Lymphoedema

What is it?

Lymphoedema is a painful, chronic condition that causes parts of the body to swell with fluid. Most people with lymphoedema develop it after damage to their lymphatic system from lifesaving cancer treatment. Damage may be from the removal of lymph nodes during surgery or due to radiation therapy treatment.

Lymphoedema from cancer treatment or trauma may appear shortly after treatment/injury or some years later. As a chronic condition there is no cure but lymphoedema can be managed successfully through manual lymphatic drainage, compression, exercise and skin care.

Early diagnosis and treatment of lymphoedema can lead to better outcomes.

Some early warning signs may be present for months or years before permanent swelling is noticed:

• Clothing or jewellery feeling tighter

• Feelings of heaviness, fullness, tightness in the affected arm/breast

• Aching or stiffness

• Swelling that comes and goes

If you are worried or experiencing these types of problems, talk to your doctor or a lymphoedema practitioner about getting assessed for lymphoedema and referred for treatment.

Treatments for Lymphoedema

Manual lymphatic drainage (specialised massage) for lymphoedema

Manual lymphatic drainage (MLD) is a way of reducing swelling caused by fluid build up after cancer treatment, trauma injury or primary lymphoedema. There are different technique disciplines of manual lymphatic drainage (MLD). The recognised techniques include Vodder, Földi, Klose and Casley-Smith.

You should only have MLD from a specialist therapist trained in one of these techniques.

How it works

The aim of MLD is to move fluid from the swollen area into a place where the lymphatic system is working normally. To do this, the therapist first uses specialised skin movements to clear the area that they want the fluid to drain into. This will always start with treatment to the neck area as this is where lymph fluid joins the venous system. Like all drainage systems we need to make sure that the final drain area is clear and not blocked. It might seem strange to have treatment on your chest and neck if you have lymphoedema in your arm. But it means that the fluid has somewhere to drain to when the therapist treats your arm.

How you have an MLD treatment

You usually lie down to have MLD. But if you have lymphoedema in your head and neck, you sit up.

When you have MLD, you feel a gentle pressure. The skin movements are very light so that the small lymph vessels are not flattened. Flattened lymph vessels would prevent the lymph fluid from draining. The movements are slow and rhythmic so that the lymph vessels open up.

You might have MLD daily or you might have it 3 times a week, for about 3 weeks.

The number of treatments you have depends on the type of MLD and what you need. Your therapist will also take into account the amount of swelling you have.

In conjunction with MLD…

Low level laser therapy in conjunction with MLD works by treating the cells, therefore treating the cause of the symptoms in addition to the symptoms themselves. There is a large amount of research that shows that LLLT facilitates wound healing, improves lymphatic function, improves the effects of MLD, in addition to reducing inflammation, pain, scar tissue and improving mobility. By delivering red or near-infrared light to cells, the cells absorb the light, re-energising them and allowing them to function better. Clinicians now use this as first-line treatment in conjunction with other treatment modalities such as MLD/intermittent pneumatic compression, compression bandaging, hosiery or kinesiotaping.

After MLD and LLLT treatment

Compression therapy is a key component of lymphoedema management to prevent rebound swelling. The therapist might bandage the area using a specialised bandaging technique called multi-layered lymphoedema bandaging, or apply kinesiotaping and/or you will need to wear a compression garment.

Your lymphoedema specialist will regularly check how well your treatment is working. They’ll look at whether the tissues are softening and how much the swelling is going down.

Once the swelling is under control, you might need another compression garment to wear.

Take home points

Lymphoedema is a chronic condition and at present there is no cure. However, by implementing the four cornerstones of treatment on a daily basis, lymphoedema can be successfully managed. Your lymphoedema therapist can demonstrate self lymphatic massage techniques, offer easy to follow exercises, provide guidance on skin care and ensure you have appropriate compression garments.

Lymphoedema Classification:

• Primary lymphoedema - is a congenital abnormality of the lymphatic system. It can become apparent from birth or present at puberty or as an adult

• Secondary lymphoedema - is a result of obstruction or interruption of the lymphatic system. This can be due to cancer treatment (lymph node removal / radiation), surgery, burns, soft tissue damage (historic injuries)

• Lymphoedema develops in stages:

  • Stage 0 A stage where swelling isn't obvious, even though the lymphatic system has been damaged

  • Stage I In this early stage, lymph fluid accumulates in the tissues, causing swelling that goes down with elevation. There may be some "pitting" (an indentation that remains after pressure is applied to a small area)

  • Stage II Elevating the area doesn't reduce the swelling and pitting is obvious

  • Stage III The tissue is hard and no longer pits. The overlying skin thickens, gradually becoming discoloured and increased fat deposits develop. At this stage the affected area is usually very swollen and the swelling is irreversible

Lymphoedema therapy funding

If you've been diagnosed with lymphoedema following breast cancer surgery, or are at high risk, the Breast Cancer Foundation NZ can help fund lymphoedema treatment. Ask your GP, breast cancer specialist, or breast nurse to complete this referral form and email it to supportservices@bcf.org.nz