Frequently Asked Questions
You may have heard of arteries and veins that carry blood to and from the heart to all parts of the body. We also have another network of blood vessels called the lymphatic system.
The lymphatic system is a network of very small or microscopic vessels and nodes (glands) throughout the body and function to carry excess lymph fluid from all parts of the body into the bloodstream and also has an important role in the immune system in fighting infection.
Lymphoedema is a condition that occurs when there is excessive accumulation of protein rich fluid called lymph that results in swelling or a limb or body part.
The most common reason for lymphoedema is as a result of cancer treatment. Cancer treatment often requires surgery to remove lymph nodes and radiotherapy to treat cancer affected lymph nodes which result in damage and blockage to the lymphatic vessels. The blocked lymphatic vessels in turn prevents lymph fluid from draining which causes build-up and swelling of the affected limb or body part.
Lymphoedema is classified as primary or secondary lymphoedema. Primary lymphoedema is caused by a developmental problem with the lymphatic system and is often inherited. Secondary lymphoedema however is caused by damage to the lymphatics by a disease or surgical treatment and is the most common type of lymphoedema.
Primary Lymphoedema (rare):
- Milroy's disease (congenital lymphedema). This disorder begins in infancy and causes lymph nodes to form abnormally.
- Meige's disease (lymphedema praecox). This disorder often causes lymphedema around puberty or during pregnancy, though it can occur later, until age 35.
- Late-onset lymphedema (lymphedema tarda). This occurs rarely and usually begins after age 35.
- Surgery - lymph nodes can be affected by cancer spread and surgery is often required to remove the lymph nodes to treat the cancer, especially breast or gynaecological cancer and melanoma. Removal of lymph nodes can cause blockage of the lymph drainage and result in lymphoedema.
- Radiotherapy. Radiation treatment (radiotherapy) is often used to treat cancer either on its own, or in addition to surgery to a lymph node basin such as the armpit (axilla), groin, neck etc. Radiation causes tissue fibrosis (stiffening) and scarring which results in blockage of the lymphatic vessels, causing lymphoedema.
- Cancer. Some types of cancer spread is via the lymphatic vessels and into lymph nodes and this cause blockage of lymphatic vessels which causes lymphoedema.
- Infection. Filariasis is a parasite infection which causes "elephantiasis" or lymphoedema due to the damage it causes to the lymphatic vessels. This condition is more common in tropical countries. Other recurrent infections such as cellulitis can also lead to lymphatic damage and lymphoedema.
Lymphoedema is diagnosed by the treating clinician based on a medical history, examination and sometimes imaging investigations. The diagnosis is usually obvious, however, imaging can be very helpful to the lymphoedema therapist and medical practitioner in understanding the patient's specific lymphoedema and assists in treatment planning.
Please refer to the Diagnosing Lymphoedema section of this website for more detailed information on different diagnostic tests we may recommend.
The Gold Standard test for lymphoedema imaging is a Indocyanine Green (ICG) test also known as ICG lymphography or ICG Mapping.
Please refer to the ICG Mapping section on this website for more detailed information on this test, and our approach to performing the ICG lymphography.
No, unfortunately lymphoedema is a chronic and often progressive condition with no cure, however it can be well controlled with patient education and early intervention.
The mainstay of lymphoedema treatment is patient education, massage and compression therapy and a good relationship between patient and Lymphoedema therapist.
Please refer to Lymphoedema Surgery section of this website for more detailed information on surgical options for treating lymphoedema.
Briefly the following options are available:
- LymphoVenous Anastamosis (LVA)
- Vascularised Lymph Node Transfer (VLNT)