What is Lymphoedema?
Lymphoedema is the accumulation of excessive amounts of protein rich fluid resulting in swelling of one or more regions of the body.
The condition usually affects the one or more limbs although it may also involve the trunk, breast, head and neck or genital area.
The lymphatic system is a network of vessels and nodes throughout the body that transports lymph fluid from the body tissues back to the bloodstream. The functions of the lymphatic system are to maintain the volume and protein concentration of the extracellular fluid in the body and to assist the immune system.
What causes Lymphoedema?
Lymphoedema may arise because the lymphatic vessels or nodes have been damaged or were not formed correctly.
Secondary lymphoedema is the most common type developing following damage to the lymphatic system. The damage may occur as a result of some cancer treatments including the removal of lymph nodes, following radiotherapy to lymph node groups or with the progression of malignant disease. The onset of lymphoedema may be at any time. It may occur within months of the damage or it may appear years later.
Secondary lymphoedema may also arise without a cancer diagnosis when one or more of the following conditions occur:
- Trauma and tissue damage
- Venous disease
- Immobility and dependency
- Factious – self harm
- Infection such as cellulitis
- Filariasis – Lymphatic filariasis is a major cause of lymphoedema in the sup-tropical areas of the world. Parasitic fitarial worms are transmitted through mosquito bites. The parasites lodge in the lymphatic system causing destruction of the healthy vessels and modes resulting the lymphoedema. More information can be found on the WHO web site: http://www.who.int/tdr/diseases/lymphatic-filariasis/en/
Primary Lymphoedema in comparison to Secondary Lymphoedema is the result of a congenital condition that affects how the lymph vessels where formed. This may result in Hypoplasia of lymphatic vessels (a reduced number of lymphatic vessels). Hyperplasia of lymphatic vessels (vessels that are too large to be functional) or aplasia (absence) of some part of the lymphatic system. This form may be presents at birth (congenital), develop at the onset of puberty (praecox), or not become apparent for many years into adulthood (tarda). It may be associated with other congenital abnormalities/syndromes
Primary and secondary lymphoedema can occur together.
Causes of Lymphoedema
Any major damage to the lymphatic system causes a life-long risk of lymphoedema
- Primary – due to a congenital malformation of the lymphoedema
- Secondary – due to damage to lymph nodes (surgery/radiation), infection or trauma
- Mixed lymphoedema – combined with venous disease, immobility or lipoedema (abnormal deposition of fat tissue)
Patients most at risk of developing secondary Lymphoedema include:
- any patients who has been treated for cancer where the lymph nodes have been removed or damaged during surgery and/or radiation
- cancer patients who have been identified as being most at risk include those treated for breast, melanoma, gynaecological and prostate cancer.
Key risk factors
The stage, location and severity of lymphoedema, together with the individual circumstances of the patient play a vital role in managing the condition.
Key risk factors include:
- the extent of surgery, lymph node dissertion and radiation treatment
- wounds, trauma, infection (cellulitis & fungal infections)
- increased body mass index (BMI) and immobility
Early signs and symptoms
Many conditions may cause similar symptoms however, if early warning signs are experiences, other possible causes of the swelling should be excluded.
Early warning signs of lymphoedema can be intermitted and may include:
- swelling of the limb or other region of the body after surgery, even if intermitted
- infection (due to lymph stasis) is often the first sign of a problem
- feeling of aching, heaviness, stiffness in the affected body part
- limitation of movement
- tightness or temperature changes to areas of the body clothing, jewellery or shoes may feel tighter
- swelling may be aggravated by heat, overuse, sustained positions and prolonged inactivity and more obvious at the end of the day
- permanent swelling of more than 3 months (pitting in early stages)
- usually asymmetrical, especially when affecting the upper limb
- Stemmer’s sign positive (unable to pinch the skin at the base of the second toe)
Referral to accredited Lymphoedema Practitioner
Lymphoedema is a chronic condition that qualifies the patient for the Chronic Disease Management Plan
Complex Lymphoedema therapy (CLT) or Complex Decongestive Therapy (CDT) is the treatment of choice in Australia consisting of:
- Skin care
- Manual Lymphatic Drainage
- Compression therapy
For more information: www.lymphoedema.org.au