Lymphedema (or lymphoedema) is the result of a disruption of the lymphatic transport system, leading to the accumulation of the protein-rich lymph fluid in tissues and resulting in swelling of a region of the body.
The lymphatic system is a network of lymphatic vessels and lymphatic nodes. Its function is to regulate the volume and protein concentration of the fluid contained in the tissues in the body. It also plays an important role in the immune system by helping destroying pathogens and eliminating them from the body tissues.
More about the lymphatic system…
Lymphedema is a common chronic and progressive condition after cancer treatment.
Lymphedema mainly affects the limbs but it can also involve other parts of the body (breast, head, neck, genital area, trunk)
What causes lymphedema?
Lymphedema appears when the lymphatic system is either not formed correctly (primary lymphedema or congenital lymphedema) or when it has been damaged following an illness or surgery (secondary lymphedema or iatrogenic lymphedema).
Iatrogenic lymphedema is the most prevalent form of lymphedema.
It is very often the result of cancer treatments involving the removal of lymph nodes, or radiotherapy on lymph nodes, but it can also be caused by a damage resulting from trauma, another surgery, a malignant disease, venous disease, obesity or a parasitic disease (filiaris).
When does lymphedema appear?
Iatrogenic lymphedema may happen at any time, immediately after the damage or many years later.
Between 24% to 49% of patients will develop a lymphedema after mastectomy, and 4% to 28% after lumpectomy.
About a quarter of patients will develop lymphedema years after breast cancer treatment.
Congenital lymphedema may appear at birth or during the very first years. It often develops at puberty but can also appear later in life at adulthood.
What is the progression of the disease?
Lymphedema is a chronic and progressive condition.
Lymphedema develops in stages:
- At the early stage, lymphedema is at the “pitting” stage (the affected area indents when pressed and holds the indentation). Limbs are generally normal at waking.
- At the “non-pitting” stage, the indentation created when the tissues are pressed bounces back. The growth of the extremity is irreversible. The affected area has a spongy consistency and starts to harden (fibrosis).
- The affected area becomes very large, very hard and the swelling is irreversible. This stage is called elephantiasis.
What are the complications of lymphedema?
- Lymphedema is a debilitating condition which reduces the movements in the patient and has an impact on the quality of life of the patient.
- As the disease progresses and the fluids accumulate in the tissues, it creates an environment which is prone to various infections and skin ulcers.
- Lymphangiosarcoma is a very rare malignant tumor that occurs in long-standing cases of lymphedema.
How is lymphedema diagnosed?
The specialist has to make a good clinical examination. A lymphoscintigraphy may provide some information, but the lymphatic MRI is the best method to provide an exact mapping of the lymphatic system.