Hostname: page-component-586b7cd67f-l7hp2 Total loading time: 0 Render date: 2024-11-28T02:24:42.838Z Has data issue: false hasContentIssue false
  • English
  • Français

Lymphoedema: causes, prevention and management in older people

Published online by Cambridge University Press:  15 February 2013

Neil Piller
Neil Piller*
Affiliation:
Lymphoedema Research Unit, Department of Surgery, Flinders University and Medical Centre, Adelaide, Australia
*
Address for correspondence: Professor Neil Piller, Room 3A.260, Department of Surgery, Level 3, Flinders Medical Centre, Bedford Park, Adelaide, South Australia5042. Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Summary

The lymphatic system must have variation in tissue pressure to load it and to help flow. Being a low pressure system, external pressure must not be constantly high on any segment and there must be a pressure gradient along it. When the flow rate of lymph fails there can be compromised immunity, a tendency to deposit fat, fibrotic induration, and a vicious cycle of worsening of cellular and organ health often associated with recurrent infection.

As we age we become less active, lose muscle tone, and increase our weight, develop a higher percentage of body fat, and may have poor skin care and be prescribed medications which impact on lymphatic load. Combined with this, the tendency to immobility, limb dependency and periods of time when high external pressures exist in small superficial areas increase the risk of or contribute to lymphoedema through reducing lymphatic flow. Older people are more likely to have had more radical surgery and radiotherapy for cancer with more significant damage to their lymphatic systems, again adding to lymphoedema risk. Immobility, hypertension, venous disease, kidney and liver failure can lead to oedema, while thyroid dysfunction can cause myxedema, and genetic or metabolic issues can cause lipoedema, compounding the clinical problems.

A key point in good management is early identification and accurate diagnosis. Ideally, other issues that especially impact on lymphatic load should be managed prior to targeted and sequenced treatment for the swelling, with the aim being to improve patient comfort. Management can involve the patient, partner, family or carer as well as a range of health professionals to help reduce or maintain limb size, appearance and function as well as reduce symptoms of heaviness, tension and discomfort and a range of other issues that impact on quality of life and activities of living.

Keywords

lymphoedemalymphaticsageingtreatmentdiagnosis
Type
Clinical geriatrics
Information
Reviews in Clinical Gerontology , Volume 23 , Issue 2 , May 2013 , pp. 142 - 154
Copyright
Copyright © Cambridge University Press 2013

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Foeldi, M, Foeldi, E, Kubik, S.Sufficiency and insufficiency of the lymphatic system. Textbook of Lymphology for Physicians and Lymphoedema Therapists. Urban and Fisher, Munich, 2003.Google Scholar
2Umno, N, Tanaka, H, Suzuki, Met al.Influence of age and gender on human lymphatic pumping pressure in the leg. Lymphology 2011; 44: 113–20.Google Scholar
3Thangaswamy, S, Bridenbaugh, EA, Gashev, AA. Evidence of increased oxidative stress in aged mesenteric lymph vessels. Lymphatic Res Biol 2012; 10: 53–62.CrossRefGoogle Scholar
4Cavezzi, A, Michelini, S.Phlebolymphoedema from Diagnosis to Therapy. Edizioni PR, Bologna, 1998.Google Scholar
5Schmeller, W and Meier-Vollrath, I. (2008) Lipoedema. In Lymphoedema Diagnosis and Therapy Via Vital, Weissleder, H and Schuchardt, (eds), pp. 294–323.Google Scholar
6International Society of Lymphology. The diagnosis and treatment of peripheral lymphoedema. Consensus document of the International Society of Lymphology. Lymphology 2009; 42: 51–60.Google Scholar
7Lee, BB, Andrade, M, Bergan, Jet al.Diagnosis and treatment of primary lymphoedemas: Consensus document of the International Union of Phlebology. Int Angiology 2010; 29: 454–70.Google ScholarPubMed
8Lymphoedema Framework. Best Practice for the Management of Lymphoedema. International Concensus London MEP Ltd, 2006.Google Scholar
9Damstra, R, Kaandorp, CMultidisciplinary guidelines for early diagnosis and management. Journal of Lymphoedema 2007; 2: 57–61.Google Scholar
10Vasileiou, AMet al.Oedema in obesity; role of structural lymphatic abnormalities. Int J Obesity 2011; 35: 1247–50.CrossRefGoogle ScholarPubMed
11Aki, T, Nagai, T, Cote, G, Gashev, A.Mesenteric lymph flow in adult and aged rats. Am J Physiol Heart Circ Physiol 2011; 301: H1828–40.Google Scholar
12Tzanetakou, I, Katsilambros, N, Benetos, Aet al.Is obesity linked to aging? Adipose tissue and the role of the telomeres. Aging Res Rev 2012; 11: 220–29.CrossRefGoogle ScholarPubMed
13Al-Niami, F, Cox, N.Cellulitis and lymphedema: a vicious cycle. J Lymphoedema 2009; 4: 38–43.Google Scholar
14Casley-Smith, JR, Casley-Smith, JR.High Protein Oedemas and the Benzo-pyrones. Lippencott, Sydney, 1986.Google Scholar
15Keeley, V.The use of lymphoscintigraphy in the management of chronic lymphoedema. J Lymphoedema 2006; 1: 42–57.Google Scholar
16Simpson, RJ.Aging. Persistant viral infections and immunosenescence: Can exercise “make space”. Exerc Sport Sci Rev 2011; 39: 23–33.CrossRefGoogle Scholar
17Lumeng, CNet al.Aging is associated with an increase in T cells and inflammatory macrophages in visceral adipose tissues. Immunol 2011; 187: 6208–16.CrossRefGoogle Scholar
18Ridner, SH, Montgomery, LD, Hepworth, J, Armer, J.Comparison of upper limb volume measurement techniques and arm symptoms in healthy volunteers and individuals with known lymphedema. Lymphology 2007; 40: 35–46.Google ScholarPubMed
19Franks, Pet al.Assessment of health related quality of life in patients with lymphoedema of the lower limb. Wound Repair Regen 2006; 14: 110–18.CrossRefGoogle ScholarPubMed
20Amer, M, Ramati, A.Post-traumatic symptoms, emotional distress and quality of life in long term survivors of breast cancer. J Anxiety Disorders 2002; 16: 195–206.Google Scholar
21Armer, JM, Stewart, BR.A comparison of 4 diagnostic criteria for lymphoedema in a post breast cancer population. Lymphatic Res Biol 2005; 3: 208–17.CrossRefGoogle Scholar
22Ridner, SH.Quality of life and a symptom cluster associated with breast cancer treatment-related lymphedema. Support Cancer Care 2005; 13: 904–11.CrossRefGoogle Scholar
23Moseley, A, Piller, NB.Relationships between limb size and composition using objective measures. Lymphology 2007; 40 (suppl): 170–75.Google Scholar
24Moseley, AL, Piller, NB.A pilot study of the reliability of bioimpedance spectroscopy (BIS) and tonometry for the measurement of breast fluid volume and fibrous tissue and their changes in women who have had breast conserving cancer treatment. Lymphatic Res Biol 2008; 6: 85–87.CrossRefGoogle Scholar
25Stanton, AW, Northfield, J, Holroyd, Bet al.Validation of an optoelectronic limb volumeter (Perometer). Lymphology 1997; 30: 77–79.Google ScholarPubMed
26Piller, NB.To measure or not to measure? What and where is the question. J Lymphoedema 2007; 2: 39–45.Google Scholar
27Australian Lymphology Association Measuring Standard. Available at: http://lymphology.asn.au/new/documents/ALA_Measuring_Standards.pdf (accessed 21 Nov 2012).Google Scholar
28Bates, Det al.Quantification of the rate and depth of pitting in human oedema using an electronic tonometer. Lymphology 1994; 27: 159.Google ScholarPubMed
29Modi, S, Stanton, AWB, Svensson, W, Peters, A, Mortimer, P, Levick, J.Human lymphatic pumping measured in healthy and lymphoedematous arms by lymphatic congestion lymphoscintigraphy. J Physiol 2007; 583: 271–85.CrossRefGoogle ScholarPubMed
30Stanton, AWet al.Comparison of micro-vascular filtration in human arms with and without post mastectomy lymphedema. Exp Physiol 1999; 84: 405–19.CrossRefGoogle Scholar
31Piller, NB.Proactive treatment for lymphoedema patients. J Lymphoedema 2011; 6: 6.Google Scholar
32Piller, N, Thelander, A.Treatment of chronic lymphoedema with low level laser therapy: A 2.5 year Follow-up. Lymphology 1998; 31: 74.Google ScholarPubMed
33Carati, C, Anderson, S, Gannon, B, Piller, N.Treatment of post mastectomy lymphoedema with low level laser therapy. Results of double blind placebo controlled trial Cancer 2003; 98: 1114–22.CrossRefGoogle ScholarPubMed
34Tilley, S.Use of laser therapy in the management of lymphoedema. J Lymphoedema 2009; 4: 39–48.Google Scholar
35Wigg, J.Use and response to treatment using low level laser therapy. J Lymphoedema 2009; 4: 73–76.Google Scholar
36Carati, C, Gannon, B, Piller, NB.Low level laser as a treatment option for postmastectomy lymphoedema. Am J Oncology Rev 2004; 3: 2–7.Google Scholar
37Partsch, H, Atout, N, Forner-Cordero, Iet al.Clinical trials needed to evaluate compression therapy in breast cancer-related lymphoedema: proposals from an expert group. Int Angiology 2010; 29: 442–53.Google ScholarPubMed
38Williams, A. Manual lymphatic drainage: exploring the history and evidence base. Chronic Oedema 2010; S18–24.CrossRefGoogle Scholar
39Stanisic, M, Gabriel, M, Pawlaczyk, K.Intensive decongestive treatment restores ability to work in patients with advanced forms of primary and secondary lower extremity lymphoedema. Phlebology 2012; 27: 347–51.CrossRefGoogle ScholarPubMed
40Moseley, Aet al.A new patient focused, home based therapy for people with chronic lymphoedema. Lymphology 2004; 37: 53.Google Scholar
41Piller, NB, Rice, J, Heddle, R, Miller, A.Partner training as an effective means of managing chronic arm lymphoedema subsequent to breast cancer surgery. Proceedings of the XV Lymphology Congress. Lymphology 2000; 33 (suppl): 261–65.Google Scholar
42Piller, N, Merritt, J, Esterman, A, Moseley, A.Home use of a massage pad for chronic secondary lymphoedemas – what the patient can expect. Lymphology 2004; 37 (suppl): 385–93.Google Scholar
43Moseley, A, Piller, NB, Heidenreich, B and Douglass, JA Pilot Study of a handheld massage unit. J Lymphoedema 2009; 4: 24–28.Google Scholar
44Moseley, A, Piller, N, Carati, C, Esterman, AThe impact of the Sun Ancon Aerobic Exerciser on chronic secondary lymphoedema of the legs. Lymphology 2002; 35 (suppl): 336–39.Google Scholar
45Moseley, A, Piller, N, Carati, C.The effect of gentle arm exercise and deep breathing on secondary arm lymphoedema. Lymphology 2005; 38: 136–45.Google Scholar
46Loudon, A, Barnett, T, Piller, Net al.The effect of yoga on women with secondary arm lymphoedema from breast cancer treatment. BMC Complement Altern Med 2012; 12: 66.CrossRefGoogle ScholarPubMed
47Moseley, A, Piller, NB.Exercise for limb lymphoedema: Evidence that it is beneficial. J Lymphoedema 2008; 3: 51–56.Google Scholar
48Moseley, AL, Carati, C, Piller, NB. A systematic review of common conservative therapies for arm lymphoedema secondary to breast cancer treatment. Annals Oncology 2003; doc10.1093/annonc/md182.Google Scholar
49Johansson, K.Weight bearing exercise and its impact on arm lymphedema. J Lymphoedema 2007; 2: 115–22.Google Scholar
50Tidar, D, Katz-Leurer, M.Aqua lymphatic therapy in patients who suffer from breast cancer related lymphoedema: A randomized controlled study. Suppl Care Cancer 2010; 18: 383–92.CrossRefGoogle Scholar
51Box, R, Marnes, T, Robertson, V. Aquatic physiotherapy and breast cancer related lymphoedema. 5th Australasian Lymphology Association Conference Proceedings, March 2004; pp. 47–49.Google Scholar
52Casley-Smith, JR, Casley-Smith, JR (1997) Modern Treatment for Lymphoedema. Ch. 28. Exercises for lymphoedema and acute injuries. Lymphoedema Association of Australia pp. 188–221.Google Scholar
53Bracha, J, Jacob, T.Using exercise classes to reduce lymphedema. J Lymphoedema 2010; 5: 46–55.Google Scholar
54Johansson, K, Tibe, K, Kanne, L, Skantz, H.Controlled physical training for arm lymphoedema patients. Lymphology 2004; 37 (suppl): 37–39.Google Scholar
55Todd, J, Scally, A, Dodwell, D, Horgan, K, Topping, A.A randomized controlled trial of two programs of shoulder exercise following axillary node dissection for invasive breast cancer. Physiotherapy 2008; 94: 265–73.CrossRefGoogle Scholar
56Pecking, AP, Fevrier, B, Wargon, C, Pillion, G.Efficacy of Daflon 500 mg in the treatment of lymphoedema (secondary to conventional therapy of breast cancer). Angiology 1997; 148: 93–98.CrossRefGoogle Scholar
57Cluzan, RV, Alliot, F, Ghabboun, S, Pascot, M. Treatment of secondary lymphoedema of the upper limb with CYCLO 3 FORT. Lymphology 1996; 29: 29–35.Google ScholarPubMed
58Loprinzi, CL, Kugler, JW, Sloan, JAet al.Lack of effect of Coumarin in women with lymphedema after treatment for breast cancer. New Engl J Med 1999; 340: 346–50.CrossRefGoogle ScholarPubMed
59Farinola, N, Piller, N.Pharmaco-genomics- its role in re-establishing coumarin as treatment for lymphedema. Lymphatic Res Biol 2005; 3: 81–86.CrossRefGoogle Scholar
60Piller, NB, Douglass, J, Heidenreic, B, Moseley, A.Placebo controlled trial of mild electrical stimulation. J Lymphoedema 2010; 5: 15–25.Google Scholar
61Moseley, A, Piller, NB, Douglass, J, Esplin, M. Comparision of the effectiveness of MLD and LPG. J Lymphoedema 2007; 2: 30–36.Google Scholar
62Kinesio UK. Kinesio Taping for Lymphoedema. Available online at: www.kinseiotaping.co.uk (accessed 13 May 2009).Google Scholar
63Rock-Stockheimer, K.Kinesiotaping for Lymphoedema and Chronic Swelling, Kinesio USA, 2006.Google Scholar
64Bosman, J, Piller, NB.Lymph taping and seroma formation post breast cancer. J Lymphoedema 2010; 5: 12–21.Google Scholar
65Foeldi, M, Foeldi, E, Kubik, S.Lymphostatic diseases – chylous reflux. In Textbook of Lymphology for Physicians and Lymphoedema Therapists. Urban and Fisher Munich, 2012.Google Scholar
66Dawson, R, Piller, N.Diet and BCRL: facts and fallacies on the web. J Lymphoedema 2011; 6: 36–42.Google Scholar
67Todd, J, Austwick, T, Berridge, Det al.B type natriuretic peptide in lymphoedema. Lymphology 2011; 44: 29–34.Google Scholar
68Gashev, A, Zawieja, D.Hydrodynamic regulation of lymphatic transport and the impact of aging. Pathophysiology 2010; 17: 277–87.CrossRefGoogle ScholarPubMed
69National Lymphedema Network Medical Advisory Committee. Position Statement of the National Lymphedema Network: Exercise, December 2011. Available at: http://www.lymphnet.org/lymphedemaFAQs/positionPapers.htm (accessed 22 January 2013).Google Scholar