Secondary lymphoedema of left arm following surgery for breast cancer.

Lymphoedema

What is Lymphoedema?

The lymphatic system is a network of vessels similar to the blood

circulatory system, which transports a straw coloured fluid called lymph

from areas around our cells in the tissues (extracellular spaces) back

into the blood circulation.


Lymph contains excess proteins, water and waste products, as well as

fats near the digestive system. It is called an "open-ended" system

unlike the blood system which is a continual loop.

The smallest lymph vessels called initial lymph capillaries are just under

the skin and pick up excess fluid and particles rather like a vacuum

cleaner. This is then pushed into larger vessels called collectors deeper

in the tissues.


The movement of this fluid is dependant largely on pressure changes

from movement and muscles contracting, and also by the small amount

of muscle in the vessel which squeezes the fluid along one way valve

channels. The vessels slowly become larger in the chest cavity and

eventually drain into the veins near the heart.


Along the way, cell debris and bacteria are filtered through lymph nodes,

and so as well as helping to maintain fluid balance and transport fatty acids, the lymphatic system also has an important role in immunodefense.

The lymph nodes or glands are found in clumps throughout our body (e.g. in our armpits, groins and neck). The total number of lymph nodes in our bodies varies between individuals, and can even differ from one side of our body to the other. For example, there could be any number between 20-60 nodes in the armpit alone.


In normal situations, swelling can occur after an injury (e.g. a sprained ankle), from surgery or in an area of inflammation (e.g. an infected cut). Over a matter of several days to a few months, the body has the capacity to "pick up" this extra fluid as part of the normal healing process. This transient swelling is not lymphoedema, and so early swelling, for example after breast surgery should not be assumed to be lymphoedema.

 

Professionals trained in lymphoedema management are the best people to make this assessment.

 


Unfortunately however, trauma or disruption to the lymph nodes and vessels will affect the ability to transport lymph fluid. Such events could be burns, surgical procedures, radiotherapy and other traumatic accidents that cause tissue damage. Although our body can be quite effective in redirecting fluid to other areas where lymph vessels are functioning well, sometimes the fluid will accumulate too quickly when the load exceeds the transport capacity. This is then called secondary lymphoedema.


Primary lymphoedema results from a poorly developed part of the lymphatic system, and this often has a genetic component to its cause. It can appear at birth, during puberty or around midlife. Primary lymphoedema only effects about 5-10% of the population.

Lymphoedema cannot be cured, but there is certainly great potential to minimise its severity with correct management. There is even some recent research which suggests early changes can be reversed, at least until reassessed at a 1 year follow up period.


Certainly, much research has shown that the best long term outcomes occur with early detection and correct intervention.

Secondary lymphoedema of left arm
skin & tissue changes assoc with lymphoedema
Bilateral secondary lower limb lymphoedema with a venous component. This also shows the skin and tissue changes which can be associated with lymphoedema.
bilateral secondary limb lymphoedema

In contrast, secondary lymphoedema such as that following treatment for breast cancer, can effect up to 30% of people, depending on the extent of surgery, number of nodes removed and the need for radiotherapy.

 

Lymphoedema is classified into various stages

(grades 1-3), depending on its severity. As it progresses, tissue can become firmer (fibrosis), and skin becomes thickened and dry, largely due to the protein build up in the tissue spaces.

Close up of skin and tissue changes associated with lymphoedema.