Lymphoedema

WHAT IS LYMPHEDEMA? (PRIMARY/SECONDARY)

Lymphedema may be considered a condition in which there is a failure of the lymphatic system to drain excess fluid and substances from the interstitial spaces, and/or a symptom arising from another primary health problem. It is a chronic condition characterised by swelling, usually of one or more limbs, and in some cases involving the trunk, head or genital area. People of all ages can be affected by lymphoedema, including babies and children and it can profoundly affect quality of life. (Lymphedema Framework 2006)

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Lymphoedema explained video – From the Macmillan Cancer Support organisation in the UK

 

STAGES OF LYMPOEDEMA

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 OR SUB CLINICAL STAGE
  • 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)
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