What is Lymphoedema?
What is Lymphoedema?
According to the NHS website: ‘Lymphoedema is a long-term (chronic) condition that causes swelling in the body's tissues. It can affect any part of the body, but usually develops in the arms or legs.
It develops when the lymphatic system does not work properly. The lymphatic system is a network of channels and glands throughout the body that helps fight infection and remove excess fluid.
It's important that lymphoedema is identified and treated as soon as possible. If it is not treated, it can get worse.’
More information, including a useful video, is on the Macmillan Cancer Support website.
How is lymphoedema managed?
There is a range of strategies used in lymphoedema management to reduce and control swelling. They can be used independently or collectively and include:
- Compression: bandaging, compression garments and intermittent pneumatic compression devices
- Lymphatic drainage: manual lymphatic drainage (MLD); a special type of skin massage designed to stimulate the lymphatic system) and simple lymphatic drainage (SLD); a simple type of massage to be performed by patients themselves)
- Exercise and weight management: Exercise promotes lymphatic drainage through muscular action and recent guidelines suggest it is safe and does not exacerbate lymphoedema10. In London, clinicians advise that compression garments should be worn whilst exercising, except for swimming when it is not required. It is increasingly recognised that weight management should be addressed in patients who present with a high BMI.
- Skin care: Important to promote skin integrity and prevent risk of infection, both acute and recurrent.
- Surgical approaches: There are 3 surgical approaches; lymphatic venous anastomosis (LVA), liposuction and lymph node transfer. This is a developing area and not widely available on the NHS.
How does Lymphoedema occur?
According to the Lymphoedema Support Network: ‘If, for whatever reason, the lymphatic system is not working correctly, or the vessels are not draining adequately, the fluid and other materials in lymph build up in the tissues (as when a river is dammed and flooding occurs). Swelling occurs when the amount of fluid in an area is greater than the capacity of the lymphatic system to transport it away. Lymphoedema can be defined as ‘oedema (swelling) due to the accumulation of lymph in the tissues’.
Types of Lymphoedema
Lymphoedema can be described as primary or secondary.
Primary Lymphoedema is usually determined from birth and arises due to some failure of the lymphatic system itself – usually with the underdevelopment of the lymphatic system. It may occur without any obvious cause at different stages in life, but particularly at puberty.
Secondary Lymphoedema is the result of some influence from outside of the lymphatic system that prevents it working properly. Examples of secondary lymphoedema are:
- Surgery – particularly when lymph nodes are removed during treatment for cancer: breast, prostate, gynaecological, head or neck, sarcoma or melanoma.
- Radiotherapy – this kills cancer/tumour cells, but it can also cause scar tissue that interrupts the normal flow of lymph in the lymphatic system.
- Accidental trauma/injury or infection – that may damage the lymph vessels and therefore, reduces drainage of lymph.
- Reduced mobility/paralysis – muscle contractions (during activity/exercise) are important to help the lymph to move
- Problems with veins not working efficiently (varicose veins/after deep vein thrombosis) – often known as venous insufficiency. This results in the lymph system becoming overloaded and unable to function effectively.
- Obesity – this can also cause lymphoedema or exacerbate the problem.
- Cancer itself – may also result in a blockage of the lymphatic system.
Unfortunately, most of the underlying causes of lymphoedema are irreversible and as such, there is currently no known cure – however, appropriate treatment can be implemented to reduce the swelling and keep it to a minimum.