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Non-extremity Lymphedema

Lymphedema is most often seen in the arms and legs, but it is possible to develop lymphedema in any part of the body.

Breast and chest wall edema

One of the more common forms of lymphedema develops in the arm following breast cancer intervention. Because your lymphatic system is part of your body’s immune system, cancer often spreads to lymph nodes first. It is common practice for breast surgeons to include a sentinel lymph node biopsy or axillary lymph node removal while performing a mastectomy or lumpectomy. Swelling can also be noted with radiation treatments that are often implemented after surgery. Breast and chest wall edema can also occur following these surgeries and treatments.

Your breast does not have the same muscle pump that your limb has, making it harder for that area to drain. Common symptoms include swelling of the affected breast, chest wall area right under your armpit, and your back. It might also feel hot, painful, stiff, and heavy. There are compression garments made specifically for the breast and trunk as well as small chipped foam pads that can be used to break up fibrosis and help the area drain.

Head and neck

When surgery and/or radiation are performed on certain areas of the head and neck, lymphedema can occur. If the area being treated drains lymph fluid from the head and neck, the vessels can be affected and swelling can occur. Because the only avenue of drainage from the head is through the neck, swelling is frequently a side-effect from head and neck cancer treatments.

Patients suffering from head or neck lymphedema may feel isolated and avoid social situations. Our faces are very visible and swelling here could make a person feel awkward. If you are suffering from head and neck lymphedema and feel this way, talk to your therapist and physician and make sure they know how you feel. Consider referral for counseling and try to live your live to the fullest. Know that others like you also have a similar situation.

Sometimes, lymphedema patients report that they are unaware of the swelling and only realize it when they look in a mirror.

Swelling is often seen:

  • under the chin
  • circumference of the neck can greatly increase
  • jawline
  • lips
  • in front or behind the ear(s)
  • the cheek(s)
  • the orbits of the eyes
  • forehead

In most cases, this lymphedema is managed daily by you. It is highly recommended that a Certified Lymphedema Therapist instruct you on proper management techniques and garment uses. Swelling can usually be brought into control within 4-6 months. As with all lymphedema, the earlier the condition is managed, the better the prognosis. Patients frequently have the most swelling in the morning and see an improvement throughout the day, likely due to the influence of gravity on the head area. Sometimes patients need ongoing therapy for a long period of time, however the general outcomes are good for resolution of the swelling with proper management.

Genital

Swelling of the genitals, in both males and females, is a possible side effect of pelvic surgery, radiation, or defective lymphatic systems. Genital lymphedema is also frequently seen in primary lymphedema when the lymphatic system is damaged in the lower body. The swelling often occurs in the area over the pubic bone for both males and females.

Genital lymphedema is difficult to control with just MLD. Bandaging and compression garments are very useful to help manage these edemas. It is believed that genital lymphedema occurs at a rate of 10-20% of those who undergo pelvic surgeries and most commonly occurs within the first 5 years following surgery, but can occur any time for the remainder their life.

Because the genitals are personal and sensitive areas, swelling in this area can be a difficult discussion to have with your health care practitioner. For management of genital lymphedema, it is essential to find a CLT who understands the delicacy and complications of these edemas.

Scrotal lymphedema can be very dramatic and can easily accumulate a large amount of fluid. This type of swelling can make walking a challenge, in addition to causing isolation from friends and family. The fit of clothing is sometimes an issue. Compressive garments or bandages and MLD are necessary for management, but difficult because of the spherical nature of the scrotum.

Although more unusual, the penis can also become swollen. This type of lymphedema can lead to impotency and an inability to maintain an erection. Treatment can improve symptoms of penile lymphedema, and specialized reductive surgery has been reported in the literature as well.

Labial lymphedema is most problematic for women when sitting, as this area is often painful. This lymphedema is managed best when compression garments and self MLD are coupled together. Sometimes the edema is so severe that a leakage of fluid from this delicate tissue will require use of sanitary pads to manage.

Exercise is always important to stimulate the muscle pump to promote lymph drainage. Genital lymphedema responds well to swimming or walking in a pool to encourage drainage. Deep Breathing, yoga, and even bicycle riding is possible, but good padding on the seat is required. For labial edema, pelvic floor exercises can also assist with drainage.