So, if you are following my series on the lymphatic system, then recall that last month the topic was causes of lymphedema. Today I will dive into how modern medical care and disease processes can affect the lymphatic system

The Impact of Surgery on the Lymphatic System

Many people are aware that after mastectomy, people can develop lymphedema in the same-side arm. This can also happen with surgeries for other types of cancer when the lymphatic vessels or lymph nodes are damaged or removed. Pelvic, urological, abdominal, and gynecological cancers, as a result of their lifesaving surgeries, can disrupt lymphatic flow in the legs, genitals, gut, back, or pelvis. Sentinel lymph node biopsies have decreased the number of nodes needing to be removed because surgeons are now aware of which ones are affected. Reverse mapping the lymphatics from the extremities to the lymph nodes can indicate which nodes are draining the body part and perhaps conserve lymph function. Risk factors that increase lymphedema post-operatively are infection, obesity, weight gain, radiation, and some types of chemotherapy.

Non-oncological surgeries can also cause lymphedema because perhaps lymphangiogenesis is impaired by scar tissue and/or trauma to the local lymphatics. This may be true for abdominal, thoracic, extremity, joint, pelvic, cranial, and spinal surgeries or indeed anywhere given that the lymphatics are located throughout the body. Excessive drainage through the incision, failure to heal, or seroma formation immediately after the surgery can indicate lymphatic involvement. If it occurs immediately after surgery, this may be temporary lymphedema, but it would still respond to interventions such as manual or pneumatic lymphatic drainage, kinesiotaping to increase tissue channel drainage, or compression wraps or garments. Ongoing lymphedema treatment may or may not be necessary. Precautions for lymphedema may be advisable to prevent recurrence. (Visit lymphnet.org for precautions.) Weeks and months after the surgery if edema persists and in fact a Stemmer sign is positive, stage 2 lymphedema may be diagnosed. The risk factors of infection, obesity, and weight gain increase chronic lymphedema occurrence in non-cancer surgeries as well.

Diseases and Lymphatic Treatment

Some disease processes or medications increase the amount of third space fluid, but they don't necessarily mean the patient has edema that would benefit from complex lymphatic treatment. In fact, treatment may be contraindicated. Included would be edema resulting from kidney, heart, or liver failure. These are "safety valve" edemas. These organs are of course not able to process their normal amount of fluid, and so the fluid is stored by the body to cope with the failing organ. The higher up the legs and trunk the edema travels, the more serious the disease is. If these patients can be medically managed to stabilize or reduce the failure and if the body can tolerate it, a modified program might be used with close medical monitoring to reduce edema slowly. This can spare patients the discomfort of the fluid retention and protect their skin tear-prone skin. Medications that may cause the body to retain fluid are varied: steroids, immunosuppressants, calcium channel blockers, thiazolidinediones, non-steroidal anti-inflammatory drugs, estrogen, and more. Complex lymphatic treatment would have a much more limited application, and compression garments as needed or tolerated may be the only answer if the drug can’t be changed.

This was but a skim over how the lymphatic system can be affected by diseases or necessary medical care throughout the body. Next month will delve into medical prevention and treatment of lymphedema.

Resources
Baliu C, Esforzado N, Campistol JM, Mascaró JM Jr. Chronic lymphedema in renal transplant recipients under immunosuppression with sirolimus. JAMA Dermatol. 2014;150:1023-4.
Mathur R. Edema. emedicinehealth. https://www.emedicinehealth.com/edema/article_em.htm. Updated August 4, 2015. Accessed November 15, 2017.
Mehrara B. Patient Education: Lymphedema After Cancer Surgery (Beyond the Basics). UpToDate. https://www.uptodate.com/contents/lymphedema-after-cancer-surgery-beyon…. Updated July 19, 2017. Accessed November 15, 2017.
West D. Treating lower-body lymphedema. Oncology Times. 2004;26(9):4, 7.
American Cancer Society. What is Cancer Related Lymphedema? American Cancer Soceiety. https://www.cancer.org/treatment/treatments-and-side-effects/physical-s…. Updated July 7, 2016. Accessed November 15, 2017.

About the Author
Janet Wolfson is a wound care and lymphedema educator with ILWTI, and Lymphedema and Wound Care Coordinator at Health South of Ocala with over 30 years of field experience.