Lymphoedema: diversion brings flow into the system

If the transport of tissue water is disrupted by lymph node removal, swelling can occur. Early detection of lymphoedema is crucial to prevent persistent congestion.

Thanks to medical advances in the treatment of breast cancer, many patients can be cured and the prognosis is much better than it used to be. However, this does not mean that there are no problems. Many women suffer from bothersome side effects. "One of the most common problems is lymphoedema, a chronic and often painful condition that causes swelling in the limbs due to the build-up of lymph fluid. It is particularly common in women who have had lymph nodes removed or damaged during breast cancer surgery," explains Prof Dr Mario Scaglioni, Co-Chief Physician at the Plastic Surgery Pyramid in Zurich. The lymph nodes, small bean-shaped organs, are located in numerous parts of the body. They act as a filtering station for lymph from one region of the body and produce and store cells that fight infections in the body. This makes them an important part of the immune system. If a foreign body, such as a bacterium, is detected in the lymph node, the lymphocytes multiply and an immune defence against the pathogen develops. Swelling is therefore usually a sign of a natural defence reaction.

According to estimates by the Lymphoedema Association, around 50,000 to 100,000 people in Switzerland live with lymphoedema. The most common areas of fluid accumulation are the arms, chest, breast and armpits. Lymphoedema can occur anywhere on the body where lymph nodes have been removed or irradiated. "However, this does not happen immediately after the operation. The symptoms develop gradually over weeks or months and can even occur years after cancer treatment," says Prof Scaglioni.

Lymphoedema manifests itself in the form of visible and palpable swelling in the arms or legs, a feeling of tightness, especially when wearing tight-fitting clothing. Other symptoms include obvious and prolonged pressure points, thickening or hardening of the skin, dull pain in the affected areas and small blisters from which a clear fluid emerges. The combination of lymphatic drainage and compression therapy is the gold standard in the conservative treatment of lymphoedema. "At an advanced stage, lymphoedema cannot be cured, but we can improve the quality of life through conservative treatment," explains Prof Mario Scaglioni. Lymphoedema can even be cured if it is discovered early and corrected by surgery.

With the help of microsurgery and supermicrosurgery, it is possible to restore lymphatic flow. "Lymphovenous anastomosis, or LVA for short, is a bypass. We connect the lymphatic vessels to a vein, which improves lymphatic drainage," says Prof Scaglioni. The procedure can be performed at any site where the lymph is disturbed. "In the case of advanced lymphoedema, we achieve a reduction in swelling of up to 40 per cent. After that, conservative measures such as lymphatic drainage or compression are also reduced," he adds.

For oedema that has been present for some time and where fibrosis of the tissue has already occurred, LVA is not enough. "In this case, an additional transfer of tissue containing lymph nodes must be performed. This is usually followed by LVA to optimise lymphatic drainage."

Interview with Verena Thurner, Schweizer Illustrierte

Stages of oedema

Stage 0: No visible swelling despite damaged lymphatic system.

Stage I: Reversible oedema that subsides with elevation. Soft tissue.

Stage II: Irreversible oedema that does not subside with elevation. Hardened tissue.

Stage III: Severe swelling, deformation and connective tissue changes. This stage is accompanied by complications such as infections, severe movement restrictions and psychosocial impairments.

The lymphatic system is part of the immune system and is made up of delicate lymphatic vessels and nodes. Its main functions are the elimination of harmful cells and the transfer of white blood cells.