So, what is lymphoedema anyway?
Although many people have never heard of this condition, it affects an estimated 250 million people worldwide. Most notably it affects 1 in 5 people following breast cancer treatment. Lymphoedema is defined as a long-term abnormal swelling in part of the body caused by a collection of lymphatic fluid in the tissues below the skin as a result of a dysfunctional lymphatic system.
We are all familiar with veins and arteries that make up our circulatory system but for some reason the lymphatic system doesn’t get the same airtime.
Blood, containing much needed oxygen proteins, nutrients and water pumps via the arteries to maintain healthy tissues. The tissues use what they need and the excess, as well as waste products, are then removed via the venous and lymphatic systems.
The lymphatic system is a network of vessels and lymph nodes (‘glands’) which drain lymphatic fluid from your tissues. This fluid is made up mostly of water and proteins, and resembles the fluid in a blister.
Almost every tissue has a network of tiny lymphatic vessels, which converge to form larger ones.
These larger lymphatic vessels transport fluid to lymph nodes. The nodes filter the fluid and are responsible for the production of anti-bodies which help fight infection. This is why you may have felt swollen nodes when you are sick. After filtration in the lymph nodes, the fluid finally drains into a large vein close to the heart. It is circulated back into the bloodstream and eventually removed from the body as urine by the kidneys.
The superficial part of the lymphatic system drains and transports lymphatic fluid from the skin and subcutaneous areas which is where most lymphoedema occurs.
What causes a dysfunctional lymphatic system?
Lymphoedema is categorised as either primary, or secondary.
While it can develop at any age, 80% of all primary lymphoedema cases occur between puberty and 35 years of age. It most commonly affects the lower limbs but can affect other areas as well. There may or may not have been a trigger event such as minor trauma, infections or immobility. Often the swelling is mild at first but progresses without treatment.
How do I know if I have lymphoedema?
Lymphoedema signs and symptoms, which occur in your affected limb, include:
- Swelling of part or all of your limb, including fingers or toes
- A feeling of heaviness or tightness
- Aching, discomfort, tingling
- Recurring infections
- Hardening and thickening of the skin (fibrosis)
If you experience any of the above symptoms it is always best to see your doctor and rule out any other causes of swelling, especially if it has begun suddenly. In some instances with a good medical history the diagnosis and cause is very clear and no special tests are required.
Is lymphoedema curable?
Lymphoedema cannot be fully cured and it worsens if not treated. However, it can be effectively managed. There are different stages of lymphedema. Treatment is most effective when started early and works to prevent progression to the next stage.
Stages of lympoedema
Prevention is better than cure
Preventative screening is recommended for patients that have had lymph node removal and/or radiation. e.g. breast cancer treatment. Lymphoedema can occur many years later and is normally triggered by trauma (insect bite, sunburn); infection or even long distance air travel that results in the lymphatic system being unable to effectively clear the lymphatic fluid. It has been shown that breast cancer patients that receive early education and exercises had a reduced incidence of lymphoedema compared to those that did not.
What does lymphoedema treatment entail?
Complete decongestive therapy (CDT) is used to treat lymphoedema. CDT helps the lymphatic system to function better and reduces the collection of lymph fluid in the swollen limb. This type of treatment does not cure the problem and it needs to be maintained regularly.
Treatment involves manual lymph drainage, multi-layer bandaging, compression garments, skin and nail care, exercise.
If you feel that you may have lymphoedema or that you are at risk of developing lymphoedema it is best to seek out a certified lymphoedema therapist. Your therapist will be able to assess your condition and guide you through the next steps of your treatment.
A list of all therapists registered with the Lymphoedema Association of South Africa can be found here: www.laosa.co.za
Written by Sinead Owen.
Douglas, J. & Kelly-Hope, L. (2019) ‘Comparison of Staging Systems to Assess Lymphedema Caused by Cancer Therapies, Lymphatic Filariasis, and Podoconiosis’. Lymphatic Research and Biology. 17(5): 550–556.
Gillespie, T., Sayegh, H., Brunelle, C. et al. (2018) ‘Breast cancer-related lymphedema: risk factors, precautionary measures, and treatments’. Gland Surgery 7(4): 379–403.
The Benefits of Education Plus Early Diagnosis and Treatment of Breast Cancer Related Lymphedema. Available at: www.lymphedemablog.com
Greene, A. (2015) ‘Epidemiology and Morbidity of Lymphedema’. Lymphedema: 33-34.
What is Lymphoedema? Available at: www.laosa.co.za/blog