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The Role of the Lymphatic System

 

The lymphatic system is a complex network consisting of lymphatic vessels, lymph nodes and other organs functioning in parallel to the bloodstream. The lymphatic system helps maintain fluid balance in the body by draining excess fluid and tissue particles and returning them to the bloodstream. It is also an important part of our immune system that defends the body against infections by providing cells that fight disease. Its integrity is essential and can be altered by the treatment of cancer that leads to the development of lymphatic diseases such as lymphedema.

What is Lymphedema?

 

Lymphedema is a chronic and progressive medical condition defined as swelling of a body part due to the accumulation of fluid in the tissue. It is the result of an impairment, caused by the obstruction or impairment of the lymphatic system. We distinguished primary lymphedema and secondary lymphedema. Primary lymphedema is a genetic and is characterized by a lymphatic malformation during the development. In the industrialized countries, secondary lymphedema occurs mostly as a consequence of malignancy, surgery, trauma, infection, inflammation or radiation therapy. Secondary lymphedema can affect both women and men in a different part of the body, but mainly the limbs, after having received an effective treatment for breast and prostate cancers among many others. The main problem of lymphedema is the lack of adequate diagnosis in the sub-clinical stage of the disease and a reliable quantitative monitoring. In fact, the current diagnostic methods are mostly unreliable and allow the detection only at an advanced stage. An early diagnosis (stage 0) combined with existing effective treatments and care can improve the therapeutic outcome and the quality of life of the patient.

Stage of progression of secondary lymphedema

0

1

2

3

Stage 0

(Sub-clinical)

 

No visible clinical evidence despite initial lymphatic dysfunction

Stage 1

(Mild)

Early accumulation of fluid, that often improves with limb elevation

Stage 2

(Moderate)

Tissue starts to harden as fibrosis develops and tissue damage becomes visible

Stage 3

(Severe)

The tissue is often large and a large swelling of the affected limb is visible. Also called lymphostatic elephantiasis. 

As a progressive condition, four stages of lymphedema have been described depending on the pathogenic mechanisms and the severity of the symptoms.

Stage 3 Lymphedema