Lymphoedema

Lymphoedema is swelling of a body part (e.g. arm, leg, breast, etc.) due to insufficiency of the lymphatic system. The lymphatic system is in charge of recycling the fluids and waste products in our body. It also filters the bodily fluids to get rid of harmful particles such as bacteria.

Insufficiency of the lymphatic system can be congenital, or caused by damage during trauma or cancer treatment etc. For example, breast cancer treatment may require surgical removal of lymph nodes in the armpit on the affected side. This may reduce the capacity of the lymphatic system to drain the fluids in the affected arm, and cause swelling.

Symptoms of lymphoedema include:

- swelling in the affected body part (usually an arm or a leg)

- feeling of heaviness, tightness and pain in the affected arm or leg

- stiffness in joint movement in the affected arm or leg

- skin changes such as thickening of the skin in the affected arm or leg

- slow wound healing in the affected arm or leg

Patients with lymphoedema are also twice as likely to develop cellulitis, which is infection of the skin. Patients will then require antibiotic treatment, or even hospitalization.

Once lymphoedema reaches stage 2, it is a life-long condition. However, symptoms can still be reduced significantly with treatment. This improvement then needs to be maintained with patients' self-management in the long run.

Lymphoedema is classified into four stages, namely stage 0, stage 1, stage 2 (early/late), and stage 3.

In stage 0, patients may not display any signs or symptoms of lymphoedema, although insufficiency exists in the lymphatic system, for example due to previous cancer treatment. Small increase in fluid level in the affected body part can be identified when tested with equipment.

This stage may persist for months or years before symptoms start to develop.

In stage 1 lymphoedema, swelling becomes more noticeable, and can be detected through circumference measurement of the limb. Swelling usually goes away with elevation of the affected body part.

In stage 2 lymphoedema, fibrosis starts to develop in the swollen area, gradually hardening the tissue. Swelling no longer goes away with elevation.

In stage 3 lymphoedema, fibrosis is prominent. The swollen area becomes hard. Changes of the skin become more prominent. The shape of the limb may be altered.

A variety of treatment methods are utilized in treatment of lymphoedema. They include education, skin care, manual lymphatic drainage, bandaging, compression garments, exercises, and Kinesio taping. We also use laser treatment for cording, scars, and fibrosis from lymphoedema.

The treatment program is customized according to each patient's stage of lymphoedema, general health, lifestyle, and budget.

For example, a patient in her early 40s with stage 1 lymphoedema after early stage breast cancer may only need education, exercise, and a piece of off-the-shelf compression garment. On the other hand, a patient in her 60s with stage 3 lymphoedema which has gradually developed in the past 3 years, may need daily manual lymphatic drainage, bandaging, and custom-made compression garment. She may need to undergo such intensive treatment for 1-2 weeks, before the frequency of the sessions can be reduced, and eventually patient can manage the condition by herself.

Lymphoedema should be ideally identified and treated at stage 0 or stage 1, although one may not experience severe symptoms at this stage yet.

From stage 2, there will be some degree of irreversibility, as the damage to the lymphatic system is more extensive. But symptoms can still be improved tremendously with treatment.

Another important goal of early treatment is to prevent serious complications in the long run, such as recurrent cellulitis which may land the patients repeatedly in the hospital with high medical bills. Severe swelling and deformity of the limbs in later stage of lymphoedema also cause serious impacts on mental well-being, mobility and self-care, significantly reducing one's quality of life.

Early treatment and good self-care in the long run help to retain the functionality of the affected body parts. And the patient is more likely to retain normalcy in his/ her daily routine.

We work with surgeons and oncologist in Singapore to identify patients at risk of developing lymphoedema, so that the condition can be minimized or picked up early as much as possible.

Measures can be taken to prevent lymphoedema, for example:

- Doing scar massage and stretching exercises after surgery

- Using the affected limb as normally as tolerated

- Doing regular exercises

- Maintaining a healthy weight

To learn more about how to prevent lymphoedema after breast cancer surgery, check out our free guide here.

Our therapist visits you at your home for your treatment sessions. On the first session, the therapist will assess your condition, measure the circumference of the affected and unaffected limbs, and discuss with you to draw up a treatment plan that meets your needs. We do not provide any packages as each individual's needs are different, and treatment plan may be adjusted to meet your changing needs.