Lymphoedema has been recognised as a chronic disease since 1940.( International Classification of Diseases code:ICD-10-CM )

Lymphoedema is considered a chronic, potentially progressive condition resulting from failure of the lymphatic system to drain fluid and proteins from tissue throughout the body and return it to the circulatory system. Early detection, early intervention is the goal standard approach to treating lymphoedema , and when not treated in a timely fashion, becomes more complex.

There are two main types of lymphoedema: Primary lymphoedema is caused by abnormal development of the lymphatic system and symptoms may be present at birth, develop at puberty or in midlife, often triggered by hormonal or traumatic or stressful situations.

St Georges Primary Lymphoedema Algorythmn

Secondary lymphoedema is caused by damage to an otherwise healthy lymphatic system including venous disease, reduced mobility, cellulitis, obesity, trauma and oncology / cancer related Lymphoedema when the lymphatic system is compromised the result is swelling, most typically in the limbs (Figure 1) but can affect any part of the body including breast, trunk, genitalia and face.

Cancer -related lymphoedema is a condition which may result from treatments such as surgery , radiation , chemotherapy for some cancers including :

• Breast Cancer
• Melanoma
• Pelvic / Gynae cancers

If lymphoedema is left untreated , it can cause painful swelling , may lead to infection ( cellulitis) and become a life-long condition

Prospective surveillance is the preferred philosophy in relation to lymphoedema detection at the Lymph Clinic. Early detection permits early intervention.  The first visit to The Lymph Clinic will include a consultation during which the therapist will measure the affected area(s); take Bio-impedance measurements, educate on the cornerstones of lymphedema prevention and assess the need for treatment. Each session will last approximately one hour. We will always work in conjunction with your GP or referring oncologist or radiologist. 

Chronic oedema is de­fined as oedema of a body part lasting more than 3 months, irrespective of the aetiology. It can be caused by, for example, immobility, venous insu ciency, heart failure, obesity and/or lymphoedema, but is often complex and multifactorial in nature. Although the pathophysiology of chronic oedema and lymphoedema may differ, the terms are today often used interchangeably, as the clinical manifestations are often similar (Keast et al, 2015; Mo‑ att et al, 2019b). Recent research has also shown that there is no net absorption of tissue  uid by the capillary bed, as previously thought, and that all tissue  uid is mobilised by the lymphatics (Mortimer and Levick, 2004).  erefore, it has been argued by some that all chronic oedema can be regarded as an overload of the lymphatics and thereby lymphoedema (Mo‑ att et al, 2019b).

Patients with wounds and chronic oedema/lymphoedema present a complex management task. The management often includes a multidisciplinary team, which addresses the following:

● the underlying condition causing oedema and/or factors affecting wound healing

● Compression therapy and oedema management

● Encouragement of exercise/increased mobility, enhancing the venous and lymphatic return

For more information on Chronic oedema go to : https://email.mah-communications.co.uk/files/amf_mark_allen_group/workspace_16/Chronic_oedema_JWC_resources_.pdf

There are three basic stages of lymphedema. The earlier lymphedema is recognised and diagnosed, the easier it is to successfully treat and avoid many complications.

LATENT – STAGE 0

• Lymphatic transport capacity reduced
• No visible/palpable oedema
• Subjective complaints are possible such as a feeling of heaviness, skin tightness, aching or discomfort.

STAGE 1

• Reversible lymphoedema (mild)
• Accumulation of protein rich oedema fluid
• Pitting oedema
• Reduces with elevation (no fibrosis)
• Upon waking in the morning the limb or affected area is almost a normal size.
• The tissue is still in a “pitting stage” (when pressed by a finger the area indents and holds the indentation).

STAGE 2

• Spontaneously Irreversible Lymphoedema (moderate)
• Accumulation of protein rich edema fluid
• Pitting becomes progressively more difficult
• Connective tissue proliferation (fibrosis)
• Connective tissue proliferation (fibrosis)

STAGE 3

• Lymphostatic Elephantiasis (severe)
• Accumulation of protein rich edema fluid
• Non pitting oedema
• Fibrosis and sclerosis (severe induration)
• Skin changes (papillomas, hyperkeratosis)
• The tissue at this stage is hard (fibrotic) and will only be slightly responsive to the touch.
• The limb is very large and swollen and the swelling is almost irreversible.
• Infections are possible at any stage of lymphoedema but occurrence becomes greater as the stages progress. A swollen limb left untreated becomes hard and full of lymph fluid which is high in protein and a perfect medium for bacteria and infections.
• While complications can arise in all stages of lymphoedema, it is Stage 3 that presents with the most significant and severe complications which is another very important reason for early diagnosis and immediate treatment.