Causes of lymphoedema related to cancer and how it’s treated

Posted on 29 September 2017

Lymphoedema is an incurable but manageable condition that causes swelling, usually in the arms or legs. It develops when the lymphatic system – the network of channels and glands in the body that helps fight infection and remove excess fluid – is disrupted.

‘Lymphoedema usually only affects a single lymph draining the area where the disruption took place,’ says Dr Lizanne Langenhoven, a Cape Town clinical and radiation oncologist.

What are the signs and symptoms?

The main sign of lymphoedema is swelling in the limbs. This may come and go initially, but without treatment it will become more severe and persistent. It can cause other problems, such as difficulty moving and skin infections such as cellulitis. Other symptoms in affected body parts include an aching, heavy feeling; hard, tight skin; and fluid leaking through the skin.

Water retention as a result of heart failure may be mistaken for lymphoedema – you need to see a doctor for the right diagnosis.

What causes lymphoedema in cancer patients?

Common causes include surgical removal of the glands, radiotherapy to the glands and involvement of the glands by cancer.

‘Lymphoedema in the arm is commonly seen in breast-cancer survivors who required an axillary dissection – removal of lymph nodes in the armpit – as part of their surgical management. These patients often require radiotherapy, and the combination of these two procedures increases the risk of developing lymphoedema to about 30%,’ says Dr Langenhoven.

An axillary dissection without radiotherapy carries a lymphoedema risk of 20%.

There’s a smaller procedure available to patients whose breast cancer is caught early. Called a sentinel lymph node biopsy, only 1-3 nodes are usually removed, and although radiotherapy often follows, the risk of developing lymphoedema for this combination drops to 10%. ‘Unfortunately, not all women are candidates for the smaller procedure, as their cancer might warrant a more aggressive approach to removing the lymphatics in the axilla,’ says Dr Langenhoven.

Lymphoedema in the lower limbs may occur in patients who’ve had pelvic lymph nodes removed for gynaecological malignancies, followed by radiotherapy.

Treatment

‘Start management early, before any signs are apparent, if you’ve had a procedure putting you at risk,’ says Dr Langenhoven. ‘Early rehabilitation by a specialist decreases your risk of developing a more severe form of the condition.’

A practitioner with formal training in lymphoedema rehabilitation should be able to help. ‘It’s important to ensure that your therapist is trained and registered by the Lymphoedema Association of South Africa (Laosa),’ says Dr Langenhoven.

Techniques to minimise fluid build-up and stimulate the flow of fluid through the lymphatic system can help control the symptoms. These include wearing compression garments, moving and exercising regularly, and using specialised massage techniques.

‘Where all conservative measures have failed, surgery aimed at forming new lymphatic pathways may offer some symptomatic relief,’ says Dr Langenhoven.

References

http://www.nhs.uk/conditions/Lymphoedema/Pages/Introduction.aspx

Published in Prime

In the interest of our patients, in accordance with SA law and our commitment to expertise, Mediclinic cannot subscribe to the practice of online diagnosis. Please consult a medical professional for specific medical advice. If you have any major concerns, please see your doctor for an assessment. If you have any cause for concern, your GP will be able to direct you to the appropriate specialists.

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2 Responses to “Causes of lymphoedema related to cancer and how it’s treated”

  1. Wilhelmina Buter says:

    Good day,
    What is the difference between Lymphoedema and lipoedema?
    Can you recommend a doctor that can deal with the latter?
    I was told that most doctors have no knowledge of this and that is exactly what I experienced.

    Thank you

    Wilhelmina Buter

    • Frances Bailey says:

      Dear Wilhelmina,

      Thank you for taking the time to read the article.

      I will try to clarify the difference between the 2 conditions.

      Lymphoedema is usually caused by a disruption in the lymphatic drainage of a specific part of the body. Lymph is a term we use loosely to refer to the fluid between cells. This fluid is generally drained through small lymphatic pathways similar to arteries and veins. This pathway passes though the lymphnodes into the systemic circulation. When the lymphatic pathway is disrupted, the lymphatic fluid is unable to drain as efficiently as before, and causes swelling in the area where the drainage through the lymph nodes are impaired.
      This complication is associated with many conditions, but is probably best known following surgical removal of the lymphnodes in breast cancer.

      Insofar lipedema is concerned, this condition is usually associated with an abnormal accumulation of fat deposits under the skin. We don’t really understand the causes of this condition clearly yet. We believe there might be a genetic predisposition to the condition, and we know it normally occurs in women after menopause. Lipedema can also exist in combination with lymphoedema, worsening the swelling of the affected area even further.

      My advice it to see an endocrinologist to exclude underlying hormonal imbalances and direct the treatment team. You can find a list of endocrinologists at this link: http://www.mediclinic.co.za/Doctors. Please select ‘endocrinologist’ in the first drop down list and then select your desired location in the second.

      With kind regards,

      Lizanne

      Dr Lizanne Langenhoven
      Clinical and Radiation Oncologist
      Cancercare Panorama
      021 944 3882

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