Lymphedema: Background and Symptomatology

 

The lymphatic system is part of the human circulatory system along with the arterial, venous and nervous systems and consists of the lymphatic ducts, lymph nodes, bone marrow, spleen, thymus and tonsils, etc. The lymphatic system transports lymph, which is interstitial fluid that exists between cells and consists of water, solutes, and plasma protein. It is absorbed through lymphatic ducts to prevent edema and circulate through the venules. About 8 liters of lymph is produced daily and 4 liters are excreted through the thymus.

The function of the lymphatic system is to collect excessive extracellular fluids including plasma protein, capillary filtrates, and fats as well as other micro substances and return them to cardiovascular system. This prevents edema and circulates lymphocytes which fight against inflammation in immune response. Lymphedema is a lymphatic obstruction arising from the damage, infection, and removal, etc. of the lymphatic system.

 

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What is lymphedema?

 

Lymphedema is a circulatory disturbance of the lymphatic system where the lymph is not circulated back into the vascular system and abnormally retained in the skin or subcutaneous fat in the form of edema. Lymphedema is often complicated by chronic inflammation of the skin and tissue fibrosis, etc.

Lymphedema refers to abnormal swelling caused by abnormal subcutaneous collection of interstitial fluid and protein that failed to be excreted through lymphatic ducts due to complete or partial loss of the lymphatic duct function following surgery, trauma, infection or congenital deformity of the lymphatic duct. Lymphedema most commonly arises following surgery or radiotherapy of breast and uterine cancer. Patients with history of such conditions and treatment should be closely observed for the risk of lymphedema.

It is estimated that about 120 million people are affected by lymphedema worldwide and the number continues to rise. Lymphedema is known to develop in 2-27% of patients receiving breast cancer surgery and 9-36% of patients receiving radiotherapy. According to the US statistics, about 2.5 million patients with breast cancer developed lymphedema after cancer therapy.

Lymphedema is classified primary lymphedema when inherited and secondary lymphedema when arising from lymphatic vessel damage from surgery or radiotherapy. Primary lymphedema takes up roughly about half of all affected cases and secondary lymphedema takes up the other half over the world.

Lymphedema is not limited to limbs but can also affect the abdomen, neck, head, face and eye areas. Patients newly diagnosed with lymphedema suffers psychological distress and shock.

Therefore, it is very important for patients to be given correct information about the disease and treatment. Doctors should advise patients to disregard ungrounded hearsay regarding the treatment choices.

 

-To be continued-