The lymphatic system is responsible for protein homeostasis and the immune response through the detection and destruction of pathogens. Lymphoedema, a condition of this system, is the accumulation of excess protein-rich extracellular fluid, resulting in swelling of the affected areas. It may be classified into two types:

• Primary lymphoedema – due to a congenital or genetic malformation of the lymphatic system
• Secondary lymphoedema – due to damage or destruction of any part of the lymphatic system, commonly through trauma, surgery, radiotherapy, or because of other chronic conditions such as obesity or diabetes.

How does it happen in cancer treatment?

Cancer treatments typically involve lymph node removal through radiation or surgery to prevent the spread of cancer cells throughout your body. One of the functions of the lymph node is to direct excess lymphatic fluid to the kidneys for processing and excretion.  When the lymph node is removed, this process is impeded

When this lymph remains in one area, it tends to attract fat cells, which bind to the tissues and may eventually solidify into a dense, solid mass. This can cause a thickening or hardening of the surrounding skin (fibrosis), which further reduces lymphatic circulation and starts a vicious cycle.

There is also a risk of fibrosis development from surgical intervention. The healing process activates a natural inflammatory response in the body, which stimulates the production of collagen to close wounds. Sometimes, this collagen extends deeper into the skin and becomes rigid, restricting lymphatic flow.

Lymphoedema often becomes a cycle: surgery or radiation therapy can initiate lymphoedema by restricting lymphatic flow, which can then lead to fibrosis, further impeding lymphatic circulation. Co-morbidities such as diabetes can also affect sensation on the limb, increasing the risk of open wounds, heightening the immune response in the affected area, and leading to more fluid in the already-swollen limb.

Importance of early diagnosis

It is important to monitor for any early signs of swelling or heaviness after your surgery or radiation therapy to minimise the disease progression and reduce the overall oedema. By being proactive, you can minimise the amount of swelling and get a head start on addressing many of the factors that contribute to the cycle of lymphoedema.

Early recognition means less swelling, fewer mobility restrictions, fewer cosmetic effects, and a better quality of life.