Lymphedema is not uncommon, affecting at least 3 million Americans. Some patients develop it after surgery or radiation therapy for various cancers (breast, prostate, bladder, uterus, melanoma, lymphoma) in which case it is referred to as secondary lymphedema. Other patients develop it without obvious cause at different stages in life (primary lymphedema), and still others develop it after trauma or deep vein thrombosis.
If a lymph channel becomes blocked, perhaps by a tumor or because of damage caused by radiotherapy or surgery, the lymph fluid is unable to pass along the lymph vessel. Excess tissue fluid builds up and causes swelling, because it is unable to drain away through the lymph vessels as it normally would. The medical term for swelling is edema which gives rise to the name Lymphedema. The degree of swelling will depend on the number of nodes and vessels, which have become obstructed or damaged. Another cause of Lymphedema is the removal of lymphnodes by surgery. Surgery or radiotherapy on their own are less likely to result in Lymphedema than if they are both given together to the same area -- for example, when lymph nodes are removed from the armpit during surgery for breast cancer and the area is then treated with radiotherapy. Only a minority of people who have radiotherapy to the lymph nodes will develop Lymphedema. Among those who do develop it, many will experience only mild swelling.
Lymphedema can develop in the arm after breast cancer treatment to the armpit. If cancer or treatment affects nodes in the groin area, then it can occur in the leg. The affected arm or leg may become swollen, stiff, uncomfortable and awkward to move, making daily activities like dressing difficult. It can develop weeks, months or even years after cancer treatment and it is difficult to predict who will be affected. Although Lymphedema is usually found in an arm or leg, other parts of the body can become swollen. There may be swelling of the trunk (chest or abdomen) or groin and more rarely facial swelling if nearby lymph nodes are affected. It is not possible to replace lymph nodes that have been removed or lymphatic vessels, which have been damaged. Once Lymphedema has developed it cannot be cured permanently. However, it can usually be reduced and controlled.
According to the World Health Organization (UN/WHO), each year approximately 250 million people acquire lymphedema, mainly as a result of mosquito-borne microfilaria parasite infection in the tropics. In industrialized nations, the onset of lymphedema is associated with complications following cancer treatment by means of surgery or radiation therapy. Women are particularly at risk of developing lymphedema in their arms following surgery or radiation therapy for breast cancer, or in their legs following treatment for cervical cancer, uterine cancer, etc. Men are particularly at risk of developing lymphedema in their legs following surgery for prostate cancer, testicular cancer, etc. Both men and women are at risk following treatment of malignant melanomas (skin cancer) with lymph node dissection and/or radiation involving an arm, hand, leg or foot.
About 50-70% of patients who have had axillary node surgery will develop lymphedema (1). Patients who have had axillary surgery plus radiation therapy are at even higher risk. It is estimated that at least 1-2 million breast cancer survivors are alive today after lymphadenectomy and that 400,000 of them cope daily with the disfigurement, discomfort and disability of arm and hand swelling (2). In six different recent reports from three different countries on the incidence of lymphedema in patients who had different breast cancer treatments, Petrek and Lerner noted that the incidence of lymphedema is about 20% (16-26%) (3). They also noted that the incidence remains the same or higher in patients having breast conservation surgery because of the postoperative radiation reaching the axilla. Axillary radiation to a dissected axilla was a strong predictor of lymphedema in all studies that evaluated this issue. The true numbers of patients suffering from any form of lymphedema is unknown. Based on the numbers above and other statistics, we estimate the incidence of lymphedema in the United States as follows:
- Secondary Lymphedema: 2-3 million
- Primary Lymphedema: 1-2 million
The cause of lymphedema is fundamentally unknown, but there are identifiable circumstances associated with the onset of the condition. Primary [inborn] lymphedema can be present at birth (congenital), can occur during adolescence (Milroy's), or can occur after age 35. Secondary [acquired] Lymphedema can triggered in an otherwise lymphedema-free person by surgery/radiation therapy for cancer, a traumatic injury, or an infection. Secondary lymphedema is far more common than primary.
In equatorial regions of the earth, most cases of lymphedema result from infection associated with parasites. In Europe, the U.S.A., and other areas, acquired lymphedema is commonly associated with complications following treatment for cancers. Other causes of secondary lymphedema include trauma, tuberculosis, and iatrogenic injury; subcutaneous injections of drugs (such as pentazocine) may also injure the lymphatics and induce this disorder. Lymphedema may be a temporary condition, or it may be chronic. Chronic lymphedema is seen more commonly in cancer patients.
Lymphedema symptoms usually begin with swelling of the hands or feet. Anyone who notices persistent swelling in an extremity should seek medical advice. If lymphedema is diagnosed and if treatment begins early, the prognosis for improvement of the condition is much greater than if the swelling is ignored and remains untreated.
While Lymphedema is not curable, Lymphedema therapy is instrumental in controlling the condition and easing symptoms. Methods of Lymphedema therapy include manual lymph drainage performed by a trained therapist, exercise, weight loss, proper nutrition and skin care, and compression therapy.
Compression therapy provides the necessary resistance over the affected tissue to return the excess fluid accumulation to normal circulation in the lymphatic system. Compression therapy is usually administered by the use of elastics, such as bandages and pressure garments, and pneumatic compression devices (OUR PUMP).
Our pneumatic compression device consists of an inflatable garment controlled by an electrical pneumatic pump that intermittently inflates and deflates the garment (or sleeve) with compressed air in varying intervals and pressures. Pneumatic compression is an effective form of Lymphedema therapy because it helps pump stagnant fluids back into the lymphatic system.
Lymphedema can be controlled by elevating the limb, regular use of a lymphatic sleeve, and lymphedema treatment with a pneumatic sleeve that massages the limb. Exercise, weight loss, and physical therapy also may help. In cases of infection, antibiotics are administered. In some cases, diuretics are used. Elevating the limb means simply putting one's feet up, or propping one's arm on a pillow, to allow gravity to facilitate drainage of fluid from the limb(s). The elevated limb should be above the level of the heart.
A lymphatic sleeve is an elastic bandage that fits over the swollen area. Used once or twice per day, the pressure of the sleeve forces fluid into the lymph system. A pneumatic sleeve is an air-filled applicance that fits over the swollen area, with an air pump to administer messaging. The sleeve has overlapping air compartments that inflate sequentially to provide a pumping motion along the lymphatic vessels and toward the heart. Pneumatic sleeve and pump systems stimulate the weakened lymphatic system by pushing stagnant fluid through the lymphatics.
This lymphedema treatment can be performed by the patient at home for a few minutes or a few hours each day, according to the therapy program recommended by the physician. In the U.S.A., Medicare pays for the sleeve and pump so that patients can self-administer therapy at home as outpatients.
Chronic lymphedema is a progressive condition that must be treated at the onset. If untreated, lymphedema can lead to:
- Increased limb swelling, reduced range of motion, permanent disfigurement
- Limb heaviness, fungal infections, invasive biological infections
- Recurrent lymphagnitis leading to lymphadenitis, bacteremia
- Lymphatic destruction, thrombosis of lymphatic
- Skin changes, such as hyperkeratosis, fissuring
- Cellulitis, such as erysipelas
- Progressive reduction of lymphatic and vascular circulation
- Chronic ulceration
- Tissue necrosis, gangrene, amputation.
Lymphedema can be treated, managed, and controlled. Although Lymphedema has afflicted the population for centuries, little was understood about the disease. Only in the past ten to fifteen years have clinicians begun to seriously focus on its treatment. Our pump is designed by implementing the latest research and technology and can DRAMATICALLY improve the quality of your Life!