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Lymphedema and Colon Cancer

Arm and Leg Swelling After Cancer

With the advent of better and more effective cancer treatments, the survival rate for all cancers has risen dramatically.  With this progress, a new and often misunderstood and misdiagnosed complication has arisen.

Many cancer survivors , having overcome cancer, find themselves with sudden and often unexplained swelling, usually of the arms or of the legs. With colon cancer the lympehdema is almost 100% leg lymphedema, with sometimes genital involvment.  This is due to the fact that inguinal nodes may be taken for biopsy or damaged through treatment (radiation.)

Patients are devestated and horrified when after overcoming cancer, all of a sudden their legs (or arms) begin to swell.  Not only do many of the medical providers not know what lymphedema is, but they tell patients to accept it because there is no treatment or nothing that can be done. As I have stated in my other cancers articles,  patients must be informed about the possibility of lymphedema BEFORE any biopsies are done and /or before any treatment is done.

To me, failure to do this constitutes seiour medical mispractice (or malpractice).  

Causes of Leg Lymphedema

This swelling occurs because of one of several factors.

First, the swelling begins after lymph nodes have been removed for cancer biopsies. 

Second, the swelling may start as a result of radiation damage to either the lymph nodes and/or the lymph system.

Due to either the removal of lymph nodes or damage to the lymph system, your body is no longer able to rid itself of excess fluids.  The fluids collect in the limbs effected and swelling beings.

This swelling is called lymphedema. The swelling that occurs is permanent, and while it is not curable it is treatable.

Other causes may include:

Severe infections/sepsis. Generally referred to as lymphangitis, this is a serious life-threatening infection of the lymph system/nodes.

6.) Trauma injuries such as those experienced in an automobile accident that severly injures the leg and the lymph system.

7.) Burns - this even includes severe sunburn. We have a member that acquired secondary leg lymphedema from this.

8.) Bone breaks and fractures.

9.) Morbid obesity - the lymphatics are eventually crushed by the excessive weight. When that occurs, the damage is permanent and chronic secondary leg lymphedema begins.

10.)Insect bites 

11.) Parasitic infections

The article below lists the early symptoms of leg lymphedema

Permanent Leg or Arm Swelling

****In the situation of any permanent leg swelling whether the cause is known or unknown, the diagnoses of lymphedema must be considered****

There are several groups of people who experience leg or arm swelling from known causes, but it doesn't go away or unknown causes where the swelling can actually get worse as time goes by.

Group One

This group includes those who have had the injuries, infections, insect bites, trauma to the leg, surgeries or reaction to a medication. When this swelling does not go away, and becomes permanent it is called secondary lymphedema.

Group Two

Another extremely large group that experiences permanent leg or arm swelling are cancer patients, people who are morbidly obese, or those with the condition called lepedema.  What causes the swelling to remain permanent is that the lymph system has been so damaged that it can no longer operate normally in removing the body's waste fluid.

In cancer patients this  is the result of either removal of the lymph nodes for cancer biopsy, radiation damage to the lymph system, or damage from tumor/cancer surgeries.

This is also referred to as secondary lymphedema.

Group Three

Group three consists of people who have leg or arm  swelling from seemingly unknown reasons.  There may be no injury, no cancer, no trauma, but for some reason the leg simply is swollen all the time.

The swelling may start at birth, it may begin at puberty, or may begin in the 3rd, 4th or even 5th decade of life or sometimes later.

This type of leg or arm  swelling is called primary lymphedema.  It can be caused by a genetic defect, malformation or damage to the lymph system while in the womb or at birth or be part of another birth condition that also effects the lymph system.

This is an extremely serious medical condition that must be diagnosed early, and treated quickly so as to avoid painful, debilitating and even life threatening complications.  Treatment should NOT include the use of diuretics.

What is Lymphedema?

Lymphedema is defined simply as an accumulation of excessive protein rich fluid in the tissues of the leg.  The accumulation of fluid causes the permanent swelling caused by a defective lymph system.

A conservative estimate is that there may be 1-2 million people in the United States with some form of primary lymphedema and two to three million with secondary lymphedema.

What are the symptoms of Lymphedema?

If you are an at risk person for arm lymphedema there are early warning signs you should be aware of.  If you experience any or several of these symptoms, you should immediately make your physician aware of them.

1.)  Unexplained aching, hurting or pain in the arm

2.)  Experiencing "fleeting lymphedema."  This is where the limb may swell, even slightly, then return to normal.  This may be a precursor to full blown arm lymphedema.

3.)  Localized swelling of any area.  Sometimes lymphedema may start as swelling in one area, for example the hand, or between the elbow and hand.  This is an indication of early lymphatic malfunction.

4.)  Any arm inflammation, redness or infection.

5.)  You may experience a feeling of tightness, heaviness or weakness of the arm.

How is Lymphedema Treated?

The preferred treatment today is decongestive therapy. The forms of therapy are complete decongestive therapy (CDT) or manual decongestive therapy (MDT), there are variances, but most involve these two type of treatment.

It is a form of massage therapy where the leg is very gently massaged to actually move the fluid out of the leg and into an area where the lymph system still functions normally.

With these massage treatments, swelling is reduced and then the patient is fitted with a pre-measured custom pressure garment to keep the swelling down and/or is taught to use compression wraps to maintain the leg size.

What are some of the complications of lymphedema?

1. Infections such as cellulitis, lymphangitis, erysipelas. This is due not only to the large accumulation of fluid, but it is well documented that lymphodemous limbs are localized immuno-deficient.

2. Draining wounds that leak lymphorrea which is very caustic to surrounding skin tissue and acts as a port of entry for infections.

3. Increased pain as a result of the compression of nerves usually caused by the development of fibrosis and increased build up of fluids.

4. Loss of Function due to the swelling and limb changes.

5. Depression - Psychological coping as a result of the disfigurement and debilitating effect of lymphedema.

6. Deep venous thrombosis again as a result of the pressure of the swelling and fibrosis against the vascular system. Also, can happen as a result of cellulitis, lymphangitis and infections.

7. Sepsis, Gangrene are possibilities as a result of the infections.

8. Possible amputation of the limb.

9. Pleural effusions may result if the lymphatics in the abdomen or chest are to overwhelmed to clear the lung cavity of fluids.

10. Skin complications such as splitting, plaques, susceptibility to fungus and bacterial infections.

11. Chronic localized inflammations.

Can lymphedema be cured?

No, at the present time there is no cure for lymphedema. But it can be treated and managed and most of the complications can be avoided.  Life with lymphedema can still be active and full, with proper treatment, patient education, and patient life style adaptation.

For extensive information on lymphedema, please visit our home page:

Lymphedema People

http://www.lymphedemapeople.com

(c) Copyright 2005 by Pat O'Connor and Lymphedema People. Use of this information for educational purpose is encouraged and permitted.  It  must be available free and without charge and not used for financial renumeration or gain.  Please include an acknowledgement to the author and a link to Lymphedema People.

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Colon Cancer: The Basics
Carolyn Coyle, RN, MSN, AOCN
The University of Pennsylvania Cancer Center
Posting Date: May 26, 2002

What is the colon?

The colon is part of a section of the digestive tract called the large intestine. The large intestine is a tube that is 5 to 6 feet in length. The first 5 feet make up the colon, which connects to about 6 inches of rectum, and ends with the anus. By the time food reaches the colon (about 3 to 8 hours after eating), the nutrients have been absorbed and it has become a liquid waste product. The colon's function is to change this liquid waste into stool. The stool can spend anywhere from 10 hours to several days in the colon. It has been suggested that the longer stool remains in the colon, the higher the risk for colon cancer, but this has not been proven.

What is colon cancer?

Colon cancer is malignant tissue that grows in the wall of the colon. The majority of tumors begin when normal tissue in the colon wall forms an adenomatous polyp, or pre-cancerous growth projecting from the colon wall. As this polyp grows larger, the tumor is formed. This process can take many years, which allows time for early detection with screening tests.

Am I at Risk for Colon Cancer?

Colon cancer is the third most common type of cancer, in both males and females, in the western world. The incidence is highest in African Americans, who are also more likely to die of the disease. Certain factors put people at higher risk, but with over 135,000 new cases each year in the United States, we must all be aware of this deadly disease. The risk of colon cancer rises substantially at age 50, but every year there are numerous cases in younger people. Individuals with a personal or family history of colon cancer or polyps, inherited colon cancer syndromes (i.e., FAP and HNPCC), and patients with ulcerative colitis or Crohn's disease are at higher risk, and may require screening at an earlier age than the general population. A person with one first degree relative (parent, sibling or child) with colon cancer is 2 to 3 times as likely to develop the cancer as someone who does not have an affected relative.

However, this does not mean that people without a family history are not at risk. About 80% of new colon cancer cases are diagnosed in people who would not be identified as being at high risk. Studies of colon cancer cases found that lifestyle factors may put a person at higher risk. These factors include: a diet high in fat and red meat, low in fruits and vegetables, high caloric intake, low levels of physical activity, and obesity. In addition, smoking and excessive alcohol intake may play a role in colon cancer development. Despite avoiding all of these factors, some people will still develop colon cancer. With screening and early detection, these patients can be cured in a majority of the cases.

How Can I Prevent Colon Cancer?

Given the things that put a person at higher risk, a low-fat diet high in fruits and vegetables and low in red meat, getting regular exercise, and maintaining a healthy body weight may aide in prevention. The term chemoprevention can be defined as 'the use of a chemical compound to prevent, inhibit, or reverse the formation of the cancer'. There are studies ongoing looking at vitamins A, E, D, and C, folic acid, calcium, selenium, aspirin, cox-2 inhibitors, and hormone replacement therapy as chemopreventive agents, that may prevent or reverse the formation of polyps and colon cancer. These studies, thus far, have been inconclusive, so no specific recommendations have been made for the general population. Some of these agents continue to be evaluated in clinical trials.

What Screening Tests are Available?

Some tumors and polyps may bleed intermittently, and this blood can be detected in stool samples by a test called fecal occult blood testing (FOBT). By itself, FOBT only finds about 24% of cancers. It is recommended by the American Cancer Society that FOBT be done annually, in conjunction with a flexible sigmoidoscopy every 5 years after age 50. This combination of tests detects about 76% of colon tumors. The sigmoidoscope is a slender, flexible tube that has the ability to view about of the colon. If a polyp or tumor is detected with this test, the patient must be referred for a full colonoscopy.

The colonoscope is similar to the sigmoidoscope, but is longer, and can view the entire colon. If a polyp is found, the physician can remove it, and send it to a pathology lab to determine if it is adenomatous (cancerous). As a screening method, the American Cancer Society recommends that a colonoscopy be done every 10 years after age 50. Patients with a family or personal history should have more frequent screenings, beginning at an earlier age than their relative was diagnosed. Patients with a history of ulcerative colitis are also at increased risk and should have more frequent screening than the general public. Patients should talk with their physician about which screening method is best for them, and how often it should be performed. You can learn more about screening by reading Basic Information about Colorectal Cancer and Colorectal Cancer Screening. You can learn about two new tests still in development, virtual colonoscopy and DNA stool testing.

Despite the effectiveness of screening tests for colon cancer, one study found that only 44% of adults, age 50 and older, had undergone testing. Recent media focus, including Katie Couric's efforts, has helped to raise public awareness of this cancer, but more education is needed.

What are the Signs of Colon Cancer?

Unfortunately, the early stages of colon cancer may not have any symptoms. This is why it is important to have screening tests done even though you feel well. As the polyp grows into a tumor, it may bleed or obstruct the colon, causing symptoms. These symptoms include:

  • Bleeding from the rectum
  • Blood in the stool or toilet after a bowel movement
  • A change in the shape of the stool (i.e. thinning)
  • Cramping pain in the abdomen
  • Feeling the need to have a bowel movement when you don't have to have one

As you can see, these symptoms can also be caused by other conditions. If you experience these symptoms, you should be checked by a doctor.

How is Colon Cancer Diagnosed and Staged?

After a cancer has been found, the stage must be determined to decide on appropriate treatment. The stage tells how far the tumor has invaded the colon wall, and if it has spread to other parts of the body.

  • Stage 0 (also called carcinoma in situ) - the cancer is confined to the outermost portion of the colon wall.
  • Stage I - the cancer has spread to the second and third layer of the colon wall, but not to the outer colon wall or beyond. This is also called Dukes' A colon cancer.
  • Stage II - the cancer has spread through the colon wall, but has not invaded any lymph nodes (these are small structures that help in fighting infection and disease). This is also called Dukes' B colon cancer.
  • Stage III - the cancer has spread through the colon wall and into lymph nodes, but has not spread to other areas of the body. This is also called Dukes' C colon cancer.
  • Stage IV - the cancer has spread to other areas of the body (i.e. liver and lungs). This is also called Dukes' D colon cancer.

After the tumor and lymph nodes are removed by a surgeon, they are examined by a pathologist, who determines how much of the colon wall and lymph nodes have been invaded by tumor. Patients with invasive cancer (stages II, III, and IV) require a staging workup, including full colonoscopy, carcinoembryonic antigen (CEA) level (a marker for colon cancer found in the blood), chest x-ray, and CT scan of the abdomen and pelvis, to determine if the cancer has spread.

What are the Treatments for Colon Cancer?

Surgery

Surgery is the most common treatment for colon cancer. If the cancer is limited to a polyp, the patient can undergo a polypectomy (removal of the polyp), or a local excision, where a small amount of surrounding tissue is also removed. If the tumor invades the bowel wall or surrounding tissues, the patient will require a partial resection (removal of the cancer and a portion of the bowel) and removal of local lymph nodes to determine if the cancer has spread into them. After the tumor is removed, the two ends of the remaining colon are reconnected, allowing normal bowel function. In some situations, it may not be possible to reconnect the colon, and a colostomy (an opening in the abdominal wall to allow passage of stool) is needed.

Chemotherapy

Despite the fact that a majority of patients have the entire tumor removed by surgery, as many as 40% will develop a recurrence. Chemotherapy is given to reduce this chance of recurrence. There is some controversy over patients with stage II disease receiving chemotherapy. Studies have not consistently shown a benefit in treating these patients. Generally, patients with stage II disease who present with a bowel perforation or obstruction, or have poorly differentiated tumors (determined by a pathologist), are considered at higher risk for recurrence, and are treated with 6 to 8 months of Fluorouracil (5-FU) and Leucovorin (LV) (both chemotherapy agents). Other patients with stage II disease are followed closely, but generally receive no chemotherapy. Patients who present with stage III colon cancer are typically treated with a regimen of Fluorouracil and Leucovorin for 12 months.

Forty to fifty percent of patients have metastatic (disease that has spread to other organs) at the time of diagnosis, or have a recurrence of the disease after therapy. Unfortunately, the prognosis for these patients is poor. The standard therapy for patients with advanced disease is Fluorouracil, Leucovorin, and irinotecan (CPT-11). This regimen was found to be more effective than Fluorouracil and Leucovorin alone in these patients. With this therapy, an average of 39% of patients have a response, but the average survival is still only 15 months. Patients and their physicians must weigh the benefits of therapy versus the side effects of the treatment. Younger patients and those in better physical shape are better able to tolerate therapy.

Two new medications, capecitabine (Xeloda) and oxaliplatin, are also being used in the treatment of advanced colon cancer. Capecitabine is currently approved by the FDA for the treatment of advanced colon cancer that has failed treatment, but is still being investigated in untreated patients. Oxaliplatin is widely used in Europe, but has not yet been approved by the FDA for use in the United States. Currently, patients can only receive this medication in a clinical trial.

Radiotherapy

Colon cancer is not typically treated with radiation therapy. If the cancer has invaded another organ, or adhered to the abdominal wall, radiation therapy may be one option. One way to understand this is that radiation needs a "target". If the tumor has been surgically resected, there is no target to radiate. If the tumor has spread to other organs, chemotherapy is needed to reach all the tumor cells, whereas radiation can only treat a small area.

Follow-Up Testing

Once a patient has completed chemotherapy, they must be followed closely for recurrence. The guidelines for follow-up surveillance, written by the National Comprehensive Cancer Network are: physical exam (including digital rectal exam) every 3 months for 2 years, then every 6 months for 3 years, CEA level checked every 3 months for 2 years, then every 6 months for 3 years, and colonoscopy in 1 year, repeat in 1 year if abnormal, or every 3 years if no polyps are found. There is not enough evidence to support or refute the use of chest x-ray or CT scan for surveillance at this time, so this varies from physician to physician.

Clinical trials have, and continue to play an important role in the treatment of colon cancer. In the past 20 years, considerable improvements have been made in colon cancer therapy, with overall survival rates increasing from 45 to 75 percent. The treatments we have today were refined through clinical trials, and many new avenues continue to be explored. Talk with your physician about current clinical trials for colon cancer in your area.

This article is meant to give you a better understanding of colon cancer. Use this knowledge when meeting with your physician, making treatment decisions, and continuing your search for information. You can learn more about colon cancer on OncoLink through the related links on the left.

References

  • The American Cancer Society. Facts and Figures 2002. www.cancer.org
  • Blumberg, D. & Ramanathan, R. K. (2002) Treatment of Colon and Rectal Cancer. Journal of Clinical Gastroenterology, 34(1), 15-26.
  • Lieberman, D. A. & Weiss, D. G. (2001) One-Time Screening for Colorectal Cancer with Combined Fecal Occult Blood Testing and Examination of the Distal Colon. The New England Journal of Medicine, 345(8), 555-560.
  • National Cancer Institute. Patient Statement on Colon Cancer.
  • National Comprehensive Cancer Network Practice Guidelines for Colorectal Cancer (2000). Oncology, 14(11A), 203-212.
  • Yarbro, C. H., Frogge, M. H., Goodman, M., & Groenwald, S. L. (Eds.): Cancer Nursing: Principles and Practice (2001). Jones and Bartlett Publishers, Boston, Massachusetts.

http://www.oncolink.upenn.edu/types/article.cfm?c=5&s=11&ss=81&id=7336

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Colon cancer - Medlines Plus

http://www.nlm.nih.gov/medlineplus/ency/article/000262.htm

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Colorectal Cancer - Medline Plus Information and Links Page

http://www.nlm.nih.gov/medlineplus/colorectalcancer.html

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Colon Cancer Alliance

http://www.ccalliance.org/

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Colon Cancer Concern

http://www.coloncancer.org.uk/

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Colon Cancer Information Library

http://www.meds.com/colon/colon.html

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Colon Cancer - Cancer News

http://www.cancernews.com/colon.htm

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What are Colon Cancer Symptoms?

http://coloncancer.about.com/od/coloncancerbasics/a/colcansymptoms.htm

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Cancer Resources and Information:

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Cancer Topics - National Cancer Institute

http://www.nci.nih.gov/cancertopics

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American Cancer Society

http://www.cancer.org/docroot/home/index.asp

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Canadian Cancer Society

http://www.cancer.ca/ccs/internet/niw_splash/0%2C%2C3172%2C00.html

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The Cancer Council Australia

http://www.cancer.org.au/

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ACOR.ORG - Association of Cancer Online Resources

http://www.acor.org/

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Your Body After Cancer Treatment

http://www.nci.nih.gov/cancertopics/life-after-treatment/page5

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Cancer - Medline Plus Information and Links Page

http://www.nlm.nih.gov/medlineplus/cancer.html

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Cancer Resource Center

http://patient.cancerconsultants.com/links.aspx?id=32333

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Cancer Lynx

http://www.cancerlynx.com/

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The Cancer Information Network

http://www.cancerlinksusa.com/

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Lymphedema

WHAT IS IT?

Lymphedema is a buildup of a fluid called lymph and protein in the tissues under the skin. Lymph accumulates when there is an obstruction to normal flow causing swelling, usually in an arm or leg. The lymph system is similar to the blood system in its network of vessels that carry lymph fluid throughout the body.

Trauma to lymphatic tissue by surgery or radiotherapy is the main cause of lymphedema in the context of cancer. It can result from surgery and/or radiation therapy during treatment for cancers of the breast, abdomen, melanoma, connective tissues (sarcomas) and the pelvic area, as well as lymphomas, in both men and women. Lymphedema may also be the result of infection, such as dermatophytosis in the foot.

Cancer tumors also can block the lymph vessels, especially in people with prostate cancer or lymphoma.

IF I HAVE CANCER WILL I DEVELOP LYMPHEDEMA?

Not necessarily. The most frequent cases occur in women with breast cancer; 10% to 25% of breast cancer patients will develop lymphedema. While most cases are mild, approximately 400,000 women cope daily with some degree of disfigurement, discomfort, and sometimes disability because of arm and hand swelling.

Because of improvements in radiation and surgical techniques (such as removing smaller samples of lymph nodes), lymphedema is less common today than it use to be. Lymphedema develops in about one in four breast cancer patients who have a mastectomy with lymph-node dissection. The risk doubles for those who also receive radiation treatments to the underarm area.

Radical prostatectomy, a procedure that removes the prostate gland, seminal vesicles and sometimes the nearby pelvic lymph nodes, can lead to lymphedema .One type of Kaposi’s sarcoma is called the lymphadenopathic form that can spread throughout the body and may aggressively involve lymph nodes, viscera, and occasionally the GI tract – resulting in a kind of lymphedema. 

SENTINEL LYMPH NODE BIOPSY

If breast cancer spreads, it first goes to the lymph nodes under the arm. That's why women with breast cancer have these nodes examined. Until recently, surgeons would remove as many lymph nodes as possible, but this greatly increased the risk of lymphedema. More recently, a growing number of physicians have begun focusing on finding the sentinel nodes — the first nodes to receive the drainage from breast tumors and therefore the first to show evidence of cancer’s spread. Experts believe that if a sentinel node is removed and found to be healthy, then the chance of finding cancer in any of the remaining nodes is very small and no other nodes need to be removed. This spares as many as 75% of women who have no evidence of tumor spread to the axillary nodes the risk of complications, especially lymphedema.

WHEN DOES IT DEVELOP?

Lymphedema can appear any time after surgery or radiation treatment including many years later.

When the condition develops very soon after surgery, it is usually mild, and goes away within one to two weeks. It can also develop six to eight weeks after surgery or radiation. Again, this type of lymphedema usually goes away in a few weeks. 

Unfortunately, the more common form of lymphedema in cancer survivors develops slowly over time. It may show up many months or even years after treatment ends and swelling can range from mild to severe. In most cases however, lymphedema appears between six and 12 months after treatment. While people who have many lymph nodes removed and radiation therapy have the highest risk of developing lymphedema, some high-risk patients won’t develop the condition.

WHEN TO CALL A PROFESSIONAL

Patients should contact a physician if they had a mastectomy, lower abdominal surgery or radiation treatments in the past, and the affected limb becomes red, painful or hot, or if it develops open sores or areas of broken skin. Doctors should be consulted especially if there is a fever in addition to swelling.

Diagnostic Tests

Usually, no specific testing is necessary to diagnose lymphedema, but tests may be done such as a blood count that can identify signs of infection. Ultrasound may be ordered to look for blood clots, which can cause swelling. Computed tomography (CT) may be used to find a tumor that could be blocking lymph vessels. In addition, there are more specialized tests that can identify lymph flow and lymph vessel abnormalities. 

Symptoms

The first signs of lymphedema can be a change in a patient’s arms or legs or other affected area such as the groin. Initially, skin will remain soft, but if the problem continues, the limb may become hot and red and the skin hard and stiff. The lymph fluid that collects in the tissues can be very uncomfortable, but pain is not always present. Early symptoms of lymphedema may include: 

In most cases, only one arm or leg is affected. If the leg is involved, swelling usually begins at the foot, then progresses upward toward the ankle, calf and knee.

Severity

The severity is directly related to the extent of surgery and radiation treatment to the lymph nodes. Severity and general risk of developing lymphedema seems to increase with obesity, weight gain and infection in the affected area. 

TREATMENTS

Lymphedema has no cure so treatment focuses on reducing the symptoms. Treatment has varied from virtually no treatment to surgery, but there are various practical methods to deal with the condition, including elevation of the limb (in the first year only), compression garments (no greater than 20-30 mm Hg), certain types of massage and exercises, pneumatic compression devices (controversial), and other types of physical therapy. Experts also recommend keeping the affected limb clean, dry and lubricated.

The National Lymphedema Network (www. Lymphnet.org) encourages massage by an specially certified expert in lymphedema massage.. In many cases, patients can also be trained to massage themselves to improve the flow of lymph fluids. 

Medications

There are no medications to treat lymphedema. Diuretics have been found to be ineffective and may actually exacerbate the condition. Other medicines have been tried, but there is no clear evidence of significant effectiveness with any particular drug. 

MILD LYMPHEDEMA: 

Elevating the arm or leg above the level of the heart(during the first year) and flexing it frequently are basic methods to manage the condition. Since elevation is impractical except for short periods, patients should be fitted with an elastic sleeve, covering the arm or leg. 
A significant reduction in edema (swelling) has been reported after wearing elastic sleeves for 6 consecutive hours per day. Using these garments during exercise, physical activity, and especially air travel is recommended, since air travel seems to exacerbate the condition. 
If the legs are affected, avoid periods of prolonged standing. If working or standing a lot, a doctor may prescribe special graduated compression stockings to wear throughout the day. A doctor may also suggest a protein-rich, low-salt diet for those who are over-weight or obese. 

MODERATE TO SEVERE: 

For people with moderate to severe lymphedema in the legs, doctors prescribe pneumatic compression devices to be used at home to help reduce limb swelling. The “pneumatic stockings” are worn every day for an hour or two to reduce the swelling. Once the swelling has been reduced, a person may still need to wear elastic stockings up to the knee every day from the moment of rising until bedtime. 

For lymphedema in the arm, pneumatic sleeves--like pneumatic stockings--can be used every day to reduce the swelling; elastic sleeves may also be needed.

Others recommend a special type of massage therapy called manual lymph drainage. Antibiotics also may be prescribed to prevent or treat infection in the affected limb. Since skin infections can be more serious in people with lymphedema, a person may need to have antibiotics administered intravenously in the hospital during an infection.

Complex Decongestive Therapy

More serious cases of lymphedema can be treated with Complex Decongestive Therapy by a physical therapist or other health care professional, who has special training. Complex Decongestive Therapy consists of skin care, massage, special bandaging, exercise, and fitting for a compression sleeve. Seeking and getting treatment early should lead to a shorter course of treatment to get the lymphedema under control. While most insurance companies will pay for this treatment, some do not.

Someone certified in the procedure should perform Manual Lymph Drainage (MLD). 
In the case of lymphedema of the arm, the procedure involves a type of massage that moves built up fluid around the blocked vessels and across the chest to the other side of the body where the lymphatic system is still in tact. Usually the healthy area will be “worked” first. After each treatment, the effected area is carefully bandaged with a special layered wrap that looks like an ace bandage but is made of a different fabric. The wrap is important for keeping the effected limb de-congested. An average course is 15 daily treatments of 60 to 90 minutes each. After a MLD course of treatments, the patients will wear a compression garment every day. The patient should be measured for a new compression sleeve every six months or so. Sometimes a yearly MLD treatment course is recommended as a kind of “tune up.”

PREVENTING COMPLICATIONS

Because lymphedema development may occur even after several decades, patients should monitor themselves for signs of lymphedema and report any changes to their physicians. 
Prevention is important and can require daily attention to manage the symptoms of swelling in particular. Arm and hand precautions are based on two key ideas: (1) Do not increase lymph production, which is directly proportional to blood flow, and (2) do not increase blockage to lymph system. Therefore, patients should avoid excessive heat, infections, and overly-strenuous arm exercises which would increase blood flow in the arm and thereby increase lymph production.

MANAGING LYMPHEDEMA

Patients should follow these suggestions to manage their lymphedema: 

It is important to use your affected limb for normal everyday activities, yet overuse can cause lymphedema to occur in some people. Follow these suggestions whenever possible: 

For More Information

American Cancer Society

The American Cancer Society held an international conference on lymphedema in 1998 in New York City. It involved 60 of the world’s leading experts and included a forum of more than 250 breast cancer survivors, leaders of breast cancer advocacy groups, and others. The conference report plus a lymphedema resource guide are available as a book from the ACS at cancer.org. (See below for title.)

National Lymphedema Network

The National Lymphedema Network is a charitable organization with an international scope. Founded in 1988, the Network’s mission is to provide education and guidance to patients and health care professionals. The Network promotes standardizing quality treatment for lymphedema patients. In addition, the organization supports research into the causes and possible alternative treatments for this “often incapacitating, often-neglected condition.”

Link no longer valid

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Lower leg edema

http://www.nlm.nih.gov/medlineplus/ency/imagepages/8857.htm

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Lymphedema ArmLymphedema is swelling,

 

 

 

 

 

http://www.biohorizonmedical.com/aboutlymph/aboutlymph.html

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Lymphedema People Cancer Information Pages

Cervical, ovarian Cancer

http://www.lymphedemapeople.com/phpBB2/viewtopic.php?t=152

Kidney and Renal Cancer

http://www.lymphedemapeople.com/phpBB2/viewtopic.php?t=150

Hodgkins Disease or Hodgkins Lymphoma

http://www.lymphedemapeople.com/phpBB2/viewtopic.php?t=149

Gynecological Cancer

http://www.lymphedemapeople.com/phpBB2/viewtopic.php?t=977

Leg Lymphedema After Gynecological Cancer

http://www.lymphedemapeople.com/phpBB2/viewtopic.php?t=979

Kaposi’s Sarcoma

http://www.lymphedemapeople.com/phpBB2/viewtopic.php?t=641

Skin Cancer

http://www.lymphedemapeople.com/phpBB2/viewtopic.php?t=278

Testicular Cancer

http://www.lymphedemapeople.com/phpBB2/viewtopic.php?t=153

Primary Lymphedema and Cancer

http://www.lymphedemapeople.com/phpBB2/viewtopic.php?t=277

Cutaneous T-cell Lymphoma

http://www.lymphedemapeople.com/phpBB2/viewtopic.php?t=147

Cutaneous B-cell Lymphoma

http://www.lymphedemapeople.com/phpBB2/viewtopic.php?t=146

My Life with Lymphedema and Lymphoma

http://www.lymphedemapeople.com/wiki/doku.php?id=my_life_with_lymphedema_and_lymphoma

Lymphedema Affects Quality of Life

http://www.lymphedemapeople.com/phpBB2/viewtopic.php?t=980

Angiosarcoma and Long Term Lymphedema

http://www.lymphedemapeople.com/phpBB2/viewtopic.php?t=564

Colon Cancer

http://www.lymphedemapeople.com/thesite/lymphedema_and_colon_cancer.htm

Prostate Cancer

http://www.lymphedemapeople.com/thesite/lymphedema_and_prostate_cancer.htm

Melanoma

http://www.lymphedemapeople.com/thesite/lymphedema_and_melanoma.htm

Male Breast Cancer

http://www.lymphedemapeople.com/thesite/lymphedema_and_male_breast_cancer.htm

Leg Swelling

http://www.lymphedemapeople.com/thesite/leg_swelling.htm

Arm Swelling

http://www.lymphedemapeople.com/thesite/arm_swelling.htm

Swelling

http://www.lymphedemapeople.com/thesite/swelling.htm

Breast Cancer

http://www.lymphedemapeople.com/thesite/lymphedema_and_breast_cancer.htm

Lymphedema After Cancer - How Serious Is It?

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_after_cancer_-_how_serious_is_it

Secondary Lymphedema in the Cancer Patient

http://www.lymphedemapeople.com/wiki/doku.php?id=secondary_lymphedema_in_the_cancer_patient

Complications of Breast Cancer Radiotherapy

http://www.lymphedemapeople.com/wiki/doku.php?id=complications_of_breast_cancer_radiotherapy

Complete decongestive therapy lymphedema in breast cancer

http://www.lymphedemapeople.com/phpBB2/viewtopic.php?t=792

Patient self-massage for breast cancer-related lymphedema

http://www.lymphedemapeople.com/phpBB2/viewtopic.php?t=332

Predictive Factors of Response to Intensive Decongestive Physiotherapy in Upper Limb Lymphedema After Breast Cancer Treatment: a Cohort Study

http://www.lymphedemapeople.com/phpBB2/viewtopic.php?t=283

Lymphedema Therapy and the Quality of Life for Breast Cancer Patients

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_therapy_and_the_quality_of_life_for_breast_cancer_patients

Cancer Associated with Lymphedema

http://www.lymphedemapeople.com/wiki/doku.php?id=cancer_associated_with_lymphedema

Pseudolymphomatous Cutaneous Angiosarcoma: A Rare Variant of Cutaneous Angiosarcoma Readily Mistaken for Cutaneous Lymphoma.

http://www.lymphedemapeople.com/phpBB2/viewtopic.php?t=1178

Lymphomatoid Papulosis

http://www.lymphedemapeople.com/phpBB2/viewtopic.php?t=265

Papillomatosis cutis carcinoides

Related Terms: Verrucous Carcinoma, Squamous Cell Carcinoma, Epithelioma cuniculatum, Carcinoma cuniculatum

http://www.lymphedemapeople.com/phpBB2/viewtopic.php?t=108

Cutaneous lymphomas assoc with lymphoproliferative disorders

http://www.lymphedemapeople.com/phpBB2/viewtopic.php?t=992

Aqua Lymphatic Therapy for Postsurgical Breast Cancer Lymphedema

http://www.lymphedemapeople.com/wiki/doku.php?id=aqua_therapy_for_postsurgical_breast_cancer_arm_lymphedema

Sporadic Cutaneous Angiosarcomas

http://www.lymphedemapeople.com/phpBB2/viewtopic.php?t=1265

Axillary node biopsy

http://www.lymphedemapeople.com/wiki/doku.php?id=axillary_node_biopsy

Sentinel Node Biopsy

http://www.lymphedemapeople.com/wiki/doku.php?id=sentinel_node_biopsy

Small Needle Biopsy - Fine Needle Aspiration

http://www.lymphedemapeople.com/wiki/doku.php?id=small_needle_biopsy

Extraperitoneal para-aortic lymph node dissection (EPLND)

also includes (1) Retroperitoneal Lymph Node Dissection and (2) Laparoscopic Retroperitoneal Lymph Node Dissection

http://www.lymphedemapeople.com/wiki/doku.php?id=extraperitoneal_para-aortic_lymph_node_dissection_eplnd

Lymphoscintigraphy

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphoscintigraphy

Magnetic Resonance Imaging

http://www.lymphedemapeople.com/wiki/doku.php?id=magnetic_resonance_imaging

Cancer Glossary

http://www.lymphedemapeople.com/phpBB2/viewforum.php?f=36

Skin Glossary

http://www.lymphedemapeople.com/phpBB2/viewforum.php?f=42

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Lymphedema People Online Support Groups

MEN WITH LYMPHEDEMA

If you are a man with lymphedema; a man with a loved one with lymphedema who you are trying to help and understand come join us and discover what it is to be the master instead of the sufferer of lymphedema.

http://health.groups.yahoo.com/group/menwithlymphedema/

Subscribe: menwithlymphedema-subscribe@yahoogroups.com

Pat O'Connor

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Join us as we work for lymphedema patients everywehere:

Advocates for Lymphedema

Dedicated to be an advocacy group for lymphedema patients. Working towards education, legal reform, changing insurance practices, promoting research, reaching for a cure.

http://health.groups.yahoo.com/group/AdvocatesforLymphedema/

Subscribe: AdvocatesforLymphedema-subscribe@yahoogroups.com

Pat O'Connor

Lymphedema People / Advocates for Lymphedema

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For information about Lymphedema

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema\

For Information about Lymphedema Complications

http://www.lymphedemapeople.com/wiki/doku.php?id=complications_of_lymphedema

For Lymphedema Personal Stories

http://www.lymphedemapeople.com/phpBB2/viewforum.php?f=3

For information about How to Treat a Lymphedema Wound

http://www.lymphedemapeople.com/wiki/doku.php?id=how_to_treat_a_lymphedema_wound

For information about Lymphedema Treatment 

http://www.lymphedemapeople.com/wiki/doku.php?id=treatment

For information about Exercises for Lymphedema 

http://www.lymphedemapeople.com/wiki/doku.php?id=exercises_for_lymphedema

For information on Infections Associated with Lymphedema

http://www.lymphedemapeople.com/wiki/doku.php?id=infections_associated_with_lymphedema

For information on Lymphedema in Children

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_in_children

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Lymphedema Glossary

http://www.lymphedemapeople.com/wiki/doku.php?id=glossary:listing

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Home page: Lymphedema People

http://www.lymphedemapeople.com

Updated Jan. 2, 2012