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Lymphedema Overview
John P. Cooke, MD, PhD, Andrzej Szuba, MD, PhD, Stanley G. Rockson, MD and Gary Abrams, MD

What is Lymphedema ?
Can Lymphedema be Prevented?
Can Lymphedema be Treated?
The Stanford Lymphedema Center

What is Lymphedema?
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Lymphedema is a swelling caused by a buildup of fluid (lymph) in the soft tissues of the limbs. This buildup often occurs after surgical removal of lymph nodes or after radiation therapy to lymph nodes (because of damage to the lymphatic system). Where cancer is involved, lymphedema is most often seen after surgical or radiation therapy for breast cancer, malignant melanoma, and testicular or prostate cancer. Lymphedema may also be caused by chronic infection, usually involving the legs. Less commonly, lymphedema is primary (i.e., due to the genetic make-up). Children with primary lymphedema may be born with it (congenital lymphedema) or it may become evident in their teens (lymphedema praecox) or in adulthood (lymphedema tarda).

Chronic lymphedema may result in minor swelling and discomfort. Occasionally it leads to a grave disability and disfigurement. Lymphedema may be precipitated, or made worse, by a skin infection. Skin infections can be difficult to treat in someone with pre-existing lymphedema.

Can Lymphedema be Prevented?
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Acquired lymphedema (such as that following surgery and radiation) 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 questions.

Can Lymphedema be Treated?
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Emotional problems associated with lymphedema are not uncommon. The need to address the psychological aspects, especially with adolescent patients, cannot be overemphasized. Emphasis should be placed on the individual's ability to modify the course of lymphedema by careful attention to the details of the medical program.

Some people reduce their activity in response to uncomfortable or heavy sensations in the affected limb. This is not necessary nor is it healthy. Regular exercise appears to reduce lymphedema as long as good compressive support is applied. Swimming is a particularly good activity because the surrounding hydrostatic pressure of the water means compressive support isn't needed.

Compressive support should be fitted to the limb after the edema has been reduced as much as possible by compression and elevation. This is important, because compressive stockings do not reduce the size of the leg but only maintain the circumference to which they are fitted. If the limb is fitted for a stocking while in a swollen state, it will be maintained by the stocking in a swollen state. To reduce the swelling to a minimum may take several days of elevation and bandaging.

Special compression stockings and sleeves or ace bandages help keep the lymphedema under control. To reduce the edema, the favored approach is decongestive physiotherapy, which employs massage, exercise and bandaging. This technique is at least as effective as mechanical pumps, and less costly if you learn how to perform the therapy yourself with the guidance of a skilled therapist.

Use a cream to lubricate and soften your skin. If you have lymphedema affecting a leg, make sure that any fungal infection of your toes is treated. If lymphedema persists, or worsens, you may have an infection or venous involvement. At the onset of lymphedema, or with any worsening in your condition, you should be seen at a center for the evaluation and treatment of lymphedema.

The Stanford Lymphedema Center
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If you have lymphedema, you might benefit from a visit to the Stanford Lymphedema Center.

The Stanford Lymphedema Center, based at Stanford Hospital and Clinics, offers comprehensive diagnostic and therapeutic approaches to lymphedema and venous disorders. An extensive research program makes the Stanford Center unique among the few other U.S. centers which offer therapy for lymphedema. The majority of the people that visit us have upper or lower limb lymphedema resulting from cancer therapy, injury, infection or primary lymphedema. Treatment is also available for venous edema, mixed extremity edema of different etiologies and chronic leg ulcers.

Stanford therapists are extensively trained in lymphatic therapy (Foldi and Vodder certified therapists). Therapists use a variety of modalities including decongestive physiotherapy, and special compressive dressings. Prior to treatment, each person is evaluated by one of our physicians to verify diagnosis and develop an appropriate course of treatment.

The Stanford Lymphedema Center has treated over 300 people with various types of lymphedema since 1995 and achieved a substantial reduction of limb volume in the majority of these individuals. On average, we have seen a reduction of over 50% of the excess volume within a mean of eight days of therapy.

Manual lymphatic therapy has proven to be an effective treatment for various types of lymphedema. Self-therapy helps maintain limb volume reduction and also reduces the risk of skin infection. We have found that appropriate treatment and education reduce the frequency of hospitalization and expensive therapy for complications such as cellulitis. In addition, the quality of life improves for these people.

Faculty and Staff
John P. Cooke, MD, PhD, Director
Stanley G. Rockson, MD, Co-Director
Andrzej Szuba, MD, PhD, Staff Physician
Nancy Burns, RN, Nurse Coordinator/Therapist
Valerie Keith, CAN, Therapist
Sandie Zumwalt, Therapist

For Referral or Program Information

Please contact us at (650) 498-7168