The information supplied below is of a general nature. please seek independent confirmation – professional advice should always be sought before acting on information.
Lymphoedema is a swelling that results from a dysfunction of the lymphatic system. The dysfunction can be a result of:
Treatment for cancer is probably the most widely recognised cause of lymphoedema in western society.
For a person who has been treated for cancer where the lymph nodes have been sampled, removed or irradiated, there may be swelling in the closest limb and the quadrant of the trunk which adjoins the surgery. More specifically, if the groin or abdominal lymph nodes have been affected, the leg on that side, the lower abdomen, buttock and genitals may be swollen. If the armpit lymph nodes are affected, then the arm, chest and upper back on that side may be swollen.
The swelling normally starts at the top of the limb or on the trunk and may be very variable at first, increasing with activity or during the day and disappearing overnight. As time progresses, the swell tends to spread lower on the limb and remains longer. Also, the nature of the swelling will change from pitting oedema (depression left by finger when swelling is pressed) to a more fibrotic (more wooden) oedema.
For arm lymphoedema, often the first complaint is of being unable to put the arm close by the side. Many women feel as though there is a ball of swelling at the back of the armpit. Otherwise, it is often noticed if jewellery becomes tight, or the tendons on the back of the hand become obscured by swelling.
Leg lymphoedema is often picked up when underwear or trousers become tight on one leg, or there is a greater dent from socks or stockings.
Lymphoedema is NEVER the cause of sharp, severe pain unless the swelling results in compression of nerves. Many people complain of aching, heaviness, tightness or a bruised feeling in the swollen area.
Chronic swelling that is not a result of lymph node damage can also be lymphoedema. Lymphoedema is simply oedema (fluid retention) which results from an impairement of the lymphatic system. There are various genetic (inherited) conditions which result in poor development of the lymphatic suystem, These may become apparent at birth, at puberty, or later in life when we start slowing down or sustain an injury. The oedema can range from a swollen ankle following a plane flight which persists for a couple of hours once you become active again, to grossly swollen limbs which limit movement and hygeine, and make buying clothing and footwear extremely difficult.
Chronic swelling which is caused by heart disease, liver disease, or kidney disease is not lymphoedema, and should be managed by your medical specialist.
The lymphatic system is basically a garbage collection system for the connective tissue (i.e. muscle, fascia, skin etc). Within the connective tissue, capillaries leak fluid from the blood into the tissue, carrying essential nutrients to the cells. This fluid then collects the waste from the connective tissue and moves into lymphatic vessels. The lymphatic vessels transport the proteins and large particles to the lymph nodes where they are filtered. The resulting fluid (waste) is then emptied into the large veins behind the collar bones, and is excreted from the body via the kidneys.
If the lymphatic vessels are damaged, or the lymph nodes are removed,there is a backlog of protein trying to exit from the tissues, resulting in waste protein not being cleared. If this protein cannot find another pathway to an intact part of the lymphatic system, more fluid is drawn into the tissues in that area, and it appears waterlogged. That is lymphoedema.
When a part of the body is injured, there will be a certain amount of leakage of blood from broken capillaries, as well as an infiltration of repair materials to mend the rift. This is seen as bruising and swelling. When this occurs, the lymphatic system will then increase the rate of drainage to clear out the leaked blood and damaged tissue. Once this has gone the swelling will subside. If the lymphatic system is damaged in the injury, or there is excessive damaged tissue, some of the waste may congeal before the lymphatic system can remove it. In this case there may be persistent swelling.
Heart failure, kidney failure, varicose veins and arthritis are also associated with swelling. These occur for various reasons, but it is still the lymphatic system which is usually responsible for returning the fluid from the swelling back into the circulation.
"At risk" people are those people who have had some damage to the lymph nodes, but have no swelling (yet). Many of these people are eager to learn ways that they can minimise the risk of developing lymphoedema.
The following methods are not foolproof, but will help some people to avoid lymphoedema:
No! Occasionally patients are angry that healthy lymph nodes have been removed or destroyed when that person has ended up with lymphoedema. Unfortunately lymph node sampling is the least invasive, early way to determine if there is a likelihood of the tumor already having spread. If the lymph nodes are simply left when they do have tumor cells present, the resulting tumor growth will definitely result in a lymphoedema which is very hard to control. Surgical methods are improving for minimising the lymph node damage, such as a sentinel node biopsy prior to clearance of lymph nodes. If the sentinel lymph node is clear of tumor cells at the time of surgery, then there is a good chance that the rest of the lymph nodes will also be clear. In this case the surgeon may elect not to complete the lymph node clearance.
Because lymphoedema is associate with retained protein in the connective tissue, many people ask whether or not they can control it with diet. The waste protein has been digested, reassembled, integrated into body tissue and is now obsolete. So, eating a low protein diet will not assist with controlling lymphoedema. However, a sensible balanced diet, with lots of fresh fruit and vegetables, which helps to maintain a healthy weight is recommended. However, if you ar aware of food which causes bloating or discomfort, it may be better to avoid these foods.