Lymphedema

The lymphatic system involves an extensive network of vessels that passes through almost all of our tissues to allow for the movement of a fluid called lymph. Lymph circulates through the body in a similar way to blood. These vessels route lymph fluid through lymph nodes throughout the body. Lymph nodes, which contain immune cells that can help fight infections, are small structures that work as filters for harmful substances. After the lymph nodes are finished with filtering process, the excess fluid in the lymph vessels is eventually returned to the bloodstream. When the lymph vessels are blocked or unable to carry lymph fluid away from the tissues, lymphedema occurs. Lymphedema, also known as localized swelling, occurs most commonly in the arm or leg. It also may occur in other parts of the body including the breast or trunk, head and neck, or genitals.

Types of Lymphedema

  • Primary lymphedema: This type of lymphedema is due to failed or faulty development of lymph nodes and/or blood vessels. This type mainly affects women. This deficiency may be present at birth, but symptoms often appear later in life. Primary lymphedema most often occurs in the legs but can affect the entire body.
  • Secondary lymphedema: This type of lymphedema is typically caused by surgical removal, injury or destruction of the lymph nodes/blood vessels, as a complication of radiation treatment, or by a tropical parasitic infection called lymphatic filariasis (elephantiasis). It can also develop due to skin infections, problems with blood vessels or obesity. Secondary lymphedema is most often present in the body part with the absent or injured lymph nodes.

Causes of Lymphedema

Any condition or procedure that damages your lymph nodes or lymph vessels can cause lymphedema. However, other conditions, traits or habits may also raise your risk for the disease. These conditions are known as risk factors and include:

Modifiable risk factors: These factors can be modified, treated or controlled through medications or lifestyle changes.

  • Obesity or having a body mass index “BMI” of 30 or greater.

Other conditions that contribute to the development of lymphedema

  • Injury or infection to your lymph nodes.
  • Recurring skin infections
  • Scar tissue from radiation therapy or surgical removal of lymph nodes.
  • Congenital familial types of lymphedema such as meige’s disease, milroy’s disease and lymphedema tarda.

Symptoms of Lymphedema

Lymphedema symptoms can include:

  • Swelling and heaviness in the affected limb or other body part, along with tightness and itchiness.
  • Progressive swelling that causes significantly reduced mobility of the affected limb.
  • Hardening and thickening of the skin.

Diagnosis of Lymphedema

Your doctor will want to know about your medical history. A history of painless leg swelling experienced as a teenager or at any age following removal or damage to lymph nodes may suggest lymphedema. If the cause of your lymphedema isn't as obvious, your doctor may order imaging tests to get a look at your lymph system, including:

Diagnostic tests and procedures

Classifications of Lymphedema

Upon diagnosis, your doctor will identify which stage best characterizes your lymphedema and diagnose treatment accordingly. There are four stages:

  • Stage 1: There is an abnormal flow in the lymphatic system. No signs or symptoms.
  • Stage 2: There is accumulation of fluid with swelling. Swelling resolves with elevation. Pressing on the area may leave a dent.
  • Stage 3: There is permanent swelling that does not resolve with elevation. Pressing on the area no longer leaves a dent. Changes in the skin with scarring and thickening.
  • Stage 4: Elephantiasis (large deformed limb), skin thickening with “wart-like” growth and extensive scarring.

Treatment of Lymphedema

There's no cure for lymphedema. Treatment focuses on reducing the swelling and controlling the pain. Treatment options include:

Lifestyle changes

  • Elevate the affected limbs and wear compression garments.
  • Reduction therapy involves wrapping with low-stretch bandages worn 24 hours a day, supplemented with massage therapy and exercise.
  • Maintenance therapy involves regular daytime use of compression garments and/or pneumatic compression sleeves that inflate and deflate to help propel lymphatic fluid.
  • If you’re overweight, talk to your doctor about weight-loss options.
  • Make and keep appointments to see your doctor for routine check-ups and follow-up tests.

Medications

  • Diuretics “water pills” will help reduce the amount of fluid retention in your body.

Medical and surgical procedures

Saint Barnabas Medical Center
94 Old Short Hills Road
Livingston, NJ 07039
(973) 322-5000
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Monmouth Medical Center
300 Second Avenue
Long Branch, NJ 07740
(732) 222-5200
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Monmouth Medical Center Southern Campus
600 River Avenue
Lakewood, NJ 08701
(732) 363-1900
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Clara Maass Medical Center
1 Clara Maass Drive
Belleville, NJ 07109
(973) 450-2000
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Community Medical Center
99 Highway 37 West
Toms River, NJ 08755
(732) 557-8000
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Newark Beth Israel Medical Center
201 Lyons Avenue at Osborne Terrace
Newark, NJ 07112
(973) 926-7000
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Jersey City Medical Center
355 Grand Street
Jersey City, NJ 07302
(201) 915-2000
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RWJ University Hospital Hamilton
1 Hamilton Health Place
Hamilton, NJ 08690
(609) 586-7900
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Robert Wood Johnson University Hospital
1 Robert Wood Johnson Place
New Brunswick, NJ 08901
(732) 828-3000
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RWJ University Hospital Rahway
865 Stone Street
Rahway, NJ 07065
(732) 381-4200
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RWJ University Hospital Somerset
110 Rehill Avenue
Somerville, NJ 08876
(908) 685-2200
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