Lymphatic obstruction, or lymphedema, is a blockage in the lymphatic system. The lymphatic system is made up of lymph nodes and vessels that drain fluids from your body’s tissues. The fluids carry toxins and other waste products to your lymph nodes before your body eliminates them.
Edema (swelling of the lymph nodes) is the most common cause of lymphatic blockage. The most common symptom of lymphatic obstruction is swelling in one or both of your arms or legs.
You can be born with lymphatic obstruction, called primary lymphedema, or develop lymphedema as a secondary condition. Lymphatic obstruction is a chronic condition for most people. This means you will probably need to treat the swelling to some degree throughout your life.
Mastectomy is one of the most common causes of lymphatic obstruction in Western countries, according to the National Institutes of Health (NIH, 2010). During most surgeries to remove a cancerous breast, surgeons also remove lymph tissue from under the arm. Fluids draining from the arm must pass through the armpit. If lymph nodes are removed from this area, it can cause lymphatic obstruction and swelling in the arm.
Other cancer treatments, including radiation therapy and the use of the drug tamoxifen, can contribute to secondary lymphedema, according to the National Lymphedema Network (NLN, 2010). The scar tissue created by radiation acts as a blockage in the lymphatic system. Tamoxifen can cause blood clots, which may in turn lead to swelling in the legs.
Primary lymphedema is a condition you are born with. Primary lymphatic obstruction is less common than secondary lymphedema. The primary, or congenital, form of the condition is largely hereditary (genetic). You are more likely to have primary lymphedema if a family member is also affected.
Two rare genetic conditions, Milroy’s disease and Meige’s disease, cause the structures that make up your lymphatic system to form incorrectly. Milroy’s disease causes your lymph nodes to form improperly in infancy. Meige’s disease causes your lymph vessels to form without valves to prevent lymph fluid from flowing backward, making it difficult for the fluid to drain from your body.
The primary symptom of lymphedema is swelling in your arms or legs. Your fingers or toes may also retain fluid. You may experience heaviness or a dull ache in the affected limb. Limited range of motion due to swelling can also be a sign of lymphatic obstruction.
Symptoms of secondary lymphedema can appear immediately after cancer treatment or surgery, or at any point in the future. Some patients do not experience swelling until months or years after their treatment, so it is important to note these symptoms even if they appear long after your surgery.
People with congenital lymphatic obstruction may show symptoms in early childhood or at the onset of puberty.
Staging Lymphedema Symptoms
Lymphedema is classified in stages. Stage 1 is the mildest form, Stage 2 is moderate, and Stage 3 is the most severe type of swelling.
- Stage 1: your limb is usually normal size in the morning, but swells during the day; the tissue holds an indentation when you press on it
- Stage 2: an irreversible form of swelling in which your limb tissue feels spongy to the touch
- Stage 3: a more severe irreversible form of edema in which your affected limb hardens and becomes very large
Infections may occur along with the swelling of lymphatic obstruction. Two such infections are cellulitis, a type of skin infection, and lymphangitis, an infection of the lymph vessels. Symptoms of infection include a red rash or blotchy patch on the affected limb. Fever, itching, and chills can accompany the edema and rash.
If you come to your doctor with symptoms of lymphatic obstruction, he or she will first take your medical history and perform a physical exam.
If your doctor suspects lymphatic obstruction, he or she may order imaging tests to aid diagnosis. A lymphangiogram is a type of X-ray scan that uses contrast dye to make your lymph nodes and vessels stand out more clearly. Your doctor will inject the dye into a vein between your toes. The X-ray images can reveal blockages in your lymphatic drainage system.
The goals of treatment are to reduce swelling as much as possible and to retain range of motion in the affected limb. Lymphedema caused by infection will be treated first with antibiotics in an effort to control pain and swelling.
Compression is a common form of treatment for lymphedema. Compression of the affected limb encourages the lymphatic fluids to move toward your torso in a more normal pattern of circulation. Wrapping your arm or leg tightly with an elastic bandage or wearing a compression garment keeps continuous pressure on the swollen area.
Compression garments are socks, stockings, or sleeves that fit tightly over the swollen limb. Your doctor may direct you to buy compression garments of a certain grade or level of compression according to the severity of your condition. Compression garments are available at most pharmacies and drugstores.
Manual compression may be required if wearing a compression garment is not enough. Manual lymph drainage is a type of massage therapy performed by a qualified professional. The manipulation of your tissues allows the lymph fluids to drain more freely. You should not undergo manual drainage, however, if you have cellulitis or other types of skin infections.
Exercise can help manage lymphedema as well. Simple range of motion exercises, such as knee bends or wrist rotations, are designed to maintain your flexibility and mobility. Light exercise also keeps fluids from pooling in your arms or legs.
The outlook for lymphedema varies for each patient. In most cases, you will need to deal with some level of swelling on an ongoing basis. You may show some reduction in swelling over time, but most people have some permanent edema.