Lymphedema

Lymphedema is the chronic swelling or feeling of tightness in the arm or hand due to an accumulation of lymphatic fluid in the soft tissue of the arm. The condition occurs when lymph vessels, which normally carry excess fluid out of the limbs and back into central circulation, have had their flow interrupted. Axillary (underarm) lymph node removal is commonly performed on breast cancer patients to stage or treat their cancer. However, between 15% and 20% of breast cancer patients who undergo axillary lymph node removal develop lymphedema. According to the American Cancer Society, of the two million breast cancer survivors in the U.S., approximately 400,000 must cope with lymphedema on a daily basis.

Lymphedema of Foot and Leg also may occur. It may also be caused by chronic infection, usually involving the legs. Less commonly, lymphedema is primary (i.e., due to the genetic make-up). Children with primary lymphedema may be born with it (congenital lymphedema) or it may become evident in their teens (lymphedema praecox) or in adulthood (lymphedema tarda).

Chronic lymphedema may result in minor swelling and discomfort. Occasionally it leads to a grave disability and disfigurement. Lymphedema may be precipitated, or made worse, by a skin infection. Skin infections can be difficult to treat in someone with pre-existing lymphedema.

Grades of Lymphedema

• Grade 1 - when the skin is pressed the pressure will leave a pit that takes some time to fill back in. This is referred to as pitting edema. Sometimes the swelling can be reduced by elevating the limb for a few hours. There is little or no fibrosis (hardening) at this state, so it is usually reversible.
• Grade 2 - when the swollen area is pressed, it does not pit, and the swelling is not reduced very much by elevation. If left untreated, the tissue in the limb gradually hardens and becomes fibrotic.
• Grade 3 - the lymphedema is often called elephantiasis. It occurs almost exclusively in the legs after progressive, long term, and untreated lymphedema. At this stage there may be gross changes to the skin and it may protrude and bulge. There may be some leakage of fluid through the tissue in the affected area, especially if there is a cut or sore. While lymphedema will respond to treatment at this state, it is rarely reversible.

This was taken from "Grades of Lymphoedema" in Information About Lymphoedema for Patients, 6th ed. (Malvern, Australia: Lymphoedema Association of Australia,1997) Judith R. Casley-Smith M.D.