Introduction to the Lymphatic System:
The lymphatic system defends the body from foreign invasion by disease causing agents such as viruses, bacteria, or fungi. It consists macroscopically of: The bone marrow, spleen, thymus gland, lymph nodes, tonsils, appendix, and a few other organs1. The lymphatic system is a network of very fine vessels or tubes called lymphatics that drain lymph from all over the body. Lymph is composed of water, protein molecules, salts, glucose, urea, lymphocytes, and other substances2.
Lymph nodes are round or kidney-shaped, and range in size from very tiny to one inch in diameter. They are usually found in groups in different places throughout the body, including the neck, armpit, chest, abdomen, pelvis, and groin. About two thirds of all lymph nodes and lymphatic tissue are within or near the gastrointestinal tract2.
The lymph system contains a network of vessels that assists in circulating body fluids. These vessels transport excess fluids away from interstitial spaces in body tissue and return it to the bloodstream. Lymphatic vessels prevent the backflow of the lymph fluid. They have specialized organs called lymph nodes, which filter out destroyed microorganisms1.
Lymph drains into open-ended, one-way lymph capillaries. It moves more slowly than blood, pushed along mainly by a person's breathing and contractions of the skeletal muscles. The walls of blood capillaries are very thin, and they have many tiny openings to allow gases, water, and chemicals to pass through to nourish cells and to take away waste products. Interstitial fluid passes out of these openings to bathe the body tissues2.
Lymph vessels recycle the interstitial fluid and return it to the bloodstream in the circulatory system. They collect the fluid and carry it from all of the body's tissues and then empty it into large veins in the upper chest, near the neck2.
Lymph nodes are made of a mesh-like network of tissue. Lymph enters the lymph node and works its way through passages called sinuses. The nodes contain macrophages, phagocytic cells that engulf and destroy bacteria, dead tissue, and other foreign matter, removing them from the bloodstream. After these substances have been filtered out, the lymph then leaves the nodes and returns to the veins, where it reenters the bloodstream2.
When a person has an infection, germs collect in great numbers in the lymph nodes. If the throat is infected, for example, the lymph nodes of the neck may swell. Sometimes the phagocytic cells may not be able to destroy all of the germs, and a local infection in the nodes may result2.
Because the lymphatic system extends to the far reaches of the body, it also plays a role in the spread of cancer. This is why lymph nodes near a cancerous growth are usually removed with the growth2.
Definition of Lymphedema:
Lymphedema is a swelling caused by a buildup of fluid (lymph) in the soft tissues of the limbs3. Lymphedema can occur in two different ways:
1. Primary lymphedema, a rare genetic condition which children may be born with, may become evident in their teens (lymphedema praecox) or in adulthood (lymphedema tarda)4.
2. Secondary lymphedema is due to damage to the lymphatic system as a result of trauma, parasites (in developing countries), surgery, or radiation therapy. In contrast to edema, a condition where the lymphatic system is intact but overwhelmed, lymphedema results from mechanical insufficiency in which both water and proteins accumulate. Therefore, the lymphatic system cannot remove even normal amounts of lymph from the tissues. When the lymphatic system is damaged beyond repair, persistent lymphedema becomes a chronic condition4.
If lymphedema goes untreated, wound healing becomes increasingly difficult in the infected area, oxygen transportation decreases, and an infection known as lymphangitis may set in.
The severity of lymphedema may be mild, moderate or severe.
|
Stage |
Size of arm
(beyond normal) |
Physical Characteristics |
Physical Problems |
| Latency |
None |
-No swelling
-Limb has normal consistency although lymph transport capacity is reduced |
None |
Mild
(reversible) |
Less than 0.5 inch
(This may be within normal variation) |
-Soft, pitting edema temporarily decreased by elevation
-swelling in 1 part or entire limb
- pain, heavy/fullness or achiness of limb |
Discomfort may affect quality of life
(exercise, travel, appearance) |
Moderate: over months or years
(spontaneously irreversible) |
0.5 to 2 inch enlargement in extremity |
-Edema becomes fibrotic, less pitting and more firm
-Elevation doesn't help reduce edema |
Tissue congestion from deposition of fat and collagen that further compromises dilated, incompetent lymphatic vessels |
| Severe: without treatment (lymphostatic elephantitis) |
Over 2 inches enlargement in extremity |
Severe increase in swelling |
Depressions of skin folds may lead to ulcerations, bacterial and/or fungal infections |
The table above was obtained from Cancer Supportive Care Programs4
Symptoms:
It is possible for lymphedema to occur in any body part, but is most likely to occur in the limbs. Symptoms of lymphedema consist of decreased dexterity of the fingers (toes) and/or hand (foot/ankle), skin feeling increasingly taut and stretched in one area, difficulty fitting into jewelry and/or clothing which once fit well in a specific part of the body, or a noticeable swelling in one specific area. If you contain one or more of these symptoms, and believe that you may have lymphedema, contact a medical professional immediately. Early detection is crucial in treating lymphedema.
Prevention:
Secondary (acquired) lymphedema can be prevented, or progression can be slowed, using these steps to protect the vulnerable extremity:
1. Avoid limb injuries, especially cuts and bruises.
2. Keep skin lubricated with creams or oils.
- 3. Protect your fingers. For example, wear gloves to avoid injury when gardening or doing manual work.
- 4. Avoid cutting your cuticles and use extra care when cutting your nails.
- 5. Avoid the use of blood pressure cuffs or having needles in a limb with lymphedema.
- 6. Take care of cuts or injuries to the limbs; see your health care provider if you have any questions3.
Treatment:
Compression Garments:
Compression garments are elastic knit two-way stretch sleeves or stockings that aid in controlling swelling by providing additional support for the lymphatic system. The stretch and resistance of these garments increases the help that the lymphatic vessels receive from the movement of muscles and blood vessels during exercising and performing daily activities.
Compression garments come in a wide range of styles, sizes, and compression strengths. Some of these garments are available in local stores and from many online sources; however, in the treatment of lymphedema a garment that does not fit properly, or is of the wrong compression, can do more harm than good! For this reason it is important that your lymphedema therapist, or an appropriately trained fitter, must take the necessary measurements and make the correct recommendations.
The garment must be the appropriate length and width so that it covers the affected area and fits without bulges or wrinkles. The garment must have the proper compression. Too little, or too much compression can be damaging. Your compression garment should be reevaluated by your therapist every six months for fit, and may need to be replaced because it loses some of its stretch with wear. When this happens the garment no longer provides proper compression. Ideally you should have two compression garments. This allows you to wear one while the other is drying after hand laundering5.
Compression Bandages:
Wrapping limbs with a low stretch bandage and padding or foam allows for a low resting pressure and high working pressure that encourages lymph flow. Because each bandage is wrapped to custom fit, it can help to reshape the arm. Unfortunately, it is also difficult to apply. Professionals are encouraged to teach patients how to properly apply the bandage to avoid constriction. Rather than reducing lymphedema, constriction may in fact increase limb swelling. Wrapping should be done in spiral direction, not circular turns. The circular turns can too easily become a tourniquet. Numbness in the hand is usually the warning sign that the bandage is too tight. Coldness or change in the color of the fingers is danger sign and bandage should be removed immediately4.
Manual Lymph Drainage:
Manual Lymph Drainage (MLD) is a special, non-invasive massage technique developed in Europe in the 1930’s to treat lymphedema in a very efficient and successful way. MLD is a safe, gentle, and painless hands-on technique that drains excess fluid from the tissues. It also has detoxifying effects and combines several applications, known as complex decongestive therapy, which consists of:
1. MLD
2. Compression bandaging
3. Special decongestive exercises, and
4. Skin care
MLD improves the activity of the lymph vessels and the lymph flow— the transport capacity, by making mild mechanical stretches to the wall of the lymph collectors, which are located in the superficial skin tissue6.
References:
- 1. Lymphoma Information Network. The Lymphatic System.
- www.LymphomaInfo.net. 2005.
- 2. Nemours Foundation. Spleen and Lymphatic System. http://kidshealth.org. 2005.
- 3. Cooke, John P, Szuba, Andrezej, Rockson, Stanley G, Abrams, Gary. Cancer
- 4. Supportive Care Programs. Lymphedema Overview. www.cancersupportivecare.com.
- 2005.
- 5. Selim, Sabrina S, Manuel, Francine, Ewing, Cheryl, Rosenbaum, Ernest H.
- Cancer Supportive Care Programs. Introduction and Treatments for Lymphedema.
- www.cancerwupportivecare.com. 2005.
- 7. Compression Garments. lymphnotes.com. 2005.
- 8. Schaufele, Uli. Atlantic Breast Cancer Net. Manual Lymph Drainage. www.abcn.ca. 2005.
|
