What is lymphoedema?
Lymphoedema (also spelled as lymphedema) is a chronic condition characterized by the swelling of body parts, typically in the arms or legs, due to the accumulation of lymphatic fluid. The lymphatic system plays a crucial role in maintaining fluid balance and filtering out impurities from the body. When this system is compromised, often as a result of surgery, radiation therapy, infection, or other medical conditions, lymphoedema can occur. It’s essential for those affected to manage the condition with proper care and sometimes with the help of compression garments or physical therapy.
Lymphoedema IS NOT:
- Lymphoedema is not lymphoma. Lymphoedema does not mean someone has cancer. Lymphoma is a broad term for cancer that begins in cells of the lymphatic system.
- Lymphoedema is not contagious. It cannot be “caught” from a person like the flu.
- “Curable.” It is likely that once someone has clinical lymphoedema from Stage 1 and beyond, that the lymphoedema will exist life long. This is why early treatment is so important.
One of the most common causes of lymphoedema is cancer treatment. Lymph nodes are surgically removed for cancer treatment and as lymph nodes drain fluid the body cannot move fluid in the same way. This leads to a build up of fluid in the tissues.
Figures ranging from 4 to 75% (depending on surgery type and risk factors) of patients treated for breast, melanoma, gynecological or prostate cancers will develop lymphoedema.
A medical diagnosis is required. Blood tests cannot diagnose this condition but may be taken in order to exclude other conditions that can cause swelling. There are some specific non-invasive tests for lymphoedema such as use of tape measure to see if there is swelling and bioimpedance spectroscopy to measure fluid levels. Specific lymphoedema tests, requiring an injection of a substance into the body, are called lymphoscintigraphy (to measure the deep lymphatic system) and indocyanine green lymphography (to measure the superficial lymphatic system.)
♦ If you have symptoms of swelling see your Doctor. Do not ignore symptoms of swelling as early treatment is best.
Non-invasive treatment is simple including education, a special form of gentle massage known as manual lymphatic drainage, compression therapy including bandaging and garments, skin care and exercise.
♦ A qualified lymphoedema therapist can provide treatment.
Search for a qualified practitioner on two Australian databases:
Casley-Smith recognised practitioners: www.instituteoflymphoedema.com.au/CANfind
Lymphoedema symptoms and signs
Symptoms of lymphoedema can include:
- visible swelling in a body area
- an aching or tingling feeling (noting that pins and needles is not a symptom of lymphoedema)
- being unable to fully move the affected limb
- tightness or heaviness in the limb
- pitting of the skin
Causes of lymphoedema
Lymphoedema occurs when the lymphatic system has become damaged or overwhelmed.
Some factors that can increase the risk of lymphoedema include include:
- cancer treatments that result in damage to the lymphatic system. Cancer surgery often involves removing lymph nodes. Radiation therapy (radiotherapy), for example, causes scarring of the lymph nodes and vessels. Some chemotherapy drugs may cause swelling and increase lymph load.
- damage to the lymphatic system such as through trauma
- damage to other body systems that will load the lymphatic system mode (such as heart or kidney failure or vein problems)
- being overweight
- an infection in a limb that is at risk of developing lymphoedema
- an existing problem with the lymphatic system
- reduced movement
There are two types of lymphoedema – primary and secondary. You can learn more about each type in the separate blogs:
- primary lymphoedema
- secondary lymphoedema
Diagnosis of lymphoedema
If you are experiencing symptoms you need to see your Doctor. They may ask for tests such as Doppler ( an ultrasound to test if a blood clot is causing your swelling). Your Doctor may refer you to a qualified lymphoedema practitioner for a full assessment. Your lymphoedema therapist may do the following assessments:
You will be asked questions about your symptoms.
Your limbs may be measured with a tape measure to help determine if one side is more swollen than the other
Photographs can help you keep a record of the size of your swollen limb / area
This non-invasive test uses a mild electrical signal to measure how much fluid is in one limb compared to the other
This test requires an injection of a radio-active substance into the body. An X-Ray is then taken. This test shows how quickly your lymphatics can transport materials and which deep lymph nodes your body is using. In a healthy report of someone without any problems in their lower limb lymphatics, dye is injected into the top of the foot and in a few minutes dye can be seen entering the inguinal lymph nodes in the groin. In someone with lymphoedema in their leg, dye is injected into the top of the foot and it moves very slowly out of the lower limb with hardly any dye reading the lymph nodes in the groin.
Green lymphography (also known as ICG)
This test requires an injection of a non radio-active substance into the body. An infra-red light is then shone over the body with makes the lymphatic vessels appear to “glow green.” This test shows how your lymphatics take up fluids that have injected into the tissues. In a healthy report of someone without any problems in their lower limb lymphatics, dye is injected into the top of the foot and in a few minutes dye can be seen flowing through the superficial lymph vessels al the way to the inguinal lymph nodes in the groin. In someone with lymphoedema in their leg, dye is injected into the top of the foot and the foot stays “glowing green” with hardly any dye reading the lymph nodes in the groin.
In a healthy report of someone without any problems in their upper limb lymphatics, dye is injected into the top of the hand and in a few minutes dye can be seen entering the axillary lymph nodes in the underarm. In someone with lymphoedema in their arm, dye is injected into the top of the hand and it moves very slowly out of the forearm and hand limb with hardly any dye reading the lymph nodes in the axilla.
Treatment for lymphoedema
There is no known cure for lymphoedema but it can be managed. Symptoms are easier to manage if lymphoedema is diagnosed early.
Early on treatment will focus on scar care, skin care, a special form of gentle massage known as manual lymphatic drainage and exercise. Your lymphoedema practitioner may also suggest that you wear a compression sleeve or stocking.
People with more advanced lymphoedema may need other lymphoedema treatments including compression therapy (such as bandaging, pumps and more complex garments), manual lymphatic drainage, low level laser treatment or lymphatic surgery. Surgery may be warranted including lymph node transplants, lymphovenous anastomoses and liposuction.