Lymph is light yellow, cloudy fluid from body tissues. Lymph flows in tiny vessels called lymphatic vessels up toward the heart. The body drains about 3 quarts of lymph per day. Lymphatic vessels lead to lymph nodes (glands). In these nodes, lymphocytes (infection-fighting cells) filter wastes, which are taken out of the body. Lymphedema is swelling of the arms, legs, or both. It results from poor lymph drainage caused by blockage, injury, or abnormal development of the lymph vessels. Extreme lymphedema is sometimes called elephantiasis because the swollen leg looks like an elephant’s foot.
Lymphedema can be primary or secondary. The rare primary types are caused by developmental abnormalities. Primary lymphedema occurs in people younger than 20, more females than males.
Secondary lymphedema is caused by another disease, such as infections (streptococcus bacteria, filarial worms). Injury from trauma or radiation therapy can also cause it, as can cancer. The most common cancers causing lymphedema are breast and prostate cancers and lymphoma.
The most common symptom is swelling or edema of the legs. Women who received radiation therapy for breast cancer can have arm swelling. Men whose blockage of lymph vessels is caused by prostate cancer that spread (metastasis) can have swollen legs. Swelling is painless but constant. Sometimes, other parts of the body such as the genitals and face can swell. An affected foot can look like a buffalo hump, and a leg can look like a tree trunk because of ankle swelling. A square foot can result from swollen toes.
The health care provider makes a diagnosis from the medical history, physical examination, and X-ray studies called lymphoscintigraphy. The health care provider may also want blood tests and computed tomography (CT) to rule out other diseases. Sometimes, the health care provider orders lymphangiography. In this study, the health care provider puts a dye into a lymph vessel and takes pictures to see where blockages are.
Treatment depends on the cause. Treatment of primary lymphedema involves leg elevation, leg massage, and elastic compression stockings. Stockings must be properly fitted and have the correct pressure. Stockings can be knee-high, thigh-high, and pantyhose.
Surgery for long-standing lymphedema is used for continuing increase in leg size even with treatment, legs that don’t work well, recurring leg infections, and distress about the cosmetic appearance. A vascular surgeon with experience in surgical lymphedema treatment should be involved.
In secondary lymphedema, the underlying cause (e.g., prostate or breast cancer) needs treatment.
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