Lymph is a pale yellow liquid that contains so-called lymph plasma and certain white blood cells known as lymphocytes. Lymphatic fluid consists of interstitial fluid, protein, fatty acid and kilo. Chyle is the fat collected in the digestive system. Lymph or lymphatic fluid flows through the lymphatic vessels which is thin tubular structure spreads around viscera, muscles and subcutaneous tissue. Lymphatic fluid flows through the vessels and lymphatic fluid content is filtered into the lymph node. The lymph node acts as a station that decreases the flow of lymph to the distal lymphatic channels. The lymph nodes filter out toxins, bacteria and viruses that help purify lymph. The ganglia thus extract pathogenic germs and toxic substances.
Collection of toxins and bacteria within the lymph node in few cases causes lymph node infection and inflammation. Lymph node inflammation often follows lymph node healing. The healed lymph node blocks the flow of lymphatic fluid forward. Such blockage of lymph flow through the nodule causes swelling of the proximal lymphatic vessels. After blockage of lymph fluid from the lymph nodes, it is expelled to the surrounding tissue, resulting in swelling of the tissues. This tissue swelling caused by swollen lymph vessels and extruded lymph fluid is known as lymphedema. Lymphedema resulting in swelling of the tissue mainly seen in the upper and lower extremities. The swelling is visible and palpable and in some cases becomes inflamed, causing mild to severe pain. Lymphedema is common after surgical lymph node removal in cancer patients with chronic infection. Lymphedema is also observed on the head, neck, trunk and genitals.
Lymphedema can be due to many different causes. In most cases, it is due to obstruction of lymph vessels in the lymph node. Obstruction of the forward flow of lymphatic fluid within the lymph vessels increases pressure within the lymphatic vessels. Increased pressure causes vessels to swell and expels clear fluid to adjacent soft tissues. The condition is known as obliteration of lymphatic vessels and lymphedema. Swelling of the tissue under the skin is, in some causes, inflammation of the surrounding tissue and pain.
What is Primary Lymphedema
Primary lymphedema is caused by congenital narrowing as well as blockage of lymph vessels and lymph node. The condition is hereditary and known as hereditary lymphedema. Symptoms are rarely seen in children born with lymphatic system abnormalities. Hereditary lymphedema often affects the legs, specifically on both sides of the calf. They appear most strongly during warm seasons and, in the case of women, also during menstruation. Primary lymphedema is classified under the following conditions.
Hereditary Lymphedema Type I (Milroy’s Disease) – Congenital alteration of the lymphatic system, evidenced before birth; It is not associated with other discomforts.
Hereditary Type II Lymphedema (Meige’s Disease) – The condition is observed in several family members and is believed to be of genetic origin. Meige’s disease usually appears at puberty. The condition affects younger women more than young men. Meige’s disease is associated with other symptoms such as dwarfism, overweight and mental disability. Individual random lymphedema is caused by hereditary alteration of the lymphatic vessels. In rare cases, it is due to alteration of lymphatic fluid composition. This primary lymphedema occurs between 15 and 20 years. In 50% of cases, lymphedema is limited to one leg. The swelling initially appears on the ankle and then spreads to the leg above and below the knee joint. However, in every two cases, lymphedema also appears on the other leg after months or years. In this case, too, it affects women more than men.
What is secondary lymphedema
An acquired or secondary lymphedema always has its origin in another disease. The causes are varied. Surgical interventions are the most frequent of a secondary lymphedema. Thus, after breast cancer surgery in which the axillary lymph nodes have been removed, it is very common to see lymphedema in the arms. Lymphedema is seen in several patients after removal of breast cancer and axillary lymph node.
In these cases, overweightIt can also have a negative impact: For example, after treatment for breast cancer, being overweight increases the risk of developing lifelong secondary lymphedema by 40 to 60%. In principle, any injury, sprain or scar of different origin can trigger a secondary lymphedema. Parasites can also cause inflammatory lymphedemas that spread in the scrotum, upper and lower extremities. Filariasis is the disease caused by the parasite. Filariasis affects the lymphatic vessels of the scrotum as well as the extremities. Filariasis is a rare disease that causes inflammation of the lymphatic pathways. The disease is also known as lymphangitis. Lymphedema is also observed when lymph node function is blocked by the spread of cancer in the groin and armpit. Malignant lymph node diseases such as Hodgkin ‘ Lymphoma or certain types of leukemia also cause obstruction of lymph flow through lymphatic vessels and lymph nodes. A lymphedema can also arise from obstructive diseases of the venous system. The accumulation of serous and lymphatic fluid in subcutaneous tissue secondary to venous fluid obstruction is known as phlebolephedema.
The causes of lymphedema can be primary if they are acquired at birth or secondary when caused by diseases that result in blockage of lymph fluid flow. In less frequent cases, lymphedema is due to a change in lymph composition. Another possible trigger may be lymph node scarring secondary to infection or lymph node damage from the surrounding cancer. Lymph node damage is also caused by radiation and surgery. In some cases, the lymph node is removed to prevent the spread of cancer, which results in obstruction of lymph flow and lymphedema.