Lymphoedema

Lymphoedema is a long-term condition that causes swelling in the body's tissues. It can affect any part of the body, but it usually develops in the arms or legs.

The swelling comes from a problem with the lymphatic system. This is a group of vessels and glands spread around the body, and it helps to fight infection and drain excess fluid from the tissues.

Swelling is the main symptom of lymphoedema. At first it may come and go, getting worse during the day and easing overnight. If it isn't treated, it can get worse.

Other symptoms in the affected part of the body can include:

• an aching, heavy feeling
• difficulty moving
• skin infections that keep coming back
• the skin becoming hard and tight
• folds in the skin
• wart-like growths on the skin
• fluid leaking through the skin

If one leg is more swollen than the other, other possible causes need to be considered, for example deep vein thrombosis (DVT). You should get medical advice if you're worried about DVT.

• you think you may have lymphoedema
• you develop symptoms of skin infection, like redness and a feeling of heat in the skin

Your doctor may be able to diagnose lymphoedema by:

• asking about your symptoms and medical history
• examining the affected body part and measuring it to check if it's enlarged

Cancer treatment can put you at risk of lymphoedema, so your aftercare may include monitoring for the condition. If you have any worries, you can talk to your care team.

The main treatment for lymphoedema is decongestive lymphatic therapy (DLT). It isn't a cure, but it can help control the symptoms.

DLT has 4 parts. These are:

• compression bandages and garments, which move fluid out of the affected limb and stop more fluid from building up
• skin care, which keeps the skin in good condition and lowers the chances of infection
• exercises, which use the muscles in the affected limb to improve lymph drainage
• manual lymphatic drainage (MLD), a specialised massage that helps the flow of fluid in the lymphatic system and reduces swelling

Primary lymphoedema comes from changes (mutations) in the genes that shape the lymphatic system. Because of these changes, the lymphatic system either:

• doesn't develop properly, or
• doesn't work as it should

Primary lymphoedema usually runs in families. But not every child born to someone with the condition will develop it.

Secondary lymphoedema develops in people whose lymphatic system was normal before. It's more common than primary lymphoedema.

The causes include:

• cancer treatment, like surgery or radiotherapy
• infections, like severe cellulitis
• inflammation, like rheumatoid arthritis or eczema
• abnormal or damaged veins, like deep vein thrombosis (DVT) or varicose veins
• obesity
• trauma and injury to the lymphatic system
• lack of movement and exercise

There are some things you can do to lower your chances of developing lymphoedema, and to stop it getting worse if you already have it.

• eat a healthy diet
• maintain a healthy weight
• exercise regularly

There are some things you can do to lower your chance of getting skin infections when you have lymphoedema. You should:

• treat cuts and scratches straight away with an antiseptic cream
• use insect repellents to prevent insect bites
• moisturise the skin daily (speak to your healthcare team to find the right cream for you)
• avoid very hot baths and showers (the heat from saunas, steam rooms and sun beds may also increase swelling)
• use sun cream with a high sun protection factor (SPF) to prevent sunburn
• wear gloves for gardening and household tasks to avoid cuts, if your upper limbs are affected
• use anti-fungal powder to prevent fungal infections in your skin or feet, if your lower limbs are affected
• cut your nails with nail clippers
• visit a chiropodist for foot and nail care, and make sure you tell them you have lymphoedema
• wear shoes that fit correctly and give support on the top of your feet, if your lower limbs are affected
• use an electric razor if you need to shave, to reduce the risk of cutting yourself
• avoid wearing tight-fitting clothes or jewellery

Cellulitis (a bacterial infection of the skin) is a common complication of lymphoedema. The build-up of fluid raises the risk of infection.

Living with a long-term condition like lymphoedema can also affect your mental health. If you're feeling low, or lymphoedema is getting in the way of your daily life, speak to your doctor.

Talking to other people who have lymphoedema can help, whether that's in a support group or through a wider support network.