What is Lymphedema?
Lymphedema is a chronic condition of localized fluid retention and tissue swelling caused by a compromised lymphatic system (1). This common, yet disabling condition is most often associated with excessive swelling that occurs because the lymphatic system fails to drain fluid, cells and proteins away from tissues within the body. This disease can be either genetically inherited or acquired as a consequence of surgery, trauma, cancer therapy, inflammation or infection of the lymphatic system.
Indeed, lymphedema is reported to be the most debilitating complication for breast, ovarian, cervical, prostate, testicular, bladder, colon, and head and neck cancers, as well as melanomas. It results from surgical procedures to remove lymph nodes or from radiation therapy, which disrupts lymph drainage. Affected patients can suffer from extreme swelling and sometimes significant pain, typically affecting the arms and legs, however other areas such as the breast, genitals, head and gut can be affected as well.
Worldwide, historical data estimates that 180-250 million people suffer from lymphedema (2), however, prevalence is often underestimated due to inconsistent clinical detection and definition, as well as inadequate disease tracking (2,3). In the United States, it is estimated that 1 – 2 million people suffer from primary lymphedema and 2 – 3 million people suffer from secondary lymphedema (4). It is estimated that approximately 300,000 people in Canada suffer from lymphedema (http://canadalymph.ca/).
If left untreated, there is a risk of loss of limb function as well as the onset of chronic infections. With medical improvements in cancer treatment leading to increased rates of survival and longer survival times, the number of individuals affected by lymphedema is greatly increasing. In addition to the physical effects, lymphedema also causes psychological distress on patients, which can have a profound effect on their quality of life. Disfigurement, embarrassment and depression may result in lowered social interactions with others. Moreover, the physical effects of lymphedema may necessitate a change in lifestyle, work and activities, further affecting the psychological well-being of individuals impacted by this difficult and stressful illness.
In addition to lymphedema, malfunction of lymphatic vessels can also lead to many other lymphatic related diseases such as chronic inflammation, cancer metastasis, immune suppression, hypertension and obesity.
Current Treatments are Inadequate
Drug treatments have been ineffective to relieve chronic lymphedema. Alternate recommended treatments involve massage and compression, such as Combined Decongestive Therapy, to improve lymph drainage. Although the initial swelling in lymphedema is due to the accumulation of protein outside of cells resulting in an increase in interstitial fluid, over time the composition of the swollen area changes with the occurrence of lesions and abnormal fat deposits. While decongestive therapies tend to eliminate excess water and proteins, they have little impact on the elimination of fat, tissue composition changes or lymphatic pathologies, making it difficult to effectively treat later stages of lymphedema.
A Province-Wide Strategy
We Cannot Fix What We Do Not Understand
The lymphatic system is a network of vessels designed to drain fluid away from tissue to maintain a stable state and avoid swelling. During this process, inflammatory and immune cells are also transported to lymph nodes, enabling the immune defenses of the body to function normally. Failure of the lymphatic system is the main cause for lymphedema.
Despite the central role the lymphatic system is playing in the maintenance of human health, the function and biology of this important and complex system are poorly understood (5,6).
The first step to improving treatments and outcomes for patients suffering from lymphedema is to improve our understanding of the complex biology of the lymphatic system and its functions through targeted research initiatives in order to develop new diagnostic and therapeutic approaches for patients affected by the disease (5,6).
- The Canadian Lymphedema Framework. The Canadian Lymphedema Framework: Improving Lymphedema education, research and management. 2011.
- Stout NL, Brantus P, Moffatt C. Lymphoedema management: an international intersect between developed and developing countries. Similarities, differences and challenges. Glob Public Health. 2012;7(2):107-23.
- Rockson SG, Rivera KK. Estimating the population burden of lymphedema. Ann N Y Acad Sci. 2008;1131:147-54.
- Zuther JE, Norton S. Lymphedema Management: the comprehensive guide for practitioners. Vol 3. 3 ed. New York: Thieme Medical Publishers; 2005.
- Choi I, Lee S, and Hong YK. The New Era of the Lymphatic System: No longer Secondary to the Blood Vascular System. Cold Spring Harb Perspect Med. 2012 Apr 2(4) 1-23.
- Rockson SG. Current Concepts and Future Directions in the Diagnosis and Management of Lymphatic Vascular Disease. Vasc Med. 2010 June 15(3) 213-231.