Can Lymphedema Occur Years After Surgery?
Lymphedema occurs when the lymphatic system fails to drain lymph fluid collected in the interstitial tissues due to various reasons. One of the various reasons for the improper functioning of the lymphatic system is after cancer surgery. This is due to the fact that the lymph nodes, which are an essential part of lymphatic system, are removed during cancer surgery. The removal of lymph nodes leads to disruption of the lymph drainage leading to accumulation of fluid in the interstitial tissues causing swelling and lymphedema. Lymphedema can occur months or years after surgery.
How Does Lymphedema Occur After Surgery?
The lymphatic flow is disrupted at the time of surgery when the nearby lymph nodes are removed leading to congestion and interstitial fluid accumulation. This leads to interstitial swelling known as lymphedema. It is most commonly seen after breast cancer treatment, when some of or all of the axillary lymph nodes under the arms are treated with radiation or are excised depending on the severity of the cancer. Axillary lymph nodes are responsible for drainage of lymphatic vessels of the underarm area, upper arms, breast area, and chest and neck area.
The excision or radiation of the axillary lymph nodes makes the woman at a higher risk of lymphedema due to scarring or blockage of the lymphatic system. Lymphedema can precipitate after various surgeries, radiation or chemotherapy other than breast surgery. Lymphedema can affect one or both the arms, head, neck, trunk, genitals or the legs. Lymphedema can occur right after surgery or radiation, or months and even years after surgery. Swelling can worsen over time along with skin sores and likelihood of infection in the affected area.
Symptoms Of Lymphedema After Surgery
The most common symptom of lymphedema after cancer surgery is the swelling of the extremity on the side of the lymph node removal. However, it is not uncommon to see swelling on the side with intact lymph nodes. The amount of swelling varies according to the severity of the condition and patient care and in some cases the swelling on the non-affected side may be more severe than the affected side.
Other symptoms include feeling of tightness, fullness and heaviness, aching pain or discomfort, inability to move a joint (fingers, wrist, elbow, shoulders, foot, knee, thigh, ankle and legs), swelling in the upper or lower extremity, weakness or paresthesias of the arm or legs, dry or thickened skin of the affected part, delayed wound healing (minor cut of insect bite) and greater chances of infection in the affected area. The symptoms need to be managed without delay to prevent lymphedema from getting severe.
Diagnosis Of Lymphedema After Surgery
The diagnosis of lymphedema depends on the past and present medical history along with the complete history of any surgeries followed by clinical evaluation. Imaging tests may also be carried out for definitive diagnosis, which includes ultrasound, lymphoscintigraphy and MRI.
Treatment Of Lymphedema After Surgery
The treatment of lymphedema after surgery depends on the severity of the condition and it aims at preventing the progression of swelling and managing the symptoms. To reduce swelling, a decompression therapy program, which includes massage, skin care, exercise and compression garments (compression bandages, compression sleeve or stocking), is adopted. Tight clothing and activities that restrict the flow of lymph to and fro are avoided and wearing of compression stockings/sleeve is encouraged to minimize the swelling. Lifestyle modification with diet and exercise is also adopted for weight management.
Various surgical procedures can be incorporated to help improve lymphatic drainage or to remove excess fatty tissue, if conservative management does not limit lymphedema. These include lymphovenous bypass (lymphatic vessels are connected to small adjacent veins for rechanneling of lymphatic vessels), lymph node transplantation (healthy lymph nodes are removed from one area of the body and transplanted to the affected area with lymphedema to reestablish lymphatic circulation in the affected area) and liposuction (excess fatty tissue is removed from the affected area with the help of a cannula).