lymphedema manifest themselves:

1. Primary congenital lymphedema: represents 10-25% of all forms of primary lymphedema. It is a particular form of lymphatic occlusion clearly evident from birth. Congenital lymphedema is a typical condition of the female sex, and tends to involve almost exclusively the legs. It is estimated that 2% of congenital forms are caused by Milroy's inherited disease.
2. Early primary lymphedema: it is the most common form of primary lymphedema (65-80%). By definition, early lymphedema becomes clinically evident after birth, but before the age of 35: generally, the affected patient manifests the first symptoms during puberty. Again, women are more affected than males.
3. Late primary lymphedema (or Meige's disease): an affected person shows the first symptoms after 35 years of age. The late form represents 10% of the primary lindefemi.

Secondary lymphedema

As the term itself anticipates, this variant of lymphedema is secondary to various diseases; therefore it represents an acquired dysfunction of the lymphatic vessels, originally healthy and perfectly functioning.

Secondary lymphedema affects both sexes without distinction.

Globally, the most frequent cause of the secondary lymphocyte is lymphatic filariasis, an infection affecting lymph nodes and lymphatic vessels, caused by the Wuchereria bancrofti parasite.

Secondary lymphedema can also be caused by other diseases:

• Adenopathies (or lymphadenopathy)
• Diabetes
• Surgery / radiotherapy for the treatment of throat cancer → neck and head lymphedema
• Surgery for the treatment of colon cancer, ovarian cancer or tumors of the uterus (also associated with radiotherapy) → lymphedema of the lower limbs
• Axillary lymph node removal after surgery to treat breast cancer → arm-level lymphedema
• Removal of lymph nodes for diagnostic purposes (biopsy)
• Removal or damage to lymph nodes after surgery to treat prostate cancer or testicles → lymphedema of the lower limbs
• Lymphangitis, bacterial cellulite, erysipelas
• Morbid obesity: lymphedema occurs due to a literal "crushing" of the lymphatic vessels and lymph nodes
• Long-term therapy with tamoxifen (the drug - used to treat breast cancer - can cause blood clots and predispose the patient to deep vein thrombosis) → lymphedema in the lower limbs
• Severe burns

From what has been said, it is easily understandable how the efficiency of the lymphatic system is indispensable to protect the organism from infections: in the presence of lymphedema, the defense function is weakened, therefore the patient is more exposed and susceptible to infections.

In the next article we will analyze the characteristic symptoms of lymphedema and the currently available therapies.

Lymphedema: Symptoms and Therapies "