What is Lymphedema?

Lymphoedema is a swelling caused by a compromised lymphatic system.

The lymphatic system is a network of vessels and nodes throughout the body that transports fluid (lymph) from the body tissues back to the bloodstream. The functions of the lymphatic system are to balance the protein and fluid concentration in the body and to assist the immune process, thereby maintaining good health.

Causes

Lymphoedema may be caused by an under developed lymphatic system (primary) or caused by injury to the lymphatic vessels (secondary). It can occur anywhere in the body. Secondary lymphoedema most commonly occurs after surgery for breast cancer, pelvic cancer and melanoma when lymph nodes were removed or radiated.

Primary lymphoedema While the exact cause of primary lymphoedema is still unknown, it generally occurs due to poorly-developed or missing lymph vessels and/or nodes in the body. Lymphoedema can be inherited. It may be present at birth, develop at the onset of puberty, or not become apparent for many years into adulthood.

Secondary lymphoedema results from damage to the lymphatic system, most commonly caused by surgical procedures for cancer involving the lymph nodes. The National Breast and Ovarian Cancer Centre (NBOCC) review of research evidence on secondary lymphoedema states “conservative estimates suggest that 20% of breast, genitourinary, gynaecological, or melanoma survivors will experience secondary Lymphoedema”. (1)
Other surgical procedures or traumatic injuries may also damage the lymphatic system leading to secondary lymphoedema.

As damaged or removed lymph nodes do not recover or regrow the risk of lymphoedema is lifelong and patients could develop lymphoedema months or even years after the lymphatic damage has occurred. Primary and secondary lymphoedema can occur together.

Diagnosis

An accurate diagnosis is essential for appropriate therapy. This is determined from the clinical history and physical examination.

Symptoms

These may include swelling of a limb or fluid build up in other body areas such as the head, neck and trunk. Other symptoms may include aching, heaviness, stiffness, limitation of movement, and/or temperature changes.

Stages and Severity

Whether primary or secondary, lymphoedema develops in stages, from mild to severe.

Infections

Whether a patient has lymphoedema or is at risk of developing lymphoedema, it is vital that they be aware of the symptoms of infection (known as cellulitis) and seek urgent treatment at the first sign. In addition to the inherent danger of infection, recurrent cellulitis can further damage the lymphatic system and set up a vicious circle of increasing swelling. The first sign of an infection is redness and warmth of the affected body part and generally feeling unwell. Medical attention should be sought without delay.

References

National Breast and Ovarian Cancer Centre. Review of research evidence on secondary lymphoedema: Incidence, prevention, risk factors and treatment, NBOCC, Surry Hills, NSW, 2008. Document can be downloaded from http://www.nbocc.org.au/breasthealth/careafter/lymphoedema.html
Australasian Lymphology Association Web page and brochure www.lymphology.asn.au