Lymphoedema is a chronic condition patients may develop as a side effect of cancer treatment, so get to know what it is to reduce the risk and prevent it.
If you are a cancer survivor whose lymph nodes had been removed during surgery, or have received radiotherapy, be on the lookout for swelling in your hands or legs, as this could be the after-effect of treatment. In appearance, your affected body part will look swollen, feel achy or heavy, and the skin will feel tight.
“Lymphoedema is a chronic condition that causes swelling due to the build-up of lymph fluid in the body’s soft tissue,” explains Dr Allen Wong, Consultant for the Plastic, Reconstructive and Aesthetics Surgery Service, Sengkang General Hospital.
Our body’s lymphatic system forms part of the immune system which circulates infection-fighting lymph fluid around the body. When the lymphatic system is blocked or damaged, fluid builds up and causes persistent swelling. This fluid build-up can affect any part of the body, but it commonly occurs in the arm or leg, causing oedema (swelling) in the affected body part.
In severe cases, the skin of the affected limb can thicken and harden to resemble the skin of an elephant, hence leading some to refer to it as an ‘elephant limb’.
In Singapore, the most common cause is due to cancer or its treatment. “For example, in the treatment of breast cancer, when the axillary lymph nodes are removed, there will be a risk of developing lymphoedema. Undergoing radiotherapy can also increase the risk of developing it,” adds Dr Wong. Post-cancer radiotherapy patients are at higher risk, but post-infection, trauma-related, congenital, and even morbid obesity can cause lymphoedema too.
To treat lymphoedema, it is best to have it diagnosed early and managed to minimise the long-term impact. If you experience the following symptoms, seek medical advice immediately:
Swelling: The most obvious clue, and it is mostly in the arms or legs, although it can also occur in other body parts like the chest, abdomen, or face, depending on the lymphatic blockage location.
Heaviness: Affected limbs or body parts feel heavy or full, leading to difficulty in handling objects for affected arms.
Tightness: Skin over swollen area feels tight and stretched, and can be uncomfortable.
Skin texture: Skin over the affected area is thicker, harder or rougher due to the chronic swelling and fibrosis (formation of scar-like tissue).
Infections: Recurring infections showing redness, warmth, increased pain and fever due to the stagnant lymph fluid promote bacterial growth, leading to frequent infections like cellulitis.
“If you notice any swelling, there’s no need to panic. Consult a lymphoedema specialist for a proper diagnosis,” assures Dr Wong, adding that there are many ways to diagnose lymphoedema.
“Firstly, lymphoscintigraphy is a form of scan that uses a radioactive tracer to evaluate the lymphatic flow. Indocyanine green (ICG) lymphography using fluorescent dye can also help to identify any lymphatic blockages. Lastly, there is magnetic resonance imaging (MRI) lymphography which can visualise obstructions in both the superficial and deep lymphatic system,” explains Dr Wong.
If you are a cancer patient who has received radiotherapy or has had lymph nodes surgically removed, lymphoedema is highly probable. To reduce the risk:
At SKH, a novel technique has been developed, called the Distally-based Lymphatic Microsurgical Healing Approach (dLYMPHA), that successfully reduces the risk of lymphoedema occurring in breast cancer patients.
Dr Wong shares: “By performing this at the same time as cancer surgery, we can significantly lower the risk of lymphoedema as it can prevent lymphatic fluid from getting trapped.”
Should you be diagnosed with lymphoedema, be assured that it is manageable with proper treatments. The treatments are:
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