Lymphedema, which occurs after the surgical treatment of cancer or radiotherapy, has been garnering attention as an important issue related to activities of daily living (ADL) and quality of life (QOL) since it develops in the limbs.
What is Lymphedema?
Lymphedema refers to swelling of the arms and legs, which is caused by the stagnation of lymphatic flow due to lymph node dissection (removal of lymph nodes near the treated area) or radiation therapy in cancer treatment.
In this section, we will provide you with basic knowledge about lymphedema, how to treat it, and how to prevent it.
Swelling and Lymphedema
While 90% of body fluid is collected in veins, the 10% percent, called seminal fluid, is absorbed by lymphatic vessels throughout the body.
This is called lymphatic fluid.
As the blood conducts trades with cells via the blood vessels, the lymphatic fluid absorbs relatively large substances that cannot be collected by blood vessels along with water. Bacteria, foreign substances, cancer cells, and other pathogens are also absorbed into the lymphatic system, entering from the lymphatic vessels to lymphatic nodes. In other words, the lymph nodes act as a filter against bacteria and foreign substances, preventing inflammation throughout the body.
The difference between swelling, bloating, and edema is that bloating is usually caused by the retention of water in the body due to decreased circulation and urination. This condition is medically referred to as “edema.” Swelling usually refers to an increase in volume due to the retention of blood components outside the blood vessels.
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Causes of Lymphedema
Although lymphedema may be congenital or sudden with no known cause, most are secondary lymphedema where a clear cause can be attributed to the after-effects of a surgical operation or treatment, with the most common type being secondary lymphedema after cancer surgery.
In gynecological surgeries for cancers such as breast cancer, uterine cancer, and ovarian cancer, a lymph node dissection is sometimes performed to remove lymph nodes nearby while taking into consideration of the cancer’s metastasis.
Since the lymph nodes where many lymphatic vessels cluster are to be removed, the flow of lymph fluid becomes stagnant, resulting in edema. Lymphedema has been reported to occur in 10 to 20% of patients who have had lymph node dissection for breast cancer surgery and 30 to 35% of patients who have had lymph node dissection for gynecological cancer surgery.
The onset of the disease varies greatly from person to person, sometimes immediately after surgery, and sometimes 10 to 20 years later. However, in many cases, it will already in its advanced stage where lateral differences in the upper and lower limbs become apparent, making early detection very important. Due to lymphedema, the internal pressure of the lymph vessels increases, causing them to dilate. If this condition continues, the lymph vessels themselves will then become overloaded and start to degenerate. This deformity will further worsen the lymphedema.
- For more information, click here▶︎Causes, Development, Progression, and Symptoms
Typical test methods to evaluate the functions of lymphatic vessels include lymphoscintigraphy with radioisotopes, SPECT-CT, and indocyanine green (ICG) lymphangiography with contrast media, and MRI lymphangiography. In 2017, we established and presented the world’s first method to diagnose lymphatic vessels using ultrahigh-frequency ultrasound for more effective and efficient surgeries. By realizing treatment without the use of contrast media during surgery, this technology has made it possible to reduce the burden on the body.
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How to Treat Lymphedema
While lymphedema is difficult to cure once developed, daily care can prevent its onset, and surgical treatment can alleviate the symptoms. In any case, early detection is still the key to lymphedema.
As the skin in the area where edema develops is more susceptible to inflammation, skin care is necessary to prevent infection. Some examples of daily care (conservative treatment) include manual lymphatic drainage, compression therapy with special stockings, and exercise therapy.
For cases with worsening lymphedema due to degeneration of lymphatic vessels, conservative treatment can be combined with surgical treatment at an early stage to alleviate symptoms.
Surgical treatment includes lymphovenous anastomosis, in which a less damaged part of a narrowed or blocked lymphatic vessel is anastomosed to a vein to create a bypass pathway from the lymphatic vessel to the vein, thus eliminating lymphatic stagnation. In cases where the majority of the lymph vessels are narrowed or obstructed due to further degeneration, a procedure called lymph node grafting is available, in which lymph nodes and surrounding cellular tissue are harvested from a healthy site and transplanted into the affected area of lymphedema.
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After the above surgeries, effects such as a reduced circumference, reduced cellulitis, an improvement in subjective symptoms (heaviness, numbness, pain, etc.), and the softening of edema should be seen. However, compared to lymphovenous anastomosis, lymph node grafting is a slightly more invasive procedure and may take longer to show results. For both surgical treatments, elastic bandages and elastic wear are required after surgery, but may not be necessary if the treatment is done at an early stage.
Possible post-surgical complications include wound dehiscence, wound infection, lymph leakage, bleeding, and pain.
How to Prevent Lymphedema + Exercise Therapy
For treating lymphedema, it is important to keep the lymphatic system active in daily life. The lymphatic system is found to be able to be activated through breathing, joint movement, and aerobic exercise. Muscle training can increase lymphatic collection through the pumping action of the muscles. It is said to be more effective when done under pressure with elastic wear. While it is you might refrain from exercise after surgery due to pain, neglecting exercise can reduce the range of motion of the joints. Try your best to stretch and do light exercise regularly after rehabilitation or discharge from the hospital
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林明辰 Akitatsu Hayashi