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  • Diagnosis - Stages

    Lymphedema

    LYMPHEDEMA, A LIFE-LONG ILLNESS THAT IS OFTEN UNDER-DIAGNOSED AND IMPROPERLY TREATED

    Lymphedema is a life long chronic condition in which excess fluid (lymph) collects in tissues causing oedema (swelling). In short, lymphedema is oedema caused by a blockage of the lymphatic system, an absence of lymphatic vessels or a dysfunction of the lymphatic system.
    lymphedema tends to progress from a mild to a severe stage. 

  • Diagnosis - Stages

    Lymphedema

    Two main types of Lymphedema


    Primary Lymphedema is due to congenital or inherited condition associated with impaired development of the lymphatic vessels which undermines their ability to drain fluid correctly. Primary Lymphedema is more common in females than males. 


    Secondary Lymphedema occurs as the result of other conditions or treatments. Worldwide, the most common cause is an infection (filariasis), whilst in the developed world, nearly all cases of secondary Lymphedema are due to cancer and its treatment. In these cases, the lymphatic system gets damaged by the cancer itself or by the necessary surgery, radiation therapy or chemotherapy. Secondary Lymphedema is often a consequence of removing the lymph nodes in the armpit (axilla) or groin, or damage to them caused by radiotherapy. Other causes can be deep tissue injuries due to burns or trauma. 

  • Diagnosis - Stages

    Lymphedema

    However, there are other forms of oedema which should not be forgotten:

    
Lipoedema: a chronic disorder which results in the accumulation of fatty tissue in the legs and sometimes in the arms. Lipoedema can progress to develop an oedematous component - Lipolymphedema.

    Phlebolymphedema: a condition of mixed venous and lymphatic insufficiency. The lymphatic and venous systems are intimately interrelated. In the presence of venous hypertension, which is characteristic of most venous disorders, the increase in lymphatic flow becomes much greater than the lymph transport capacity. 

  • Diagnosis - Stages

    Lymphedema

    The lymphatic system


    Due to the complexity of the lymphatic system and its closed association with the blood circulation system, damage to any lymphatic components can lead to the development of Lymphedema. Since there might be a delay of several years from a causative event to the appearance of Lymphedema, to determine the correct diagnosis is often difficult. 

    The three main functions


    Fighting infection
    The lymphatic system transports a watery, clear fluid full of lymphocytes. Lymphocytes are infection-fighting cells. The colourless fluid is known as lymph. 


    Draining excess fluid
    After blood has circulated through tissues it leaves fluids and proteins behind; these are waste products. The excess fluid is drained through capillaries and into the lymphatic system where it is filtered and the clean fluid returned to the blood. 


    Lipid (fat) absorption
    The lymphatic system also absorbs lipids from the intestine and transports them to the blood. 

  • Diagnosis - Stages

    Lymphedema

    Risk factors & symptoms

    
The effective identification of patients at risk of Lymphedema requires an awareness of the causes of Lymphedema and associated risk factors*, as well as self monitoring.

    
*: Risk factors for self-reported arm Lymphedema among female breast cancer survivors: a prospective cohort study.“Togawa K, Ma H, Sullivan-Halley J, Neuhouser ML, Imayama I, Baumgartner KB, Smith AW, Alfano CM, McTiernan A, Ballard-Barbash R, Bernstein L Breast Cancer Res. 2014 Aug 22;16(4):414. doi: 10.1186/s13058-014-0414 

    A selection of risk factors

    • Lymph node surgery
    • Radiotherapy
    • Drain/wound infection
    • Cording (axillary web syndrome)
    • Seroma formation
    • Advanced cancer
    • Obesity
    • Congenital predisposition
    • Trauma in an ‚at risk‘ arm (venepuncture, blood pressure measurement, injection)
    • Chronic skin disorders and inflammation
    • Taxane chemotherapy
  • Diagnosis - Stages

    Lymphedema

    Symptoms

    Lymphedema can affect any part of the body, but most commonly affects the arms or legs. In some cases, both arms or both legs may be affected at the same time. Symptoms are:

    • Transient swelling of a limb or other region of the body after surgery, even if intermittent
    • Feelings of discomfort, heaviness, stiffness in the affected body part
    • Limitation of movement
    • Tightness or temperature changes to areas of the body clothing, jewellery or shoes may feel tighter
    • Permanent swelling of more than 3 months (pitting in early stages)
  • Diagnosis - Stages

    Lymphedema

    At risk


    Lymphedema patients are at risk of infections.

    • A severe cellulitis, an acute bacterial infection of the skin and the soft tissues below it, may cause/worsen tissue damage around lymph nodes or vessels. Recurrent cellulitis can further complicate Lymphedema.
    • Some inflammatory conditions, such as rheumatoid arthritis, dermatitis or eczema, can also damage the lymphatic system.
    • Patients with cardiovascular diseases such as DVT (deep vein thrombosis), venous leg ulcers and varicose veins, also have a higher risk of developing Lymphedema.
  • Diagnosis - Stages

    Lymphedema

    Though Lymphedema is a chronic condition for patients, BSN medical is here to help a potentially disabling disease

    For some patients, life with Lymphedema may feel more like a disability than an illness, affecting their quality of life. The feeling of helplessness, dependence on family members and change in daily routines is common with this life-long condition.

    A NEW BURDEN EVERY DAY
    Lymphedema therapy requires dedication every single day, making compliance often difficult. Because there is no cure, caring for Lymphedema takes time, commitment and occasionally, help from others.

  • Diagnosis - Stages

    Lymphedema

    AN UNSTABLE ILLNESS
    Even strict compliance is no guarantee of a predictable condition. Many patients reduce their edema to a manageable level through proper treatment but even the most compliant will still fluctuate from time to time. Some patients are demoralized by their lack of control over their Lymphedema.

    AN UNWELCOME REMINDER
    Being a common side-effect of radiotherapy or surgery, Lymphedema is often an unwelcome reminder of patients’ previous illnesses. Though Lymphedema does not have the peril that cancer and other co-morbidities carry, it nevertheless represents an enduring complication for life.