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Lymphoedema
Lymphoedemaischaracterisedbyswellingofcertainpartsofthebody,causedbyproblemswith thelymphaticsystem.Anypartofthebodycanbeaffectedbylymphoedema,butittendstotarget thearmsandlegs.Around300,000Australianswillexperiencelymphoedemaatanygiventime. Normally,fluidandproteinsleakintothebodytissuesregularlyfromtheblood.Thistissuefluid bathesthecells,suppliestheirnutritionalneedsandreceivesbacktheproductsoftheir metabolism.Thelymphaticsystemisanetworkoftubesthroughoutthebodythatdrainsthisfluid (calledlymph)fromtissuesandemptiesitbackintothebloodstream.Whenthissystemisnot workingproperly,lymphoedemacanoccur. Womenwhohaveundergonesurgeryandradiotherapyfortreatmentofbreastcancerare particularlysusceptibletolymphoedemaofthearmand,sometimes,theadjacentchestwallonthe affectedside.Menandwomenwhohavehadsurgeryandradiotherapyforthetreatmentofcancer oftheprostate,bowelorreproductivesystemsarealsopronetolymphoedemaofthelegsorgroin areas. Symptoms Thesymptomsoflymphoedemamayinclude: Theaffectedareafeelsheavy Theskinfeelstightandclosetoburstingpoint Theskinishotterthanotherareasofthebody Aching Pinsandneedles Dartingpains Painfuljoints Swelling.

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The lymphatic system Themainrolesofthelymphaticsystemincludemanagingthefluidlevelsinthebody,filteringout bacteria,andhousingtypesofwhitebloodcellscrucialtothebodysabilitytofightinfection. Muscularmovementsandcontractionsofthelargerlymphvesselspumpthelymphthroughthe networkoftubes.One-wayvalvesinthevesselspreventthelymphfromtravellingbackwards.The lymphisclearedofmicro-organismsinglandsoftissuecalledlymphnodes,locatedaroundthe body.Thelymphiseventuallyreturnedtothebloodstream,mainlythroughbloodvesselsinthe neck. Swelling, inflammation and risk of infection Oedema(temporaryswelling)occurswhenthelymphaticsystemcantefficientlyremoveexcess fluidfromtissues.Asprainedankle,forexample,maybeswollenforafewdaysorweeks. Lymphoedemaoccurswhenthelymphaticsystemisinjuredorobstructed.Theexcessfluidand proteinsinthetissuecauseswellinganddecreasetheamountofoxygenavailabletothecells. Theextraproteinscauseinflammation,whichleadstofibrosisiflymphoedemaisnottreated. Thecombinationofextraproteinsandbodyheatprovidesaperfectbreedinggroundforbacteria andfungus.Theseinfectionsplacegreaterstressesonthealreadylabouringlymphaticsystemand hospitaladmissionmayberequiredinseverecases. Primary lymphoedema Primarylymphoedemaischaracterisedbystructuralproblemswiththelymphaticsystem.The vesselsmaypumpsluggishlyortheremaybeinsufficientnumbersofvessels,orbothmayoccur. Primarylymphoedemamaybepresentbeforebirth(congenitallymphoedema)ormaydevelop duringpuberty(lymphoedemapraecox)ormiddleage(lymphoedematarda).

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Forthosepeoplewhohaveastructuralproblemwiththelymphaticsystem,theriskofdevelopinga secondarylymphoedemaoverlyingitishigheriftheyhavesurgeryorradiotherapyforcancer treatmentorothersurgeries. Secondary lymphoedema Secondarylymphoedemaiscausedbyobstructionsinthelymphaticdrainagesystem.Thismaybe dueto: Surgery particularlycancer-relatedsurgerywherelymphnodesareremoved. Radiotherapythex-raysusedtokillcancercellsmaydamageordestroythenearby lymphnodes. Traumaaninjurytoalymphaticvesselmaynothealproperly. Parasitessuchasworms,whichmayinhabitandblockalymphaticvessel. Lack of movementmuscularcontractionsarerequiredtohelppumpthelymphthrough thevessels.Lackofmovementallowsthelymphtopool,particularlyinthelegs. Allergy allergicreactionsmayaffectthelymphaticsystem.

Lymphoedema following treatment for breast cancer Swellingofthearm,theremainingbreasttissueorthechestcanfollowbreastcancersurgeryif thenearbylymphnodesinthearmpitareremoved.Radiotherapycanalsocauseswelling. Althoughtheincidencevariesdependingonthenumberoflymphnodesremoved,whether radiotherapywasgivenandarangeofotherfactorsaround10percentofwomenwillexperience lymphoedematosomedegreewithradiotherapyalone,whileuptoone-thirdofwomenwho undergobothradiotherapyandsurgery(andhaveotherriskfactors)willbeaffected. Lymphoedemacanoccuratanystageaftertheintervention,even20yearslater. Diagnosis Lymphoedemaisdiagnosedwithanumberofdifferenttests,including: Physical examinationtakingintoaccountthepersonspriormedicalhistory. Scansspecialisedx-rays,includingCTscansandespeciallylymphoscintigraphy(which givesafunctionalpictureofthelymphaticsystem). Bioimpedance todetectfluids. Perometry todetectlimbvolumeandcircumferencechanges. Tonometry todetectchangesinthetoughness(fibre)ofthelimb.

Treatment Lymphoedemacanbetreatedinanumberofways,including: Complex physical therapy (CPT)combinescompression,lymphaticdraining,special exercisesandskincaretechniques. Compression bandagestopromotelymphflow. Lymphatic drainage massagetomanuallymovethelymphtoapreviouslycleared, unaffectedareaandincreasewhatdrainageispresentinthelimb. Special exercisesmuscularmovementhelpstopumplymph. Medicationssuchasbenzopyrones(Paroven)tohelpremoveexcessproteinsand associatedfluidfromthetissues. Massagethepersonortheircarercanbetaughtmassagetechniques. Low-level laser therapywhichcansoftenfibrotictissueandhelpstimulatepoorly functioninglymphvessels. Electrical stimulation ofthemuscularelementsofthelymphvesselsandsurrounding musculature. Various forms of vibratory massage allofwhichinsomewayvarythetissuepressure andencourageuptakeoffluidsandtheircontentsintothelymphvessels.

Surgery Surgicalproceduresarenotsuitableforeveryoneandarebestconsideredwhenallotherefforts fail.Thedifferenttypesofsurgerythatmaybeusedinclude: Lymphatic transplant operationslymphaticvesselsfromanormallimbaresurgically transferredintotheaffectedarea. Lympho-venous anastomosisanexisting,butblockedlymphaticvesselisjoinedtoa vein.

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Liposuctionexcesssuperficialtissueissuckedoutbetweentheskinandmusclelayers. (Thisismostbeneficialinthemiddle,fattystageoflymphoedema.)

Self-help Areasofthebodyaffectedbylymphoedemaarepronetoinfection.Suggestionstomanage lymphoedemainclude: Payparticularattentiontoskincaretoreducetheriskofinfection. Avoidcuts,abrasionsorothertissueinjuriesintheaffectedarea. Dontallowyourskintobesunburned. Avoiddirectheat,suchashotbaths,saunasandsunbathing. Haveyourbraprofessionallyfitted. Dontweartightjewellery. Trynottositdownforlongperiodsoftimeor,ifyoudo,elevatetheaffectedlimb. Takeregularandgentleexercise.(Taichiandchigonghaverecentlybeenshowntobe veryeffectiveforarmlymphoedemas).Evenhigherlevelsofexercisecanbebeneficialbut talktoyourhealthprofessionalbeforestartinganynewactivity. Makesurethatanymedicalproceduressuchasinjections,bloodtestsorbloodpressure readingsaretakenfromtheunaffectedarmifpossible.Ifthisisnotpossible,makesure thatanywoundsiteiswellcleanedandsignsforanyearlyinfectionarereactedto. Avoidcarryingheavyloadsforanylengthoftime,asthisdoesnotallowgoodlymphfluid clearancefromthetissues.

Where to get help Yourdoctor NurseonCallTel.1300606024forexperthealthinformationandadvice(24hours,7 days) LymphoedemaSupportGroupsineachstatewww.lymphoedema.org.au Financialassistancetopurchasecompressiongarmentsisavailableforpeoplewhoare pensioncardholdersthroughtheGarmentReviewInformationProject(GRIP)

Things to remember

Lymphoedemaischaracterisedbyswellingofcertainpartsofthebody,causedby problemswiththelymphaticsystem. Womenwhohaveundergonesurgeryandradiotherapyfortreatmentofbreastcancerare particularlysusceptible. Treatmentoptionsincludemassage,medications,compressionbandages,specialexercises andsurgery.

This page has been produced in consultation with, and approved by:

LymphoedemaAssociationofAustralia

Copyight 1999/2009StateofVictoria.ReproducedfromtheBetterHealthChannel(www.betterhealth.vic.gov.au)at nocostwithpermissionoftheVictorianMinisterforHealth.Unauthorisedreproductionandotherusescomprisedinthe copyrightareprohibitedwithoutpermission. ThisBetterHealthChannelfactsheethaspassedthrougharigorousapprovalprocess.Forthelatestupdatesandmore informationvisitwww.betterhealth.vic.gov.au.

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