“The lymphatic system is fundamentally important to cardiovascular disease, infection and immunity, cancer, and probably obesity—the four major challenges in health care in the 21st century.”
– Drs. Peter Mortimer and Stanley Rockson
Mortimer, PS, Rockson SG. New developments in clinical aspects of lymphatic disease. The Journal of Clinical Investigation, Volume 124, Number 3, March 2014.
IT’S TIME TO START RECOGNIZING LYMPHEDEMA
The lymphatic system, a fundamental part of the cardiovascular system, consists of lymph vessels and lymph organs that protect the body against harmful bacteria and transport fluid from the body tissues back to the cardiovascular system. Lymph vessels are thin walled capillaries which absorb fluids, bacteria and protein, and propel them to lymph nodes, small lymph organs that filter and process the lymph by eliminating waste and bacteria. Lymph vessels and lymph nodes work together with larger lymph structures to maintain a normal healthy fluid balance.
Lymphedema (LE) occurs when there is impairment to the lymphatic system, disrupting normal transport of fluid within the body. When the lymphatic system becomes overwhelmed, damaged, or blocked for an extended period of time, lasting swelling (referred to as chronic edema) occurs. Symptoms related to LE can present anywhere in the body including the head, neck, arms, legs, trunk and genitals. For most, LE has a negative impact on ones quality of life. Performing daily activities of cooking, shopping, cleaning, and yard work can often become difficult, if not impossible, for people that suffer from lymphedema. For people with head and neck LE, critical functions such as swallowing, chewing, and the ability to move the head can be impaired as well. Over time, the accumulation of fluid can result in significant changes in the structure of the tissues causing thickening and hardening of the skin, referred to as fibrosis. Recurrent skin infections such as erysipelas and cellulitis, a more serious skin infection, are common complications of lymphedema.
LE is a permanent condition that can worsen over time if not properly treated; there currently is no cure. When untreated, LE can become painful and debilitating. The symptoms of LE can be managed however, and patients who are educated about effective treatment options can improve their quality of life.
An estimated 5 to 10 million Americans suffer from chronic edema caused by LE. Cancer and its treatment is usually designated as the leading cause in the US, however, chronic venous insufficiency (CVI) may be the most important predictor in the development of LE in the legs. Therefore, if we consider patients with CVI-induced lymphedema (phlebolymphedema), as those who would benefit from lymphedema treatment, the number of patients suffering with this condition increases dramatically.
LE affects more than 5 million Americans. That’s more than Muscular Dystrophy, Multiple Sclerosis, Parkinson’s Disease and AIDS combined.
According to the World Health Organization, lymphedema affects over 250 million people worldwide. Despite this, research evaluating the lymphatic system and the effectiveness of treatment has been scarce. The unfortunate result is that far too many patients are left undiagnosed and untreated and therefore suffer from unnecessary pain and suffering.
Causes of Lymphedema
Primary lymphedema may be caused by malformations of the lymphatic system present at birth (congenital) and can be passed from parent to child (hereditary). Although primary lymphedema has largely been attributed to genetic causes, lymphedema is also classified as primary when no known cause can be identified. Other primary LE diagnoses include:
- Milroy’s Disease (present at birth)
- Lymphedema Praecox (begins in adolescence; appears during puberty, mostly in females)
- May-Thurner syndrome (also known as the iliac vein compression syndrome and usually affects females in the left lower leg)
- Lymphedema Tarda (begins after 35 years of age; occurs in both male and female adults; onset is sudden with no apparent cause and can affect one or both extremities)
Secondary lymphedema is more common. It is the result of an identifiable disruption of the lymphatic system, such as:
- Chronic venous insufficiency
- Cancer treatments (removal of lymph nodes and/or radiation therapy)
- Benign or malignant tumor growth
- Filariasis (parasitic)