Causes and Types of Lymphoedema

Primary and secondary lymphoedema are the two main classifications of lymphoedema. In both cases, the swelling maybe caused by the absence of lymph vessels, damage or obstruction of the lymphatic system or because the lymphatic system is overloaded (due to other conditions such as venous disease). The protein-rich fluid called lymph or lymphatic fluid is unable to drain properly and collects in the tissues. This results in swelling of the affected areas.

Causes of primary lymphoedema

Primary lymphoedema occurs when the lymphatic system has not developed adequately (or is not functioning as it should) from birth due to a genetic reason. Primary lymphoedema develops as soon as the lymph vessel system can no longer cope with the strain. This usually happens in early life. It is called 'primary' because the impairment is not due to a ‘secondary’ cause like an illness or an injury.

Primary lymphoedema can have different causes:

• Aplasia: parts of the lymphatic system are missing
• Hypoplasia: lymphatic vessels are underdeveloped or present in below-average numbers. This is the most common cause of primary lymphoedema
• Hyperplasia: lymphatic vessels are larger than normal and don't work as well as normal-sized vessels
• Fibrosis of lymph nodes: hardening and scarring of the tissue

There are different types of primary lymphoedema and there are many known syndromes that have been linked with it, including Noonan Syndrome, Prader Willi, Yellow Nail Syndrome, and Turner Syndrome.

An example for the congenital onset lymphoedema is Milroy’s disease where the lymphoedema is noticed at birth or shortly afterwards. The late onset primary lymphoedema (e.g. Meige disease) presents at a later stage, with Meige disease usually around puberty.

Causes of secondary lymphoedema

Secondary lymphoedema is a more known common cause than primary lymphoedema and is caused by another disease or an injury. Lymphoedema develops either because the lymphatic system is damaged or there is too much lymph fluid that cannot be drained properly (overload).

Damage to the lymphatic system can be a result of:

• Complications from cancer treatment: lymphoedema can develop after cancer treatment, such as the removal of lymph nodes after surgery, radiation treatment or after some types of chemotherapy or hormone treatment. Lymphoedema is most commonly seen with breast cancer and with prostate cancer. Other cancer types that are often associated with lymphoedema are:
  • Cancer in the pelvic area: bladder, testicles, penis, cervix, ovaries, vulva, or rectum
  • Lymphoma: cancer that affects specific cells of your immune system
  • Melanoma: skin cancer with a high risk to grow and spread
  • Cancer in the area of the head and neck
• Wound or skin infections, such as cellulitis, especially in case of repeated infections
• Trauma: e.g. severe crushing, burning, scarring, large wounds
• Filariasis: this is a parasitic disease found mostly in African and in some Asian countries. It is caused by roundworms that infiltrate the lymphatic system and block the lymphatic flow. The parasites are spread by mosquitoes or black flies

An overload of the lymphatic system can be a result of:

• Obesity: overweight can add additional stress to the lymphatic system putting pressure onto lymph nodes and vessels
• Reduced or limited movement: e.g. paralysis or muscle weakness following a stroke
• Chronic venous disease; for example varicose veins or following a deep vein thrombosis (DVT)
• Chronic skin disorders such as eczema or psoriasis
• Tumor regression: localised or advancing tumors may block the local Lymphatic Drainage
• Inflammatory diseases, such as rheumatoid arthritis

All these causes affect the lymphatic system. They either impair the flow, increase higher lymph production, damage the lymph vessels or cause pressure on the lymphatic system.