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What is lymphoedema?

What is lymphoedema

Lymphoedema is long term swelling of a limb when the lymphatic system is compromised, overwhelmed or damaged.

MEDICAL DEFINITION: Lymphoedema results in swelling of part of the body. It is an inflammatory condition whereby tissues in a body area will become initially swollen and later fibrosed (which means hard) and fatty. This condition occurs when the lymphatic system has become damaged or overwhelmed.

ALSO KNOWN AS: Lymphedema (U.S. spelling)

DURATION: Chronic (meaning long-term) or lifelong. In order to be diagnosed with this condition swelling needs to have been present for at least 3 months. There is not a cure for lymphoedema nor any medication that makes this condition completely go away.

LYMPHOEDMA IS NOT:

  • Lymphoedema is not lymphoma. Lymphoma is a broad term for cancer that begins in cells of the lymphatic system.
  • Lymphoedema is not cancer.
  • Lymphoedema is not contagious. It cannot be “caught” from a person like the flu

Do not be scared if you have lymphoedema. Treatment can significantly improve the condition so it can be well managed.

CAUSES: One of the most common causes of lymphoedema is cancer treatments which damages lymph nodes. As lymph nodes drain fluid when they are removed or  damaged the body cannot move fluid in the same way and builds up in the tissues. Approximately 20% of patients treated for breast, melanoma, gynaecological or prostate cancers develop lymphoedema.

ASSESSMENT: 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.

TREATMENT: 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 one here: https://www.lymphoedema.org.au/accreditation-nlpr/find-a-practitioner/


Lymphatic system

The lymphatic system is part of both the immune and circulatory systems which include:

Lymph

Lymph is a clear fluid that is found inside lymph vessels. It carries nutrients, waste products and immune cells to lymph nodes.

Lymph vessels

Lymph vessels are a large network of pipes found throughout the body that carry lymph.

Lymph nodes (glands)

Lymph nodes filter lymph fluid and house many white blood cells. Lymph nodes are located throughout the body, including the underarms, neck, abdomen, chest and groin.

Lymph tissue

This includes lymphatic system organs such as bone marrow, spleen, tonsils, thymus and some tissues in the digestive tract (known as gut associated lymphoid tissue).


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

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:

Medical history

You will be asked questions about your symptoms.

Volume measurement

Your limbs may be measured with a tape measure to help determine if one side is more swollen than the other

Photographs

Photographs can help you keep a record of the size of your swollen limb / area

What is bioimpedance spectroscopy?

Bioimpedance spectroscopy is one tool that can be used to measure lylmphoedema. One well known brand is Impedimed’s SOZO device.

Bioimpedance spectroscopy

This non-invasive test uses a mild electrical signal to measure how much fluid is in one limb compared to the other

Lymphoscintigraphy

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.

Abnormal lymph flow is pictured in a and B. Image source: Ekim H, CC BY 2.5 https://creativeco mmons.org/licenses/by/2.5 via Wikimedia Commons

Indocyanine green lymphography

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.

What is indocyanine green lymphography

An example of abnormal lymphatic flow in the arm imaged by indocyanine green lymphography. Image source: Suami H, Heydon-White A, Mackie H, Czerniec S, Koelmeyer L, Boyages J. A new indocyanine green fluorescence lymphography protocol for identification of the lymphatic drainage pathway for patients with breast cancer-related lymphoedema. BMC cancer. 2019 Dec;19(1):1-7.This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecomm ons.org/ licenses/by/4.0/). No changes made.

 


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.