Lymphedema (Elephantiasis) Treatment

Lymphatic System Disease: What is Lymphedema (Elephantiasis)?

Lymphedema (Elephantiasis) is a swelling condition caused by the accumulation of lymph fluid in the tissues. Lymph fluid, formed as a result of cellular activity in our bodies, passes through the lymph vessels and lymph nodes, is then purified, and then enters the bloodstream. This disruption of circulation causes lymph fluid to accumulate, causing swelling in certain areas of the body, most commonly the arms and legs. This is called "lymphedema." Lymphedema can also occur in the face, neck, abdomen, and lungs.

Lymphoedema (elephantiasis) is most common in those undergoing cancer treatment and those with congenital lymphatic system insufficiency. If the armpit lymph nodes are removed during cancer treatment and radiotherapy is administered, lymph fluid can accumulate in the arms, causing swelling, or lymphedema, in the legs. If the inguinal lymph nodes are removed during cancer treatment and radiotherapy is administered, lymphedema can accumulate in the legs, causing swelling.

There are treatment methods to manage both lymphedema caused by this condition and lymphedema caused by congenital lymphatic system insufficiency, which occurs more commonly in the legs.

Where in the Body Does Lymphedema (Elephantiasis) Occur?

Lymphoedema usually occurs in the arms and legs, and the affected area depends on the underlying cause. Arm lymphedema is particularly common in patients undergoing breast cancer treatment. Up to 30 percent of breast cancer patients may develop arm lymphedema following lymph node removal or radiation therapy.

Arm Lymphedema

Patients undergoing breast cancer treatment frequently develop arm lymphedema. This condition usually occurs after lymph node removal or radiation therapy. In developed countries, arm lymphedema is a common condition related to breast cancer treatments.

Leg Lymphedema

Leg lymphedema can occur after treatment for conditions such as gynecological cancers, prostate cancer, and melanoma. Leg lymphedema due to infections is more common in regions such as Asia, South America, and Africa, especially in developing countries.

Elephant Foot Disease

Elephant foot disease is an advanced stage of lymphedema that has been left untreated or caused by infection. It is characterized by thickening, hardening, and extreme swelling of the skin and tissues. Over time, the skin hardens and thickens, and the legs take on an "elephant foot" appearance.

The causes of elephant foot disease are as follows:

• Lymphatic filariasis: A parasitic disease transmitted by mosquitoes and is particularly common in Asia, Africa, and South America.
• Severely neglected lymphedema: Lymphedema left untreated for a long time can progress to elephantiasis over time.

Who is Affected by Lymphedema (Elephantiasis)?

Although lymphedema can occur in individuals of all ages and backgrounds, factors such as a history of cancer and chemotherapy, excess weight, or location of residence may increase the risk of lymphedema.

Elephantiasis risk factors include:

• Cancer and cancer treatments: Surgery, particularly those involving lymph node removal, or radiation therapy (radiotherapy) can disrupt lymphatic drainage and cause lymphedema.
• Skin diseases: Skin infections, especially cellulitis, can damage lymphatic vessels.
  Tropical regions: Parasitic infections such as filariasis in tropical regions also increase the risk of lymphedema.
• Excessive weight: Lymphatic flow can be compromised, making lymphedema more likely, especially in individuals with a body mass index over 60.
• Vascular diseases: Vascular diseases such as chronic venous insufficiency can strain the lymphatic system, leading to fluid accumulation.
• Inactivity: Limited mobility, such as decreased mobility due to disease or arthritis, can impede lymphatic flow and increase the risk of lymphedema.
• Trauma: Large bruises or soft tissue damage resulting from trauma can affect the lymphatic vessels.
• Genetic disorders: Congenital genetic disorders, such as Milroy disease and Meige disease, can cause primary lymphedema.

What are the symptoms of lymphedema?

Lymphedema usually manifests as swelling in the arms or legs. In the early stages, mild swelling and a feeling of heaviness may be experienced, but if not treated promptly, more serious symptoms can develop. This condition manifests as skin tightness, hardness, and thickening. Additionally, skin discoloration and scarring may occur.
Symptoms of elephantiasis may include:

• Swelling
• A feeling of heaviness and tension
• Skin tension and hardness
• Limited movement
• Skin color changes
• Pain and discomfort
• Recurrent infections
• Skin sensitivity and itching
• Skin hardening and fibrosis
• Deeply pitted scars

If left untreated, lymphedema can become chronic and cause more serious health problems. Early diagnosis and management with appropriate treatment methods are crucial in this regard. Being informed about lymphedema is an important step in managing this condition. Consulting a professional healthcare professional and evaluating appropriate treatment options is critical for minimizing the effects of lymphedema.

Limited Mobility

Swelling can cause limited mobility, making daily activities difficult and reducing quality of life. Significant swelling and difficulty in movement can be observed, especially in the fingers or toes. Additionally, pain and discomfort in the affected area are common.

Skin Infections

People with lymphedema are frequently at risk of infection. The accumulation of lymph fluid creates a favorable environment for the proliferation of bacteria and viruses, which can lead to skin infections such as cellulitis. Therefore, it is crucial to recognize the symptoms of lymphedema early and begin treatment.

Leg Lymphedema Symptoms

Among the symptoms of leg lymphedema, leg swelling is the most prominent. The swelling usually begins in the ankle and spreads upward over time.
Leg lymphedema symptoms may include:

• A feeling of heaviness and fullness in the legs
• Skin tension and hardening
• Limited movement
• Skin color changes and recurring infections
• Cellulite

It's important for people who notice these symptoms in their legs to consult a specialist.

Lymphoedema Symptoms in the Arm

Lymphoedema symptoms in the arm are similar to those in the leg. It typically manifests as swelling in the arm and hand. The swelling increases throughout the day and doesn't subside with rest.

Lymphoedema symptoms in the arm may manifest as follows:

• A feeling of heaviness and fullness in the arm and hand
• Skin tension and hardening
• Limited movement
• Color changes
• Skin thickening and recurring infections

What Causes Lymphedema (Elephantiasis)?

Elephantiasis is a chronic condition caused by blockages in the lymphatic system. The lymphatic system is important for maintaining fluid balance in the body and supporting immune system functions. The causes of lymphedema generally fall into two main groups:

Primary lymphedema: It is congenital or occurs due to genetic causes.
Secondary lymphedema: It usually develops due to external factors.

Congenital Causes

Primary lymphedema, which results from congenital causes, can be present from birth or become apparent later in life. Genetic mutations can prevent the lymph vessels and nodes from functioning properly, which can be a direct result of lymphedema. Individuals with a family history of lymphedema are at higher risk of developing this condition.

External Causes

Secondary lymphedema, which develops due to external factors, usually occurs as a result of surgery, radiation therapy, infections, or trauma. Individuals undergoing cancer treatment, especially women undergoing breast cancer surgery, are at increased risk of developing lymphedema as a result of lymph node removal or damage. Additionally, serious infections or injuries can damage the lymphatic system and lead to the condition. Parasitic infections such as elephantiasis are particularly common in tropical regions and are another common cause of lymphedema.

What are the Types of Lymphedema?

Lymphedema is divided into two main types, primary (genetic) and secondary (acquired), depending on its cause. While each type develops through different mechanisms, symptoms can be managed with appropriate treatment.

Primary (Congenital) Lymphedema

Primary lymphedema occurs when the lymphatic vessels are underdeveloped while the baby is in the womb. However, healthy vessels in the body take over the functions of the underdeveloped vessels, ensuring the system functions properly.

Excessive stress on the lymphatic system (trauma, pregnancy, infection, puberty) can trigger the development of lymphedema symptoms. Primary lymphedema can occur in one leg, or it can begin in just one leg and affect the other.

Secondary Lymphedema

In secondary lymphedema, the lymphatic system functions normally from birth, but it develops after surgery or radiation therapy due to cancer.
Factors to consider for secondary lymphedema include:

• Cancer Treatment: During cancer surgery, the cancerous area is removed along with the associated lymph nodes. This surgery can disrupt lymph flow over time and cause lymphedema. For example, during breast cancer treatment, lymphedema may develop in the arm, depending on the number of lymph nodes removed from the armpit along with the breast.
• Radiation Therapy: Even if surgery is not performed in cancer treatment, radiation therapy can disrupt lymph node function, causing lymphedema. However, removal of lymph nodes does not guarantee that the patient will develop lymphedema.

Lymphedema can develop over time due to triggering factors. The incidence of lymphedema in breast cancer patients who have their axillary lymph nodes removed and undergo radiation therapy is 25%. It can be estimated that one in every four breast cancer patients develops lymphedema under these circumstances.

Lymphoedema Due to Chronic Venous Insufficiency

Venous insufficiency is defined as the inability of the veins to adequately return blood to the heart. Venous insufficiency is most common in the area below the knee, as it is the furthest point from the heart.

The lymphatic system attempts to assist the malfunctioning venous system in returning blood to the heart. During this assistance, the lymphatic system is overloaded, causing the lymphatic valves to malfunction, resulting in lymphedema.

Lymphoedema Due to Lipedema

Lipedema is a condition of unknown cause in women and is very rare in men. The condition sometimes begins at the onset of menstruation and sometimes during pregnancy. Lipedema manifests as symmetrical fat accumulation in both legs. Lipedema can also occur in the arms.

With increased body fat, the amount of water and protein the lymphatic system is responsible for transporting also increases. As a result, the overactive lymphatic system becomes damaged over time and becomes unable to function properly. Lymphedema associated with lipedema develops in this way.

Lymphedema (Elephantiasis) Diagnostic Methods

The patient's medical history and physical examination play an important role in the diagnosis of lymphedema. The first step is to evaluate the patient's symptoms and family history. During the physical examination, the affected area is examined for swelling, skin changes, and limited movement. Various imaging and laboratory tests may be used for a more detailed evaluation.

Lymphedema diagnostic methods include:

• Lymphoscintigraphy: This test uses a radioactive substance to evaluate the function of the lymphatic system. After the substance is injected into the body, lymph flow is monitored to determine if there are any blockages.
• Ultrasound: This test is used specifically to evaluate the size and condition of lymph nodes. Ultrasound is effective in detecting abnormalities that may occur in the lymph nodes.
• Magnetic Resonance Imaging (MRI): This test is used to provide a detailed view of the causes and effects of lymphedema. MRI provides detailed images of soft tissue and lymph nodes.
• Computed Tomography (CT) Scan: This test is used to evaluate the structure and function of lymph nodes and lymph vessels. CT scans provide detailed images to determine the extent of lymphedema.
• Bioimpedance Spectroscopy: This test uses electrical currents to measure fluid accumulation in the body and can be effective even in the early stages of lymphedema. This method plays an important role in the early diagnosis of lymphedema.
• Parametric Measurements: Determine the degree of lymphedema by measuring the circumference of the affected limb. This method is used to monitor the progression of lymphedema.
• Volumetric Evaluations: These are performed using water immersion and determine increases in limb volume. This measurement is used to evaluate the severity of lymphedema and its response to treatment.
• Laboratory Tests: Used to identify other underlying health problems and the cause of lymphedema. Blood tests may be performed to check for signs of infection or inflammation and can help identify secondary causes of lymphedema.

Early diagnosis is critical to the success of lymphedema treatment. Therefore, it is important for individuals experiencing lymphedema symptoms to consult a healthcare professional and undergo the necessary tests. After diagnosis, appropriate treatment options can be determined, improving the patient's quality of life.

Lymphedema Treatment Options

The goal of lymphedema treatment is to relieve symptoms and improve the patient's quality of life. Early diagnosis and adherence to treatment are crucial for preventing the progression of lymphedema and maintaining the patient's quality of life.

Manual Lymph Drainage

Manual lymph drainage is a specialized massage technique used to stimulate the movement of lymph fluid. This massage method should be performed by a professional therapist and repeated regularly. MLD reduces the accumulation of lymph fluid, alleviating swelling and improving lymphatic circulation.

Compression Therapy

Compression therapy plays an important role in the treatment of lymphedema. Compression bandages or stockings apply pressure to the affected area to prevent the accumulation of lymph fluid. This helps reduce swelling and restore normal lymphatic circulation. Additionally, pneumatic compression devices create a similar effect by using air pressure to move lymph fluid. These devices may be particularly suitable for home treatment.

Exercise

Exercise is a critical part of lymphedema treatment. Light, regular exercise stimulates the circulation of lymph fluid by creating a muscle pumping effect. Specifically designed lymphedema exercise programs increase mobility and reduce swelling. However, it is important that the exercise program be recommended and supervised by a specialist. Improperly performed exercises can worsen the condition.

Skin Care

Skin care plays a critical role in lymphedema treatment. Keeping the affected area clean and dry is essential to prevent skin infections. Moisturizers should be used to prevent skin dryness. Furthermore, skin damage such as cuts, wounds, and insect bites should be avoided. Such damage can increase the risk of infection.

Super Microsurgery

Lymphedema is a chronic condition that can occur especially after cancer treatments or surgical procedures. It is characterized by fluid accumulation and swelling in certain areas of the body. In the early stages, methods such as compression therapy and manual lymph drainage are used, while in advanced stages, surgical intervention may be necessary. Supermicrosurgical techniques significantly reduce symptoms by returning lymph fluid to the circulation. New surgical methods such as lymphovenous anastomosis (LVA) and lymph node transfer (LNT) offer effective results in the treatment of lymphedema.

Supermicrosurgical Treatment of Lymphedema

Lymphedema is a chronic disease characterized by fluid accumulation and swelling in specific areas of the body, often occurring after surgery or cancer treatments. In the early stages, conservative treatment methods such as compression therapy, manual lymph drainage, and exercises can be used. These methods aim to help reduce swelling and improve the patient's quality of life.

However, when conservative treatments prove inadequate and symptoms recur, microsurgical procedures are used. Methods such as lymphovenous anastomosis (LVA) and lymph node transfer (LNT) have yielded effective results for many patients in the treatment of lymphedema.

Lymphovenous Anastomosis (LVA)

LVA is the process of connecting blocked lymph vessels to the venous system using surgical microscopes. This method restores the natural flow of lymph fluid. Studies have shown that LVA reduces symptoms by 70-90% in patients with early-stage lymphedema. This procedure, performed through small incisions, offers a rapid recovery due to its minimally invasive nature.

Lymph Node Transfer (LNT)

This technique, used in cases of lymph node damage, involves taking healthy lymph nodes from another part of the body and transferring them to the affected area. According to one study, surgeries using this method provide permanent symptom relief in 60-80% of patients.

Excisional (Debulking) Procedures

Excisional (debulking) procedures are surgical procedures performed to reduce or remove excess fat and fibrous tissue that develop in advanced lymphedema. Liposuction is used in this context, particularly in cases where significant fat accumulation is present, and is generally supported by continuous compression therapy postoperatively. Excisional surgery, on the other hand, involves the removal of skin and subcutaneous tissue using techniques such as the Charles procedure. However, with the development of less invasive methods, excisional surgery is now more often limited to severe cases.

Advantages of Surgical Procedures

Lymphedema surgery offers an effective treatment option for patients whose symptoms cannot be relieved by conservative methods or who experience recurrence. LVA and LNT can produce highly successful results when applied to the right patient group. Significant improvement is observed in 80% of patients after LVA surgery, while long-term results have been achieved with LNT interventions.

To increase the success of surgical procedures, it is important for patients to continue conservative treatment after surgery. Regular follow-up and treatment can significantly improve patients' quality of life.

Things Those with Lymphedema Should Pay Attention to

Caring for and protecting the extremities at risk of lymphedema and those with lymphedema is crucial. Following treatment, patients should also pay attention to the following points to ensure continued success:

• Skin cleanliness and dryness should be ensured: The affected area should be cleaned daily, not left damp, and oil-free moisturizers should be used to maintain dryness.
• Skin trauma should be avoided: Care should be taken against cuts, burns, and insect bites; gloves are recommended.
• Nail and hair care should be done carefully: The skin should not be damaged during nail cutting, a shaving machine should be preferred, and the razor should be avoided.
• Sun protection should be maintained: Sun exposure should be avoided, and sunscreen with a high protection factor should be used.
• Strainful movements should be avoided: Heavy lifting, pushing, and pulling with the affected limb should be avoided.
• Appropriate exercises should be performed: Swimming and water exercises, which support lymphatic circulation, should be preferred, and exercises recommended by your doctor should be performed regularly.
• Tight clothing and jewelry should be avoided: Constrictive clothing and jewelry can impede lymphatic flow; the use of wide-strapped clothing and cotton pads is recommended.
• Blood pressure measurement should not be done from the affected limb: The measurement should be performed from the healthy arm or leg.
• Compression should be applied during air travel: Compression socks or bandages should be used against pressure changes.
• Sleep in a suitable position: Avoid lying on the affected limb; choose your position carefully.
• A balanced diet should be followed and weight should be monitored: Excessive salt consumption should be avoided and excess weight should be avoided.
• Compression garments should be used regularly: They should be worn day and night, especially for the first 6 months after treatment, and the instructions for use should be followed.
• Monthly circumference measurements should be made: Changes in the limb should be monitored and reported to the therapist regularly.
• Post-treatment care should not be neglected: Even if the swelling subsides, care must be continued as the lymphatic system will remain weak.

How to Protect the Lymphatic System?

The lymphatic system plays an important role in maintaining the immune system and fluid balance in the body. It is beneficial to adopt habits that support the lymphatic system to protect yourself from lymphedema and similar lymphatic diseases. To protect the lymphatic system, you can follow these recommendations:

• Exercise Regularly: You can support lymphatic circulation with regular exercise, such as light walking, swimming, or cycling.
• Eat Healthy: Avoid salty and fatty foods; Help speed up lymphatic flow by drinking plenty of water.
• Protect Your Skin: To reduce the risk of skin wounds or infections, take care of your skin and pay attention to hygiene rules.
• Avoid Tight Clothing: Stay away from tight clothing, jewelry, and tight elastic bands that can hinder lymphatic circulation.
• Avoid Staying inactive for Long Periods of Time: If you must sit or stand for long periods of time, support lymph flow by moving periodically.

If you have risk factors related to your lymphatic system, it's important to have a regular evaluation by a specialist. With these simple precautions, you can protect the health of your lymphatic system and reduce the risk of lymphedema.

Frequently Asked Questions About Lymphedema

What is Lymphedema?

Lymphedema is swelling caused by fluid accumulation in the tissues due to blockages in the lymphatic system.

What Are the Symptoms of Lymphedema?

The most common symptoms include swelling in the arm or leg, a feeling of heaviness, skin tightness, and limited movement.

How Is Lymphedema Treated?

Treatment methods include manual lymphatic drainage, compression garments, exercise, and skin care.

What Causes Lymphedema?

Lymphedema can occur due to lymph node removal, radiation therapy, infections, or congenital lymphatic system problems.

How to Live with Lymphedema?

Living with lymphedema becomes more manageable with regular treatment, a healthy diet, skin care, and regular exercise.

How Is Lymphedema Diagnosed?

Diagnosis is made through a physical examination, medical history, and sometimes imaging tests such as lymphoscintigraphy.

How Can Lymphedema Progression Be Prevented?

Progression can be prevented with early diagnosis and treatment, avoidance of skin infections, and regular follow-up.

Is Lymphedema Genetic?

In some cases, it can be genetic, but it most often develops as a result of external factors such as surgery or infections.

Does Lymphedema Cause Pain?

Pain or discomfort may occur due to swelling and skin tightness.

Which Doctors Should I See for Lymphedema?

Treatment for lymphedema usually involves physical therapists, lymphologists, or dermatologists.

Are the Symptoms of Lymphedema in the Leg Different?

Similar symptoms are also seen in the legs; they usually manifest as swelling, fullness, and skin changes.

How Is Lymphedema Treated?

In addition to physiological and excisional surgery, methods such as manual lymph drainage, compression, and exercise can be used in combination.

In Which Situations Are Surgical Interventions Preferred?

Surgical interventions are recommended for advanced-stage lymphedema or cases resistant to other treatments.

Are Physiological Procedures Permanent?

They provide long-term relief with the right patient selection, but results can vary from person to person.

What Should Be Considered After Excisional Procedures?

Long-term compression and regular follow-up are generally required; meticulous care is crucial.

What Can Be Done in Daily Life to Increase Treatment Success?

Regular exercise, a healthy diet, following your doctor's recommendations, and using compression products correctly are beneficial.

Does Lymphedema Go Away?

Complete recovery may not always be possible. However, early diagnosis and regular treatment can largely control swelling.

Is Lymphedema Dangerous?

If left untreated, it can lead to problems such as infection (e.g., cellulitis) and tissue damage. Therefore, it is important to seek professional support.

At What Ages Is Lymphedema More Common?

It occurs more frequently in middle-aged and older adults, particularly due to factors such as cancer treatment (e.g., breast cancer surgery or radiation therapy). Congenital (primary) lymphedema can sometimes begin to show symptoms in childhood or adolescence.

Is Turmeric Good for Lymphedema?

Turmeric (thanks to its curcumin content) is considered a herbal supplement with anti-inflammatory properties. However, there is insufficient scientific evidence that turmeric alone is sufficient to directly treat lymphedema or provides significant improvement.

Is Lymphedema Dangerous?

If left untreated, lymphedema can lead to infection, skin disorders, and limited mobility. Early diagnosis and regular follow-up can prevent serious health problems.

How Do We Know If We Have Lymphedema?

It manifests as persistent swelling, tension, and a feeling of heaviness in the affected area. Skin thickening and recurring infections are also significant symptoms.

Can Lymphedema Be Treated?

With early diagnosis and appropriate treatment, it can be controlled and symptoms can be alleviated. However, in some cases, it can become chronic and require ongoing care.