What is Lymphoedema? | Luke Davies

What is Lymphoedema

Lymphoedema is a chronic swelling of one or more limbs or body regions, such as the arms, legs and neck, breast or genitals [1-3]. Lymphoedema is a condition that occurs when the body’s system for managing fluid doesn’t work as it should. Normally, fluid moves through the body to nourish tissues and remove waste, but in lymphoedema, this process is disrupted. This can happen because the fluid isn’t being transported effectively, or too much fluid is being produced. When this balance is thrown off, the extra fluid collects in the spaces between cells, causing swelling. Over time, this swelling can lead to discomfort, skin changes, and a feeling of heaviness in the affected area [4].

Primary lymphoedema is caused by a congenital issue, meaning the lymphatic system didn’t develop properly from birth. Secondary lymphoedema occurs when the lymphatic system is damaged or disrupted later in life, often due to surgery, injury, or treatments like those for cancer. Both types result in fluid buildup and swelling because the lymphatic system can’t work as it should [4]. Whether primary or secondary and regardless of its stage, lymphoedema is a long-term condition that requires continuous care and management. It can affect not only a person’s physical health but also their emotional well-being and social interactions [5-7]. Additionally, individuals with lymphoedema are at an increased risk of developing cellulitis, a serious skin infection that can extend into the underlying tissues [8]. Watch the short below from the Cleveland Clinic on the right describing how the Lymphatic System works.

What are the early warning signs

The early warning signs of lymphoedema can be intermittent and may include:

Transient swelling of a limb or other region of the body. Swelling may be aggravated by heat, overuse, sustained positions, inappropriate external compression, due to underwear or garments, prolonged activity, and be more obvious by the end of the day
Recurrent cellulitis
Feelings of aching, heaviness, stiffness in the affected body part
Decreased range of movement in the affected body part
Tightness of the affected body part – clothing, jewellery or shoes may feel tighter

Many conditions may cause the symptoms described above. If any of these warning signs are present, other possible causes of the swelling should be excluded through a differential diagnosis which involves review of the person’s complete lifetime surgical history, medical history, family history of swelling and current medications [9].

Importance of early diagnosis

Lymphoedema cannot be cured, but it can be managed with the right diagnosis and care from a trained lymphoedema practitioner. Early detection and treatment are crucial to prevent the condition from worsening. If left untreated, lymphoedema can progress from mild to severe, increasing the risk of complications [10]. Treatment aims to reduce swelling, relieve symptoms, prevent infections, and improve quality of life.

For those with Secondary Lymphoedema, swelling may develop years after cancer treatment. Many cancer services now provide pre-treatment assessments and ongoing monitoring for early signs of lymphoedema, but being aware of the condition is key to early detection

Stages of Lymphoedema

Lymphoedema, whether primary or secondary, progresses through stages, ranging from mild to severe. In Australasia, the most widely used staging system is based on the guidelines established by the International Society of Lymphology (ISL) [11].

References

1. Padera TP, Meijer EF, Munn LL. The lymphatic system in disease processes and cancer progression. Annual Review of Biomedical Engineering. 2016; 18: 125-58

2. Rockson SG. Update on the biology and treatment of lymphedema. Current Treatment Options in Cardiovascular Medicine. 2012; 14(2): 184-92.

3. Mortimer PS, Rockson SG. New developments in clinical aspects of lymphatic disease. The Journal of Clinical Investigation. 2014; 124(3): 915.

4. International Lymphoedema Framework, International consensus: Best practice for the management of lymphoedema. London; 2006.

5. Pusic AL et al. Quality of life among breast cancer patients with lymphedema: a systematic review of patient-reported outcome instruments and outcomes. Journal of Cancer Survivorship. 2013; 7(1): 83-92.

6. Cemal Y, Pusic A, Mehrara BJ. Preventative measures for lymphedema: separating fact from fiction. Journal of the American College of Surgeons. 2011; 213(4): 543-51.

7. Paskett ED et al. Cancer-related lymphedema risk factors, diagnosis, treatment, and impact: a review. Journal of Clinical Oncology. 2012; 30(30): 3726-33.

8. Raff AB, Kroshinsky D. Cellulitis: A Review. JAMA 2016; 316(3): 325-37.

9. Australasian Lymphology Association. What is lymphoedema?. Access: https://www.lymphoedema.org.au/about-lymphoedema/what-is-lymphoedema/#Risk%20Factors

10. Executive Committee of the International Society of Lymphology. The diagnosis and treatment of peripheral lymphedema: 2020 Consensus Document of the International Society of Lymphology. Lymphology. 2020;53(1):3-19. PMID: 32521126.

11. Executive Committee of the International Society of Lymphology. The diagnosis and treatment of peripheral lymphedema: 2020 Consensus Document of the International Society of Lymphology. Lymphology. 2020;53(1):3-19. PMID: 32521126.