Lymphedema - Symptoms, causes and treatment

Lymphedema or lymphedema is swelling of the legs or arms caused by blockage of the lymphatic vessels (lymphatic obstruction)

Lymph fluid is one part of the lymphatic system or the body's defense system in eradicating infection. In carrying out its function, lymph fluid (lymph fluid) will circulate in the lymph vessels.

When there is damage to the lymph vessels, the flow of lymph fluid will be blocked and cause swelling in certain body parts.

Symptoms of Lymphedema

The main symptom of lymphedema is swelling in the legs and arms. Swelling that occurs can range from mild swelling that is not felt by the sufferer to severe swelling.

Swollen limbs or arms are often painful, heavy, or stiff, making it difficult for the sufferer to move. This blockage and swelling can cause other problems and symptoms, such as:

• Inflammation of the skin and surrounding tissue
• bruise
• cracked skin
• Hardening and thickening of the skin (skin fibrosis)
• Ulcers form on the skin
• Swollen lymph nodes

When to see a doctor

Immediately contact a doctor if swelling appears on the legs or arms even though the size is still small. Immediate treatment needs to be done to prevent the arm or leg from getting bigger.

Cancer sufferers are at risk of developing lymphedema, both due to cancer and as a side effect of cancer treatment. Therefore, cancer sufferers must regularly consult a doctor while undergoing cancer treatment.

Cancer patients need to discuss further with oncologists about the benefits and risks of the treatment that will be given. This is done to anticipate the side effects of treatment, such as lymphedema.

Lymphedema sufferers should also be careful and immediately consult a doctor if symptoms of infection appear. Untreated infection can lead to complications and tissue death. Some of the symptoms of infection to watch out for are:

• Fever
• Skin redness, swelling, and pain
• Skin feels warm to the touch

Causes of Lymphedema

Lymphedema most often occurs in cancer patients. The growth of cancer cells around the vessels or lymph nodes can block the lymph ducts thereby blocking the flow of lymph fluid.

Not only the disease, cancer treatment, such as radiotherapy or surgical removal of the tumor, can also damage the lymph channels. In addition to being associated with cancer, lymphedema also occurs in patients with elephantiasis due to filarial worm infection.

Some genetic diseases that cause abnormalities in the structure of the lymph vessels (lymph vessels) can also cause lymphedema. These abnormalities can cause lymph fluid to become blocked and accumulate. Several genetic diseases can also cause lymphedema, including:

• Meige's disease
• Milroy's disease
• Lymphedema tarda

In addition to the above factors, a person can also be at risk of developing lymphedema if they are obese, have psoriatic arthritis or rheumatoid arthritis, and are elderly.

Lymphedema Diagnosis

To diagnose lymphedema, initially the doctor will ask the patient's symptoms and perform a physical examination. The doctor will also ask the patient's medical history, for example whether the patient has cancer or is undergoing cancer treatment.

If the cause is not clear, the doctor will perform a follow-up examination to get a clearer picture of the lymph vessels. Follow-up examinations are generally carried out by scanning, either by ultrasound, CT scan, MRI, or a nuclear examination called lymphoscintigraphy.

Lymphoscintigraphy is a technique of scanning the lymph channels by previously injecting radioactive liquid.

Lymphedema Treatment

Treatment of lymphedema aims to relieve the symptoms suffered by the patient and reduce the swelling that occurs. Treatment of lymphedema also aims to prevent infection and prevent swelling from getting worse.

Methods of treatment that lymphedema patients can undergo include:

Self-therapy

There are several therapies that are used to treat lymphedema independently at home, namely:

• Position the affected leg or arm higher than the heart when lying down, to relieve pain or symptoms.
• Do light exercise to flex the problem muscles and help break down the accumulated lymph fluid.
• Protect arms or legs from injury, be careful when using sharp objects.
• Maintaining the cleanliness of swollen body parts and not walking barefoot.

Special therapy

Some special therapies that can be done to treat lymphedema include:

• Pneumatic compression, which is a device wrapped around the arms and legs to periodically pump and apply pressure to clear fluids.
• Compression garments, namely special clothing or stockings that press the arm or leg that is problematic so that lymph fluid can come out.
• Manual lymph drainage, which is a manual massage technique used to improve fluid flow. This therapy is carried out by medical personnel.
• Complete d econgestive therapy (CDT), which is a combination of several types of therapy and the application of a he althy lifestyle.

Drugs

If there is an infection in the skin or in other tissues that are affected by lymphedema, the doctor will prescribe antibiotics to relieve symptoms and prevent bacteria from spreading to the blood vessels.

In addition, other medicines, such as retinoids or diethylcarbamazine deworming drugs, can also be given by the doctor according to the cause of the lymphedema.

Operation

In severe cases, surgery may be performed to remove excess fluid or remove tissue. Keep in mind that this measure can only reduce symptoms and not completely restore lymphedema.

Operation is more aimed at removing swollen tissue due to tissue buildup, especially subcutaneous tissue and fatty tissue in problem areas.

If needed, the patient will also undergo skin removal, especially those that are already infected and decayed. The patient will undergo skin graft surgery to replace the skin lost due to surgery.

Lymph ducts that have been damaged and blocked often cannot return to normal. However, with the above treatment, the symptoms will be reduced and the risk of complications will be smaller.

Lymphedema Complications

Lymphedema that is not treated properly can lead to complications, such as:

• Infections, such as cellulitis (infection of the skin) and lymphangitis (infection of the lymph vessels).
• Lymphangiosarcoma, which is a rare soft tissue cancer, but a risk of developing lymphedema.
• Deep vein thrombosis, which is a blood clot in the deep veins, especially in the thighs and calves.

If the infection has spread and caused tissue death, the part of the body that has lymphedema is also at risk for amputation.

Lymphedema Prevention

There are several preventive steps that can be taken by people who are at risk of developing lymphedema, including:

• Moving your legs or arms through light exercise for 4-6 weeks, if you have recently had lymph node removal surgery.
• Maintaining an ideal body weight, to reduce the risk of lymphedema.
• Wear loose clothing, to keep blood and lymph fluid flowing smoothly.

Especially for cancer patients who will undergo radiotherapy or surgery, first ask the oncologist about the steps that can be taken to reduce the risk of lymphedema.