Lymphoedema
Causes
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Primary Lymphedema is not well understood and can be inherited . Its aetiology is interesting and complex. Many Australian scientissts are in the process of identifying the genetic factors associated with the problem.
For unknown reasons, these genetic factors switiches off the differentiation or growth of lymphatic system and therefore leading to the development of lymphoedema. While the exact cause of primary lymphedema is still unknown, it generally occurs due to poorly-developed or missing lymph nodes and/or channels in the body.
Lymphoedema may be present at birth, develop at the onset of puberty, or not become apparent for many years into adulthood. In men, lower-limb primary lymphedema is most common, occurring in one or both legs. Some cases of lymphedema may be associated with other vascular abnormalities.
On the other hand, secondary Chronic Lymphoedema is a more common occurance and it is most frequently seen after lymph node dissection, surgery and/or radiation therapy, in which damage to the lymphatic system is caused during the treatment of cancer. Lymphedema may also be associated with accidents or certain diseases or problems that may inhibit the lymphatic system from functioning properly.Secondary lymphedema affects both men and women. In women, it is most prevalent in the upper limbs after breast cancer surgery and lymph node dissection, occurring in the arm on the side of the body in which the surgery is performed. Head and neck lymphedema can be caused by surgery or radiation therapy for tongue or throat cancer. It may also occur in the lower limbs or groin after surgery for colon, ovarian or uterine cancer in which removal of lymph nodes or radiation therapy is required. Surgery and/or treatment for prostate, colon and testicular cancers may result in secondary lymphedema, particularly when lymph nodes have been removed or damaged.
The onset of secondary lymphedema in patients who have had cancer surgery has also been linked to aircraft flight (likely due to decreased cabin pressure). For breast cancer survivors, wearing a prescribed and properly-fitted low-compression sleeve and gauntlet may help decrease swelling during flight.
Some cases of lower-limb lymphedema have been associated with the use of Tamoxifen, due to the blood clots and deep vein thrombosis (DVT) that can be caused by this medication. Resolution of the blood clots or DVT is needed before lymphedema treatment can be initiated.
Treatment
There are many treatment approach to the early phase of lymphoedema should that be primary or secondary in etiology. There are mainly massage, mechanical compression therapy, with constant wearing of compression garment. Although there are many machinery developed for the compression therapy, this is mainly related to the principle of Starling Law. By shifting the fluid from the extra celular space back to the intra-vascular compartment. Recent understanding of Starling Law leads to its modification was discovered by Drinker who believed that the lipid components can stay in the interstial space.
Although many other surgical procesures, such as lymphatic anastomosis and lymph nodes transfer grafts have been tried by many surgeons all over the world, in a long Term follow up, the end result is still the big fatty arms requiring wearing compression Garments. Thus, it is critical that the liposuction treatment be done and managed by experienced lymphoedema medical personel, recognised by the Australian Lymphoedema Association.
There is a long management process involved and it should not be simply done by anyone, in order for you to get a good outcome. For further information, please visit Hakan Brorson’s page or check out the Australian Lymphoedema Association.