Lymphoedema

Lymphoedema

Lymphoedema is considered a chronic, potentially progressive condition resulting from failure of the lymphatic system to drain fluid and proteins from tissue throughout the body and return it to the circulatory system. Early detection, early intervention is the goal standard approach to treating lymphoedema , and when not treated in a timely fashion, becomes more complex.

There are two main types of lymphoedema: Primary lymphoedema is caused by abnormal development of the lymphatic system and symptoms may be present at birth, develop at puberty or in midlife, often triggered by hormonal or traumatic or stressful situations.

Secondary lymphoedema is caused by damage to an otherwise healthy lymphatic system including venous disease, reduced mobility, cellulitis, obesity, trauma and oncology / cancer related Lymphoedema when the lymphatic system is compromised the result is swelling, most typically in the limbs but can affect any part of the body including breast, trunk, genitalia and face.

Cancer Related Lymphoedema

Cancer related lymphoedema is a condition which may result from treatments such as surgery , radiation , chemotherapy for some cancers including :

  • Breast Cancer
  • Melanoma
  • Pelvic / Gynae cancers

If lymphoedema is left untreated , it can cause painful swelling , may lead to infection (cellulitis) and become a life-long condition

Prospective surveillance is the preferred philosophy in relation to lymphoedema detection. Early detection permits early intervention.

Non Cancer Related Lymphoedema

Non-cancer related lymphedema are diseases or conditions (not caused by cancer) that affect the lymphatic system, the network of tissues, vessels, and organs that move a specific fluid called lymph throughout the body. They occur when the lymphatic system is damaged or blocked, preventing lymph from circulating normally. Left untreated, these disorders can cause pain, heaviness, swelling, and other complications such as skin infections.

Non-cancer related lymphedema can also be secondary to a disease or condition:

  • Severe venous insufficiencies (when the veins have trouble sending blood from your limbs back to your heart)
  • Surgeries to treat non-cancerous conditions
  • Lymphatic system infections or trauma
  • Obesity

It’s important that you seek treatment immediately if you think you are experiencing this condition, as it will not go away on its own. If left untreated, lymphedema can cause serious long-term consequences.

 

The management often includes a multidisciplinary team, which addresses the following:

  • the underlying condition causing oedema and/or factors affecting wound healing
  • Compression therapy and oedema management
  • Encouragement of exercise/increased mobility, enhancing the venous and lymphatic return.

Stages of Lymphoedema

There are three basic stages of lymphedema. The earlier lymphedema is recognised and diagnosed, the easier it is to successfully treat and avoid many complications.

LATENT – STAGE 0 

  • Lymphatic transport capacity reduced
  • No visible/palpable oedema
  • Subjective complaints are possible such as a feeling of heaviness, skin tightness, aching or discomfort.

STAGE 1

  • Reversible lymphoedema (mild)
  • Accumulation of protein rich oedema fluid
  • Pitting oedema
  • Reduces with elevation (no fibrosis)
  • Upon waking in the morning the limb or affected area is almost a normal size.
  • The tissue is still in a “pitting stage” (when pressed by a finger the area indents and holds the indentation).

STAGE 2

  • Spontaneously Irreversible Lymphoedema (moderate)
  • Accumulation of protein rich edema fluid
  • Pitting becomes progressively more difficult
  • Connective tissue proliferation (fibrosis)
  • Connective tissue proliferation (fibrosis)

STAGE 3

  • Lymphostatic Elephantiasis (severe)
  • Accumulation of protein rich edema fluid
  • Non pitting oedema
  • Fibrosis and sclerosis (severe induration)
  • Skin changes (papillomas, hyperkeratosis)
  • The tissue at this stage is hard (fibrotic) and will only be slightly responsive to the touch.
  • The limb is very large and swollen and the swelling is almost irreversible.
  • Infections are possible at any stage of lymphoedema but occurrence becomes greater as the stages progress. A swollen limb left untreated becomes hard and full of lymph fluid which is high in protein and a perfect medium for bacteria and infections.
  • While complications can arise in all stages of lymphoedema, it is Stage 3 that presents with the most significant and severe complications which is another very important reason for early diagnosis and immediate treatment.

Treatment: According to the International Society of Lymphology, Combined Decongestive Therapy (CDT), also known as decongestive lymphatic therapy (DLT), is the treatment of choice for lymphoedema.

COMBINED DECONGESTIVE THERAPY

 

  1. Manual Lymph Drainage – Patients receive Manual Lymph Drainage (MLD) to remove excess fluid and protein from the tissues. The MLD is performed to open lymphatics in the unaffected regions so these can help to drain the affected area. MLD stimulates lymphangions to increase their activity, which results in a decompression and emptying of obstructed lymphatic channels.
  2. Compression Therapy – Multi-layered bandaging of the affected limb follows each MLD session. This is a precise and accurate procedure using specific bandages and interfacing materials.The bandages are applied exactly to conform to the patient’s tissues and are reapplied on a daily basis. They are short-stretch bandages that resist muscle contraction and are applied with comfortable padding underneath. The bandages help to maintain the reductions achieved with MLD and may even cause further reduction.
  3. Exercise – Effective lymph flow depends on sufficient muscle and joint activity, especially if the functionality of the lymphatic system is compromised. Decongestive exercises are most effective if performed while the patient wears compression garments or bandages, which are also essential components in lymphedema management.
  4. Skin Care and Hygiene – Good skin care plays an essential part in the treatment of lymphoedema. Daily skin cleansing with antibacterial washes and neutral balanced pH lotions will help to eliminate possible bacterial and fungal growth and so minimise the possibility of repeated attacks of cellulitis or lymphangitis.
  5. Breathing – The lymph transport in the Thoracic Duct (Ductus Thoracicus) is mainly caused by the action of breathing. Taking into consideration that this duct transports 4 litres of lymph per day explains the importance of diaphragmatic breathing to help increase transport of lymphatic fluid.