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Lymphedema

Lymphatic system is a major part of the circulatory and immune system that transports lymph fluid from tissues to the blood stream. Lymph fluid contains white blood cells that protect the body against infections and help the body detoxify. When lymph fluid is not drained properly and starts to build and cause swelling, it is called Lymphedema. Any part of the body can be affected by Lymphedema, but it usually occurs in the arms, legs and very rarely it can occur on the neck, head, groin and genital areas.


Primary Lymphedema is congenital and is caused by the defective lymphatic system present during the birth. Sometimes primary Lymphedema, though present during the birth, may surface only after puberty.

Secondary Lymphedema is an acquired lymphedema due to infection, trauma, injury or cancer that has disturbed the lymphatic system. Apart from such conditions, radiation therapy and surgery involving lymph nodes also results in malfunction of lymphatic system giving rise to Lymphedema. Women who are treated for breast cancer are at high risk for Lymphedema. Breast cancer surgery normally involves removal of one or two lymph nodes and thus disturbs the pathway of the lymphatic system. Hence breast cancer patients should be watchful of any swelling under arms or around the breast region after the surgery.


Symptoms of Lymphedema

1. Pain and heaviness in the arms, legs, chest and breast.
2. Swelling in the arms and legs including fingers and toes.
3. Hardening and redness on the skin of the affected limbs.
4. Tingling sensation or pins and needles feeling in the arms and legs.
5. Sore feeling in elbow.
6. Trouble in wearing jackets, watches, bracelets and rings.
7. Difficulty in moving the limbs.
8. Discolored skin associated with rash.
9. Skin indentation after pressing the affected region.
10. Fever

Diagnosing Lymphedema

Doctor evaluates the patient through clinical examination and also checks family and medical history of the patient. He will also look for risk factors such as history of a cancer or a surgery. Doctor may also look for pitting by gently applying the pressure on the swelling. If skin indentation occurs, it needs to be examined further. Certain imaging tests like CT scan, MRI, Lymphoscintigraphy and ultrasonography may be carried on to confirm Lymphedema.


Lymphedema treatment

Treatment for Lymphedema depends upon the extent of progression and severity of the disease. However, the following methods are broadly followed to treat Lymphedema:

Manual lymph drainage: Manual lymph drainage is a massage technique that allows the flow of lymph from affected limb. This technique helps to heal the diseased portion, restore the health of the skin and also treat the infection.

Wrapping/Bandaging: Wrapping the arm or leg with layered bandage is the most effective way of treating Lymphedema. Lymph vessels lie below the skin and take the help of the muscles to drain the lymph. The bandage wrapped around the limb provides good support to the muscles and thus fluid is pumped out easily. Bandages should be wrapped tightly around the fingers and toes and loosened as you go up the arm.

Compression garments: Compression garments are specially designed garments and they work much the way as wraps do. These garments reduce the swelling and also prevent it from recurring. They help the muscles in pushing the lymph into lymph vessels by providing firm support. Compression garments should be picked up under professional guidance with utmost care as the proper fit is essential in treating the Lymphedema. Once purchased, they should be worn regularly and all day long for speedy results.

Exercise: Certain decongestive exercises increase the lymph flow and allow it to flow back into the blood stream. Exercise sets in the movement in muscles and thereby helps in draining the lymph fluid easily. The rate of lymph flow is 15 times higher during exercise when compared to the resting period. Thus, swelling eases faster with specified exercise regimen. Always take the help of the Lymphedema therapist before starting the exercises as not all types of exercises are suitable for Lymphedema patients.

Pneumatic compression: This is a new compression device that works towards reducing swelling rapidly. It is a plastic garment with electrical pumping unit which inflates with pumped air and thus applies pressure on the muscles. These muscles in turn work on the lymphatic flow and thus reduce the swelling.

Drugs: If the affected area is infected, doctor may prescribe antibiotics to control the infection. Painkillers are also administered to relieve the patient from pain.

Hodgkin's Disease

Hodgkin's Disease refers to a condition that was first described by British physician Thomas Hodgkin. Hodgkin's disease or Hodgkin's lymphoma is a malignant growth of lymph cells. This uncommon form of cancer of the lymph system is characterized by abnormal growth of cells in the lymph system thereby spreading beyond it. It progressively compromises the body's immune system. While Hodgkin's disease can occur to a person at any time of his life, it is noticed in early adulthood or late adulthood. Usually, Hodgkin's disease begins in the lymph nodes and may spread to other parts of the body. The difference between Hodgkin's disease and non-Hodgkin's lymphoma is that tumors in Hodgkin's syndrome contain large cells called Reed-Sternberg cells.


Patients suffering from Hodgkin's disease notice painless swelling in the lymph nodes of the neck, armpit or groin. There may be fever and fatigue. The patient loses weight and feels drained of energy. Unexplained itching and lower back pain may also be noticed.


Most often diagnosis of Hodgkin's lymphomas is made during physical check-ups. A biopsy is done to test for the presence of Reed-Sternberg cells that are characteristic to Hodgkin's lymphomas. Blood test will reveal abnormal blood cell count and ESR. Bone marrow aspiration is done to aid diagnosis and treatment. Cellular activity can be traced with Positron Emission Tomography (PET) scan. Treatment for Hodgkin's disease depends on the stage that the disease is in. This determines the extent and region of lymph nodes that have been affected.


Radiation therapy is resorted to when a limited area is affected by Hodgkin's disease. Here high-energy rays are used to kill cancer cells and stop their proliferation. Often it is used in combination with chemotherapy. Chemotherapy may involve a combination of drugs that work together.


Cervical Lymphadenitis

Cervical Lymphadenitis is inflammation in the lymph glands of the neck. This lymph gland enlargement is usually secondary to any viral or bacterial infections. This condition is often noticed with tonsillitis, pharyngitis or even dental infection. Cervical Lymphadenitis is commonly seen in children suffering from upper respiratory infection. Infections such as diphtheria, tuberculosis or wounds caused by cat-scratch disease or impetigo can bring on Cervical Lymphadenitis.


Symptoms of Cervical Lymphadenitis include pain and tenderness in the lymph glands of the neck. There might be cough, sore throat and fever. Often patients suffering from Cervical Lymphadenitis experience irritability and earache. In some cases, scalp infections or impetigo or dermatitis is noticed. Chest x-rays and skin tests are used to diagnose the cause for the swollen lymph nodes. The infected nodes are sometimes aspirated for further analysis. Biopsy might be done in some cases.


In most cases, Cervical Lymphadenitis does not need any treatment. Once the cause for the swollen lymph glands is identified, appropriate treatment is prescribed. Penicillin or dicloxacillin is often used.

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Bibliography / Reference

Collection of Pages - Last revised Date: November 22, 2019