What is lymphoedema?

Lymph is the name for fluid that is contained in body tissues which has been filtered out of the blood to provide nourishment to cells. The fluid is collected by a microscopic system of tubes (similar to but smaller than blood vessels) which drain the fluid back into the main circulatory system.

If this system becomes damaged or does not function properly the area of the body affected becomes swollen. This swelling is known as lymphoedema.

There are multiple causes of swelling in the body that are not lymphoedema (including heart problems, vein problems, liver and kidney problems and medication) which should also be considered if someone starts to develop swelling of a part of their body.

What causes Lymphoedema?

Lymphoedema may be either genetic/inherited (primary lymphoedema) or due to injury/damage to the lymphatic system (secondary lymphoedema).

In primary lymphoedema the swelling may be noticeable before 1 year of age (Congenital) , develop between the age of 1 and 35 (lymphoedema Praecox) or not become noticeable until adult life (Lymphoedema Tarda).

Lymphoedema that is inherited before the age of 1 is sometimes known as Milroy's disease and that between 1 and 35 as Miege's disease.

Secondary Lymphoedema in the western world is most commonly due to lymphatic system damage following treatment of cancer. This can be as a result of either the surgery or the radiotherapy that is needed as part of the cancer treatment. Other causes of secondary lymphoedema can be cancer itself damaging the lymph nodes (which are part of the lymphatic system), infection and trauma. In developing countries a parasitic infection called filariasis can result in severe lymphoedema. This parasite is not found in the UK.

What are the effects of lymphoedema?

Lymphoedema can cause swelling in any part of the body including the head and neck but is most common in the limbs. In primary lymphoedema the lower limbs are most commonly affected but not always equally.

Apart from the swelling, lymphoedema can also cause different skin changes. The skin in the affected limb may be a pinky-red colour and feel slightly warmer. As lymphoedema progresses the skin can become thicker and develop verrucae or small blisters. Lymphoedema can also cause chronic excema and very occasionally ulceration

Aching or heaviness of the affected limb is common but fortunately significant pain is rare.

What are the complications of Lymphoedema?

Tissue that is affected by lymphoedema is prone to infection particularly fungal infections. Damage to the skin, especially between the toes, can allow the entry of bacteria which can result in cellulitis. Repeated episodes of cellulitis aggravate the lymphoedema by causing further damage to the lymphatic system.

In severe cases the lymphoedma can result in malnutrition and very rarely cancer may develop in the affected areas.

The medical information provided here is intended solely for patients of the London & Surrey Vascular Clinic, it is general information only and should not be used as a substitute for personal advice received when consulting your own surgeon face-to-face.

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