What Exactly Is Lymphedema?  

Lymphedema is the accumulation of a particular kind of fluid, typically in one part of the body. So, in breast cancer, for example, it can appear in the arm on the same side as the cancer, after lymph nodes are removed from the armpit region for cancer staging. Lymph is the protein-rich body fluid that accumulates when the lymphatic system for fluid transport is damaged.

Why is the lymphatic system important?  

Fluid transport is one very important component, but many do not realize that the lymphatic system is part of the immune system. It fulfills the function of ‘immune trafficking,’ the process whereby infection-fighting cells can be mobilized to the tissues that require assistance. When the  lymphatic system is compromised by surgery, trauma, or improper development, the affected part of the body is prone to recurrent infection because of the faulty surveillance mechanism.

What are the unique features of the edema in lymphedema? 

Most other forms of edema other than lymphedema represent the accumulation of water in the tissues. In general, there is a driving force, that is to say, a pressure gradient that will not allow the fluids to return from the tissues to the circulatory lumen. This would be true in heart failure, liver disease, and venous disease, among many other conditions. In lymphedema, it is the unique proteinaceous content of the interstitial fluid that is the driving force for edema accumulation. Protein has obligatory lymph transport from the interstitium and, when lymph transport is impaired, the increased oncotic pressure predicates edema formation. This accumulation of protein-enriched interstitial fluid seems to orchestrate many of the unique clinical features of lymphedema: in addition to pitting edema, we se a change in the architecture of the skin itself. There is an increase in cell mass and an increase deposition of fat in adipocytes that are present in the dermis and the subdermis. There is an increased deposition  of collagen, which yields a nonelastic component to the skin and changes the function of the skin. There is an impairment in immune traffic, which leads to an increased propensity to inflammation and infection. In addition, inflammation is a major driving force to the propagation and worsening of disease with time. 

If I suspect that I might have lymphedema, is it time-critical that I take action?

It is important to act promptly. There is medical evidence to suggest that the duration of lymphedema will determine its severity and its responsiveness to treatment. At the earliest sign of a potential problem, a health care professional should be consulted to initiate whichever tests and treatments may be indicated.

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