Lymphedema refers to a condition when swelling occurs in the subcutaneous tissue, caused by a buildup of protein-rich fluid that’s normally drained through the body’s lymphatic system. It usually affects the limbs, but can also occur in the chest wall, abdomen, neck and genitals, as the lymphatic system extends throughout your body. The lymphatic system is a vital network that not only regulates fluids in your body but bolsters your immune system. It comprises a web of specialized vessels and organs considered to be a part of both the circulatory and immune systems.
The main functions of the lymphatic system are to regulate the balance of fluids in the body, maintain cell moisture, remove waste and assist the immune system. It filters bacteria, viruses, or other microorganisms that can cause disease, from the blood, and then returns the lymph from the tissues back into the bloodstream. It, therefore, complements the bloodstream functions and plays a vital role in overall health and well-being.
When your lymphatic system is fighting an infection, the lymph nodes become swollen as white blood cells attack and kill the bacteria to protect the body. When the lymph nodes swell excessively, this can, however, be symptomatic of a condition known as lymphedema.
Primary and secondary lymphedema
There are two types of the disease, primary and secondary lymphedema. Primary lymphedema is evident at birth or shortly after puberty and has three variants: Milroy’s disease (congenital lymphedema) in infancy, Meige’s disease, from puberty, during pregnancy, or up until age 35, and after age 35, late-onset lymphedema, which only affects the legs.
Secondary lymphedema, on the other hand, is the most common form of the disease, and this is normally the result of some type of trauma to the lymphatic system. It is a debilitating disease that is often triggered by trauma, cancer, surgery for cancer, or radiation treatment, and often arises in breast cancer patients and can affect one in five such patients.
Risk of lymphedema
The risk of lymphedema increases whenever the lymph system is affected, and lymph nodes and vessels are damaged. These include during treatment of prostate, pelvic area cancers, lymphoma, and melanoma. Head and neck cancers often cause lymphedema in the face and neck as these areas are closer to a larger number of lymph nodes and vessels that may be removed or damaged.
Symptoms of lymphedema
Common signs of lymphedema can include symptoms such as unusual swelling in a part of the body, such as in the arm or leg, accompanied by a sensation of the skin feeling tight or taut, maybe with a change in texture or a slightly flushed appearance or warm to the touch, or burning or itchiness. It could also be aching, tingling, numbness, or other sensations of discomfort in an area as well as a noticeable thickening of the skin.
If joints feel tight and inflexible or there is puffiness of the skin or an arm or leg appears to be a slightly different size, it could be early signs of the disease, and, especially after cancer treatment, it is advisable to call your healthcare provider. Early treatment is vital to prevent the swelling from developing.
Non-invasive treatment
Non-invasive treatment today may include the use of compression bandages, light remedial exercise, manual lymphatic massage, compression stockings for lymphedema in the legs, use of a sequential pneumatic pump, a dedicated skin care regimen, and, invasive surgery to remove swollen tissue, or to create new drainage routes. Some patients have resorted to undergoing liposuction, which removes fat from the limb, resulting in less swelling, together with compression treatment. There are also other surgical options to treat established lymphedema, which include lymphatic surgery and lymph node transfer
Lymphedema relating to breast cancer is an incapacitating condition that manifests as acute swelling of the upper arm after cancerous lymph nodes are removed from under the arm during breast cancer surgery.
The World Health Organization reported that 2.3 million women were diagnosed with breast cancer globally in 2020. With this shocking prevalence of breast cancer worldwide, and after findings show that one in five breast cancer patients is at risk of developing lymphedema, the potential increase for lymphedema cases is predictable. While the condition is incurable, treatment, however, can help reduce swelling and pain. Therefore, measures to combat this disfiguring condition are continuously being sought.
Preventive supermicrosurgery
According to Raffi Gurunian, Department Chair, Plastic Surgery, Surgical Subspecialties Institute at Cleveland Clinic Abu Dhabi, a Mubadala Health partner, lymphedema preventive supermicrosurgery can reduce breast cancer-related lymphedema.
He says: “While there are numerous treatments that have had various degrees of efficacy for lymphedema, recently, Cleveland Clinic Abu Dhabi has introduced lymphedema preventive supermicrosurgery to the UAE. We believe this will lay the foundation for greater access to this treatment and a better chance of a positive outcome, especially for post-operative breast cancer patients, who have a higher risk of developing lymphedema. Given the prevalence of breast cancer in the UAE, this is indeed a positive outlook for what is often a disfiguring and embarrassing condition that is not only a threat to health but can cause social isolation and mental and emotional stress.”
The procedure that Dr Raffi describes can be performed at the same time as major breast cancer surgery, such as mastectomy, thereby not only reducing the possible occurrence of lymphedema but avoiding the necessity to undergo two separate operations.
If lymphedema is left untreated
Indeed, if left untreated, lymphedema progresses and in the worst cases, can cause the limb to swell grotesquely, affecting the mobility of the limb, and increasing the likelihood of further infection, including the risks of acute skin infections. Untreated or neglected lymphedema can also lead to sepsis, a potentially terminal infection that swiftly spreads throughout the entire body. Every subsequent infection can further weaken the immune system and increase a patient’s vulnerability to life-threatening illnesses. In addition, chronic and untreated lymphedema can rarely lead to the fatal condition lymphangiosarcoma, a sarcoma of the arm that develops and, if untreated, weakens the immune system, and has a poor survival prognosis.
Comorbidities increase risk
In addition, Dr Raffi cautions: “Obesity and other preexisting comorbidities increase the possibility of developing lymphedema after breast cancer surgery. While bypass surgery may alleviate the condition, people need to also take care of their lifestyle choices to avoid developing further health-related complications.”
As scientific advances, technology and innovation afford inroads into alleviating and curing many diseases, the first line of defense against developing any disease is following a preventive course, and that includes taking a proactive approach to your lifestyle management.
Go for regular screenings and checkups, including cardio, pulmonary and cancer screenings. Also, follow a healthy eating pattern, undertake regular exercise and minimalize stress as these are all conducive to boosting your immune system, specifically after undergoing any form of surgery, where your immune system is compromised.
