On the occasion of World Lymphedema Day, we remind you that it is a chronic disease that affects 1.7 million people in Spain and almost 300 million in the world so 1 in 30 people is affected by lymphedema (world Population estimated prevalence data). It is a disease that affects 1.3 million women with breast cancer (incidence of unilateral arm lymphoedema after breast cancer a systematic review and meta – analysis, Lancet Oncology 2013,14 500-15).
Lymphedema is a dysfunction of the lymphatic system whose function is: the absorption of interstitial fluid remaining in the body in the blood exchange between artery and vein, reabsorption of macromolecules and fundamental immune function for the body.
How do I know if I have lymphedema?
The system stops working from the lymphangion, which is the lymph transport channel, which gradually loses its light and becomes obstructed until it stops working and starts extravasating the inner liquid (lymph) through the affected area, and the lymph node as well. As this lymph does not reach the lymph, it ceases to have a purifying and immunological function.
This produces an increase in the volume of the affected arm, leg or limb and a decrease in the response of the body’s immune system, due to absence. This accumulation of fluid progresses from stage I to elephantiasis or stage V, with repeated infections, cellulitis, erysipelas, which are major complications for health and decreases its other functions of transporting molecules and its great role in the immune system. Therefore, it is of great importance to recover or stabilize the functioning for the integral physical health of the patient, in addition to his psychological health.
How is it diagnosed?
The most important thing is to have an early diagnosis of the disease and this we do as the first unit in Europe, lymphography with indocyanine green, a test that should be performed by all patients 3 months after cancer surgery or 3 months after the radiotherapeutic process.
This diagnostic test helps to detect lymphedema that goes unnoticed due to its subclinical state, which has neither signs nor symptoms but is already beginning to fail. It also serves to have an x-ray of the lymphatic system to optimize treatment therapies for those patients who have already developed it, optimizing the results of their treatments.
How is lymphedema treated?
Currently the specialists in Physiotherapy have a protocol for diagnosis and treatment with the greatest reductions in volume and function of this disease reaching the normalization of the affected limb, with a multidisciplinary approach combining conservative lymphatic drainage techniques: manual, mechanical and physical agents, psychological support, specialized nutrition, specialized exercise to specialized surgery such as lymphatic-venular anastomosis that partially repairs the system. If it is no longer functional, we would perform selective lymphatic liposuction, since the lymph produces fat (lipolymphogenesis) and this technique must be done with registered results of more than 14 years of education.