What is Lymphoedema?

Lymphoedema occurs when your lymph vessels are unable to adequately drain lymph fluid, usually from an arm or leg. It tends to develop when lymph vessels or lymph nodes are missing, impaired, damaged, or removed. However, it is necessary to know that while Lymphoedema can occur within a few days, it can also occur months, or years after a lymphatic injury.

Lymphoedema can be either primary or secondary. This means that it can occur on its own (primary lymphoedema), or it can be caused by another disease or condition (secondary lymphoedema). Secondary lymphoedema is far more common than primary lymphoedema.

CAUSES OF SECONDARY LYMPHOEDEMA:

Any condition or procedure that damages your lymph nodes or lymph vessels can cause lymphoedema. Causes include:

• Surgery:
  Lymphoedema can develop if your lymph nodes and lymph vessels are removed or cut. For example, surgery for breast cancer may include the removal of one or more lymph nodes in your armpit to look for evidence that cancer has spread. If your remaining lymph nodes and lymph vessels can’t compensate for those that have been removed, lymphoedema may result in your arm.
• Radiation:
  Radiation treatment for cancer can cause scarring and inflammation of your lymph nodes or lymph vessels, thereby causing a restriction of the flow of lymph fluid.
• Cancer:
  If cancer cells block lymphatic vessels, lymphoedema may result. For instance, a tumour growing near a lymph node or lymph vessel, could become large enough to block the flow of the lymph fluid.
• Infection:
  An infection of the lymph nodes can restrict the flow of lymph fluid and cause lymphoedema. Parasites also can block lymph vessels. Infection-related lymphoedema (filariasis) is most common in tropical and subtropical regions of the globe and is more likely to occur in developing countries.

As mentioned before, primary lymphoedema is rare. It is an inherited condition caused by problems with the development of lymph vessels in the body. Strangely, primary lymphoedema occurs most frequently in women.

SPECIFIC CAUSES OF PRIMARY LYMPHOEDEMA INCLUDE:

• Milroy’s disease (congenital lymphoedema)
  This is an inherited disorder that begins in infancy and causes the lymph nodes to form abnormally, leading to lymphoedema.
• Meige’s disease (lymphoedema praecox)
  This hereditary disorder often causes lymphoedema in childhood or around puberty, though it can occur in your 20s or early 30s. It causes your lymph vessels to form without the valves that keep lymph fluid from flowing backward, making it difficult for your body to properly drain the lymph fluid from your limbs.
• Late-onset lymphoedema (lymphoedema tarda)
  This condition occurs rarely and usually begins after age 35.

There is no cure for lymphoedema. That is why the terms “treatment” and management” literally become twins when we speak of dealing with Lymphoedema. However, if treatment modality starts early enough, many cases are reversible. In addition, lymphoedema can be managed and controlled so that it does not progress further.

The International Society of Lymphology (ISL) has tabled the stages of Lymphoedema as follows:
The International Society of Lymphology (ISL)
Lymphoedema staging (2016)

ISL stage 0 (or 1a) – A subclinical state where swelling is not evident despite impaired lymph transport, subtle alterations in tissue fluid/composition and changes in subjective symptoms. This stage may exist for months or years before oedema becomes evident.

ISL stage I – This represents an early accumulation of fluid, relatively high in protein content, which subsides with limb elevation. The oedema may be pitting at
this stage. An increase in various types of proliferating cells may also be seen.

ISL stage II – Limb elevation alone rarely reduces tissue swelling and pitting is manifest.

ISL late stage II – There may or may not be pitting as excess subcutaneous fat and fibrosis develop.

ISL stage III – this stage encompasses lymphostatic elephantiasis where pitting can be absent and trophic skin changes such as acanthosis, alterations in skin character and thickness, further deposition of fat and fibrosis, and warty overgrowths have developed.

It should be noted that a limb may exhibit more than one stage, which may reflect alterations in different lymphatic territories.

The full ISL consensus document (2020) can be viewed here

Chronic peripheral lymphoedema is a very serious and progressive condition, and if left untreated will have significant consequences. Treatment should, therefore, begin as early as possible.

In addition, for the safety of the patient and to achieve good results, it is absolutely mandatory that the therapist is thoroughly trained in all components of CLT. Only properly certified therapists have a complete understanding of the pathophysiology of lymphoedema and its treatment.

Although the training worldwide has a set standard, qualified therapists may show different therapy qualifications on their certificates. To help you discern, all of the following are valid qualifications:

• CLT complex lymphatic therapy (Casley-Smith method)
• CDT (Complex/complete decongestive therapy)
• CPT (Complete physical therapy)
• CDPT (Combined Decongestive Physical Therapy)
• DLT decongestive lymphatic therapy (Casley-Smith method)(formerly known as CLT – complex lymphatic therapy)

SYMPTOMS

The symptoms of lymphoedema include:

• swelling in all or part of a limb, which can cause problems with wearing jewellery or watches, or fitting into clothes or shoes. The swelling may occur for the first time after a traumatic event (such as bruises, cuts, sunburn, and sports injuries), after an infection, or in the part of the body that was treated for cancer.
• the affected limb feeling heavy and aching
• the affected limb is losing some of its mobility
• pain in the affected limb
  painful joints, such as the elbow or knee, caused by swelling in the limb
• repeated skin infections in the affected limb
• the skin on the affected limb is becoming hard and tight, and blisters or wart-like growths are developing on the surface

If you have any of these symptoms, please talk to your health care provider. Prompt treatment can help manage the condition before complications occur.