Editing Lymphedema (section)

===Lymph node damage===
Lymphedema is most commonly seen after [[lymphadenectomy|lymph node dissection]], [[surgery]] or [[radiation therapy]] for the treatment of cancer, most notably [[breast cancer]]. In many patients the condition does not develop until months or even years after therapy has concluded.{{Medical citation needed|date=September 2023}} Lymphedema may also be associated with [[accident]]s or certain diseases or conditions that may inhibit the lymphatic system from functioning properly.<ref name="grada-2017" /> It can also be caused by damage to the lymphatic system from infections such as [[cellulitis]].<ref>{{Cite web |date=2017-10-20 |title=Lymphoedema – Causes |url=https://www.nhs.uk/conditions/lymphoedema/causes/ |access-date=2022-06-15 |website=nhs.uk |language=en |archive-date=2022-10-21 |archive-url=https://web.archive.org/web/20221021013232/https://www.nhs.uk/conditions/lymphoedema/causes/ |url-status=live }}</ref> In tropical areas of the world where parasitic filarial worms are endemic, a common cause of secondary lymphedema is [[filariasis]].<ref>{{Cite journal |last=Shenoy |first=R. K. |date=2008-09-20 |title=Clinical and Pathological Aspects of Filarial Lymphedema and Its Management |url=http://www.parasitol.kr/journal/view.php?number=166 |journal=The Korean Journal of Parasitology |language=English |volume=46 |issue=3 |pages=119–125 |doi=10.3347/kjp.2008.46.3.119 |pmid=18830049 |pmc=2553332 |issn=0023-4001 |access-date=2022-06-15 |archive-date=2021-12-02 |archive-url=https://web.archive.org/web/20211202121527/https://www.parasitol.kr/journal/view.php?number=166 |url-status=live }}</ref>

Primary lymphedema may be congenital or may arise sporadically. Multiple syndromes are associated with primary lymphedema, including [[Turner syndrome]], [[Milroy's disease]], and [[Klippel–Trénaunay syndrome]]. In these syndromes it may occur as a result of absent or malformed lymph nodes or lymphatic channels. Lymphedema can be present at birth, develop at the onset of puberty (praecox), or not become apparent for many years into adulthood (tarda). In men, lower-limb primary lymphedema is most common, occurring in one or both legs. Some cases of lymphedema may be associated with other vascular abnormalities.<ref name="grada-2017" />{{Citation needed|date=September 2023|reason=This paragraph needs more medical citations}}

Secondary lymphedema affects both men and women, and, in Western countries, is most commonly due to cancer treatment.<ref name="Brorson2008">{{cite journal | vauthors = Brorson H, Ohlin K, Olsson G, Svensson B, Svensson H | title = Controlled compression and liposuction treatment for lower extremity lymphedema | journal = Lymphology | volume = 41 | issue = 2 | pages = 52–63 | date = June 2008 | pmid = 18720912}}</ref> In women, it is most prevalent in an upper limb after breast cancer surgery, especially [[axillary lymph node]] dissection,<ref>{{cite book|author1=Jeannie Burt|author2=Gwen White|title=Lymphedema: A Breast Cancer Patient's Guide to Prevention and Healing|url=https://archive.org/details/lymphedemabreast00burt|url-access=registration|date=1 January 2005|publisher=Hunter House|isbn=978-0-89793-458-9|pages=[https://archive.org/details/lymphedemabreast00burt/page/9 9]}}</ref> and occurs on the same side of the body as the surgery. Breast and trunk lymphedema can also occur but go unrecognised as there is swelling in the area after surgery, and its symptoms ([[peau d'orange]] and an inverted nipple) can be confused with post surgery [[fat necrosis]].<ref>{{cite web|url=http://www.nhs.uk/ipgmedia/national/Lymphoedema+Support+Network/Assets/BreastandTruncalOedemaLSN8pages.pdf|title=IPS retired|first=NHS|last=Choices|website=nhs.uk|access-date=9 May 2018|archive-date=28 August 2021|archive-url=https://web.archive.org/web/20210828152826/https://www.nhs.uk/retired/pages/ips.aspx|url-status=dead}}</ref>  Between 38 and 89% of breast cancer patients have lymphedema due to axillary lymph node dissection or radiation.<ref name="Brorson2008" /><ref>{{cite journal | vauthors = Kissin MW, Querci della Rovere G, Easton D, Westbury G | title = Risk of lymphoedema following the treatment of breast cancer | journal = The British Journal of Surgery | volume = 73 | issue = 7 | pages = 580–584 | date = July 1986 | pmid = 3730795 | doi = 10.1002/bjs.1800730723 | s2cid = 25777064}}</ref><ref>{{cite journal | vauthors = Segerström K, Bjerle P, Graffman S, Nyström A | title = Factors that influence the incidence of brachial oedema after treatment of breast cancer | journal = Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery | volume = 26 | issue = 2 | pages = 223–227 | year = 1992 | pmid = 1411352 | doi = 10.3109/02844319209016016}}</ref> Unilateral lymphedema of a lower limb occurs in up to 41% of patients after gynecologic cancer.<ref name="Brorson2008" /><ref>{{cite journal | vauthors = Werngren-Elgström M, Lidman D | title = Lymphoedema of the lower extremities after surgery and radiotherapy for cancer of the cervix | journal = Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery | volume = 28 | issue = 4 | pages = 289–293 | date = December 1994 | pmid = 7899840 | doi = 10.3109/02844319409022014}}</ref> For men treated for prostate cancer, a 5-66% incidence has been reported, with the incidence rate depending on whether staging or radical removal of lymph glands was done in addition to radiotherapy.<ref name="Brorson2008" /><ref>{{cite journal | vauthors = Pilepich MV, Asbell SO, Mulholland GS, Pajak T | title = Surgical staging in carcinoma of the prostate: the RTOG experience. Radiation Therapy Oncology Group | journal = The Prostate | volume = 5 | issue = 5 | pages = 471–476 | year = 1984 | pmid = 6483687 | doi = 10.1002/pros.2990050502 | s2cid = 36177502}}</ref><ref>{{cite journal | vauthors = Pilepich MV, Krall J, George FW, Asbell SO, Plenk HD, Johnson RJ, Stetz J, Zinninger M, Walz BJ | title = Treatment-related morbidity in phase III RTOG studies of extended-field irradiation for carcinoma of the prostate | journal = International Journal of Radiation Oncology, Biology, Physics | volume = 10 | issue = 10 | pages = 1861–1867 | date = October 1984 | pmid = 6386761 | doi = 10.1016/0360-3016(84)90263-3}}</ref>

Head and neck lymphedema can be caused by surgery or radiation therapy for tongue or throat cancer. It may also occur in the lower limbs or groin after surgery for colon, ovarian or uterine cancer, if removal of lymph nodes or radiation therapy is required. Surgery or treatment for prostate, colon and testicular cancers may result in secondary lymphedema, particularly when lymph nodes have been removed or damaged.{{medical citation needed|date=September 2023}}

The onset of secondary lymphedema in patients who have had cancer surgery has also been linked to aircraft flight (likely due to decreased cabin pressure or relative immobility). For cancer survivors wearing a prescribed and properly fitted compression garment may help decrease swelling during air travel.<ref>{{cite journal | vauthors = Lim CS, Davies AH | title = Graduated compression stockings | journal = CMAJ | volume = 186 | issue = 10 | pages = E391–E398 | date = July 2014 | pmid = 24591279 | pmc = 4081237 | doi = 10.1503/cmaj.131281}}</ref>

Some cases of lower-limb lymphedema have been associated with the use of [[tamoxifen]], due to blood clots and [[deep vein thrombosis]] (DVT) associated with this medication. Resolution of the blood clots or DVT is needed before lymphedema treatment can be initiated.{{medical citation needed|date=September 2023}}