Lymphoedema: an underestimated health problem

Moffatt, Christine; Franks, Peter J.; Doherty, Debra; Williams, Anne; Badger, Caroline; Jeffs, Eunice; Bosanquet, Nick; Mortimer, Peter

doi:10.1093/qjmed/hcg126

Cited by 455 publications

(363 citation statements)

References 10 publications

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“…26 Lymphoscintigraphy, a nuclear medicine imaging technique, along with other imaging technologies, have been used to investigate the pre-and post-operative risk of lymphoedema development in patients with breast cancer. [27][28][29] The uptake of this imaging modality in the clinical diagnostic process is not universal 30 and is the topic of continuing experimental evaluation. 31 New technologies such as bioimpedance may aid diagnosis and provide a level of accuracy in clinical examination not previously possible through traditional measurement techniques such as circumferential measures.…”

Section: Breast Cancer-related Lymphoedemamentioning

confidence: 99%

“…The health costs of management of BCRL are not available in the literature, however Moffatt et al 30 reported that in South West London 29% of people identified with lymphoedema experienced an acute infection in the affected area over the previous year with 27% being admitted for intravenous antibiotics. Mean length of stay for this condition was 12 days, and the estimated mean cost was £2300.…”

Section: Costsmentioning

confidence: 99%

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Breast cancer-related lymphoedema risk reduction advice: A challenge for health professionals

Nielsen

Gordon

Selby

2008

Cancer Treatment Reviews

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SummaryBreast cancer-related lymphoedema (BCRL) is a debilitating, distressing condition affecting approximately one in five breast cancer survivors (Clark B, Sitzia J, Harlow W. Incidence and risk of arm oedema following treatment for breast cancer: a three-year follow-up study. QJM 2005;98:343-8). The evidence-base for breast cancer-related lymphoedema risk reduction advice is scant and contradictory, with most studies in the area limited by small numbers, retrospective design and other methodological inadequacies. Current advice has the capacity to profoundly alter quality of life following treatment for breast cancer. Health professionals should review the risk reduction advice they provide to reflect the current understanding of aetiology and risk factors. Further research is required to provide more evidence for the content, to identify optimal methods of precautionary education delivery and to determine the effect of the advice on the patient's quality of life and perception of recovery.

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Section: Breast Cancer-related Lymphoedemamentioning

confidence: 99%

Section: Costsmentioning

confidence: 99%

Breast cancer-related lymphoedema risk reduction advice: A challenge for health professionals

Nielsen

Gordon

Selby

2008

Cancer Treatment Reviews

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“…It is a common observation that lymphoedema of the toes feet and legs go often unnoticed, leading to inter digital sepsis aggravating the clinical state [7,8].…”

Section: Discussionmentioning

confidence: 99%

Lymphoedema of the limbs: an experience from a tertiary clinic in the central province of Sri Lanka

et al. 2017

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ObjectiveA descriptive study to evaluate the pattern of presentation of lymphoedema of limbs to a tertiary care clinic in the central province of Sri Lanka. Patients and MethodPatients with lymphoedema seen over 28 years, (1980-2007) in the vascular clinic at the General Hospital Peradeniya were reviewed retrospectively. Results649 cases of lymphoedema of limbs were seen. 47 were in the upper limb, 36 of whom were secondary, mostly following axillary clearance associated with a mastectomy, and 11 cases were idiopathic. 602 patients had their lower limbs involved, with 96 cases amongst them being secondary, mostly to trauma, filariasis and a few with pelvic carcinoma and lymphoma. The rest (n =506) were considered to have lymphoedema of primary aetiology. The involvement of the legs was predominantly below the knees. A late onset group of lymphoedema patients, predominantly males above 60 years posed a problem in diagnosis and is worth future study.Complications among patients with lymphoedema of lower limbs with no overt secondary cause included inter digital cleft sepsis in 54.5 %, cellulitis or a history of the same in 66 %, lymphangitis 16 % lymphadenitis 3.5% and 11 % had septicaemia which aggravated the clinical state. ConclusionPrimary lymphoedema needs recognition as the dominant cause of limb lymphoedema especially in the Central Province. This diagnosis is required to prevent complications which need long term treatment. A filarial aetiology for most cases, as is popularly believed, is not evidence based. Secondary causes for lower limb lymphoedema must be looked for, such as pelvic malignancy and lymphoma. Trauma or surgery over lymphatic pathways should be avoided to prevent limb lympheodema. IntroductionNo significant documentation exists on the pattern of presentation of lymphoedema in Sri Lanka, though there exists records of its presence as a disease entity since the eighteenth century [1]. Lymphoedema is a disorder that has geographical implications such as possible association to Filaria [2], bare foot walking and the soil texture as in podoconioses [3]. It also involves genetic factors [4], with a pathogenesis seen to be of protean origin.The complications associated with lymphoedema, namely interdigital cleft sepsis, lymphangitis, lymphadenitis and cellulitis are quite disabling and aggravate the morbidity of the disease [5]. Surgical procedures that have been attempted to rectify lymphedema have yielded poor long-term results [5].The data regarding prophylactic care given to such limbs is inadequate, and makes it difficult to adopt focused and effective remedial measures. We present a database collected and collated over twenty eight years of attending to such patients in the hope that it will provide a scaffolding for care of this as yet mostly ignored area of clinical care. Patients and MethodOver a period of 28 years , 649 patients with limb lymphoedema were seen in the vascular clinic of the General Hospital Peradeniya. Majority of patients were from Central Province of Sri Lan...

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“…Quality of life suffered, with clear deficits in many domains of the well-validated SF-36 questionnaire. 1 …”

Section: Why Is Chronic Oedema Important?mentioning

confidence: 99%

Chronic peripheral oedema: the critical role of the lymphatic system

2004

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Oedema is an excess of interstitial fluid and is an important sign of ill health in clinical medicine. It may occur in the lungs (pulmonary oedema), the abdominal cavity (ascites) and other body cavities (synovial, pericardial and pleural effusions) but in this article only peripheral (subcutaneous) oedema is discussed.In medical practice peripheral oedema tends to get pigeonholed according to possible systemic or peripheral causes eg heart failure, nephrotic syndrome, venous obstruction or lymphoedema. This viewpoint fails to appreciate the many dynamic physiological forces contributing to oedema development and in particular the central role of the lymphatic drainage system in tissue fluid balance. Consequently, the clinician's approach to chronic oedema is often misguided and the necessary medical intervention inappropriate, for example, empirical use of diuretics. In this article we propose a system for managing peripheral oedema, which is based on physiological principles, that can then guide treatment. Why is chronic oedema important?Besides being a physical sign of a potentially fatal systemic condition such as heart failure, chronic oedema impairs local cell nutrition due to increased interstitial diffusion distances of oxygen and nutrients so tissue viability can become compromised. Swollen limbs can be painful, giving rise to impaired mobility as well as a predisposition to infection and blistering progressing to ulceration.Chronic oedema is a common problem in the community particularly for district nurses. A recent epidemiological study in South West London estimated a crude prevalence of 1.33/1000 population rising to one in 200 people over the age of 65. 29% of the oedema cases had experienced cellulitis in the preceding year with one quarter of these cases requiring admission. Oedema caused time off work in more than 80% of sufferers and employment status was affected in 9%. Quality of life suffered, with clear deficits in many domains of the well-validated SF-36 questionnaire. 1 Understanding oedemaOedema develops when the microvascular (capillary and venules) filtration rate exceeds lymph drainage for a sufficient period, either because the filtration rate is high or because lymph flow is low or a combination of the two. Filtration rate is governed by the Starling principle of fluid exchange, which is described succinctly and quantitatively by the Starling equation for flow across a semipermeable membrane: In theory an increase in lymph transport, if achievable, should benefit all forms of oedema Calcium channel blocking agents should be contraindicated in the presence of any peripheral oedema unless there is no alternative treatment Diuretics should only be prescribed long-term in circumstances of salt and water overload, eg heart failure, venous disease, and not on an empirical basis for any oedema Movement through active or passive exercise should always be the preferred option for reducing leg oedema due to decompensated lymph drainage, with elevation practised during the periods of rest

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Lymphoedema: an underestimated health problem

Cited by 455 publications

References 10 publications

Breast cancer-related lymphoedema risk reduction advice: A challenge for health professionals

Breast cancer-related lymphoedema risk reduction advice: A challenge for health professionals

Lymphoedema of the limbs: an experience from a tertiary clinic in the central province of Sri Lanka

Chronic peripheral oedema: the critical role of the lymphatic system

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