What is Lymphedema?

Lymphedema (LE) is defined as protein-rich fluid accumulation in the interstitial space due to reduced lymph transport capacity as a result of damage to the lymph vessels and nodes, or absence/malformation of lymph vessels.  LE is usually unilateral; if bilateral, it is usually asymmetrical.  It mostly happens on limbs. For example, breast cancer, ovarian cancer and prostate cancer patients after removal of lymph nodes. LE affects all ages and may occur months or years after surgery.  It is important to understand and manage the life-long risk.

Lymphedema Signs and Symptoms

  • A full or heavy felling in the affected limb
  • A feeling of tightness in the skin
  • Less movement or flexibility in the hand, writs, shoulder or ankle
  • Trouble fitting into clothing or jewelry in one specific area
  • Abnormal swelling in the affected area
  • Recurring infections in the affected limb

Lymphedema Staging

Stage I:

LE is spontaneously reversible.  Clinically evident edema with volume difference more than 10% compared to opposite side

Stage II:

LE is not spontaneously reversible.  Fibrosis is present.  Beginning of abnormal fat deposition starts at the later stage II

Stage III:

LE influences skin to change (elephantiasis).  Fibrosclerosis is present.

Types of Lymphedema

Primary Lymphedema :
It is a congenital abnormal development of the lymph vessel system. It progresses from distal (feet) to central

Secondary Lymphedema :
It progresses from central (thigh) to distal.  It is caused by trauma (eg, post cancer surgery and/or radiotherapy – breast, gynecological and/or prostrate cancers); damage of lymphatic pathways; inflammation; malignancy; obesity and chronic venous insufficiency

Treatments

Manual Lymph Drainage (MLD) :

Evidence suggests that MLD enhances movements of fluid into initial lymphatics, and influences the contraction rates of pre-collector and collector lymph vessels, moving lymph towards deeper drainage trunks.  It also increases the lymph pressure, frequency as well as amplitude of contraction, resulting in increased transport capacity.

Compression Bandaging :

Compression bandaging influences to increase the tissue hydrostatic pressure during active movement; reduce capillary filtration into interstitial space; encourages passive transport in the collectors; amplifies muscle and joint pump effects; stimulates lymphatic contraction and help break down fibrosclerotic tissue. Therefore, it reduces edema; restores shape to the affected area; reduces skin changes; supports overstretched inelastic skin; eliminates lymphorrhea and softens subcutaneous tissues.

Compression Garments :
Compression garments (stockings) are useful to stabilize the condition after a period of time applying the bandages.

Exercises :
Exercises include any movement help muscle pump function and lymphatic return.  For example, walking, cycling and water exercise are good for legs.  Swimming and shoulder exercises are beneficial for arms.

Excellent Skin Care :
The use of antibacterial cleansers and pH neutral lotions.

Looking for an effective way to manage your Lymphedema?

We recommend Manual Lymphatic Drainage massage and Combined Decongestive Therapy treatments to help in managing the chronic swelling. Our certified Dr Vodder Lymphatic Drainage massage therapist, Pauline Chau, specialises in treating lymphedema for cancer patients.