What are the Signs, Symptoms & Treatment of Lymphedema?
You have just been through one of the most difficult times in your life: treatment for gynecological cancer. You made it through surgery and possibly radiation and/or chemotherapy. And now it’s time to put it all behind you. But, over time, you notice that one of your legs appears to be getting larger than the other and you feel an aching in your upper thigh or pelvic region. Your favorite pants don’t seem to be fitting well and walking up the stairs requires much more effort than previously. Is this lymphedema?
Lympedema is the presence of abnormal swelling (edema) in any part of the body caused by the disruption of lymph fluid through the lymphatic system. According to Dr. Anna Towers, Director of McGill University’s Lymphedema Program, “Lymphedema is an under recognized complication of cancer treatment, and even when recognized, it is often under treated.” The onset of lymphedema may not manifest itself immediately after treatment but may develop months or years later.
Gynecologic cancer treatment often includes one or more of the following interventions: surgery, the removal of lymph nodes, radiation and chemotherapy. Surgery, with the removal of lymph nodes and/or radiation may disrupt the flow of lymph causing abnormal swelling in the abdomen, genitalia and/or legs. In addition to the swelling, there may be a feeling of heaviness in the leg, a tightness of the skin, aching in the hip joint, numbness and tingling as well as discoloration of the skin covering the swollen area.
The lymphatic system works in concert with the vascular system to rid the body of cell debris, viruses and bacteria. It also works in partnership with the immune system to destroy cancer cells and other pathogens. When the lymph fluid becomes “backed up” or stagnant and unable to flow normally, the individual becomes at high risk for developing infections (cellulitis), which could be life-threatening. If the lymphedema continues to be left untreated, mobility becomes impaired due to increased weight of the leg and difficulty in bending the extremity. Additionally, stagnant lymph fluid causes fibrosis, a hardening of the skin tissues.
Once lymphedema is suspected, it should be brought to the physician’s attention and a referral to a qualified lymphedema therapist be made. This therapist can be a licensed occupational therapist, physical therapist, massage therapist or nurse certified in lymphatic therapy after receiving postgraduate lymphedema training.
There is no cure for chronic lymphedema but with treatment and close medical and therapeutic supervision, lymphedema can be greatly improved and managed. Once referred to the lymphedema therapist, an initial evaluation is completed and an individualized treatment plan is developed. The components of treatment are known as Complete Decongestive Therapy (CDT). CDT is considered the “gold standard” of care for people with lymphedema. CDT includes Manual Lymph Drainage (MLD), the application of compression bandages or other compression devices, skin care, therapeutic exercises tailored to the individual’s capabilities and education in self-manual lymph drainage techniques. Often, CDT is considered “intensive” therapy, requiring daily treatment for one or more weeks.
Once the intensive CDT as been completed, the individual moves on to the Optimization Phase. During this phase, the individual becomes responsible for carrying out the home program of self-management techniques. Routine follow-up visits are usually included in this phase in order for the therapist to assess the effectiveness of the home program and to insure any prescribed compression garments continue to fit properly. The frequencies of follow-up visits vary from person to person depending on the degree of lymphedema.
Although lymphedema is not life-threatening, it is life-altering. But with education, early detection and treatment, millions of people can live a full life with lymphedema.
To locate a Certified Lymphedema Therapist, please explore the following resources which were also used to write this article:
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