What happens when lymph overflows

Clinical Brief — October 10th

The Brief

Limb lymphoedema is when lymph flows into the tissue after the nodes are surgically removed. It’s a fairly common procedure for the treatment of advanced-stage cancer including melanoma.

As a surgical complication, lymphoedema isn’t exactly a good thing to have. A recent study went further and detailed its negative psychological and physical impacts on patients with melanoma.

Researchers hope these results would help raise awareness of this complication and to improve its prevention and treatment.

What’s limb lymphoedema?

Lympho-edema is what happens when lymph has nowhere to go and it pools inside tissues.

See, lymph is this clear fluid that circulates throughout our bodies like blood, except it doesn’t get pumped. One of the many things it does is to give white blood cells a road to get to just about every part of the body.

Lymph nodes are like pitstops for white blood cells to gather for a while. Cancer cells also love these nodes. So, when cancer cells infiltrate these places the nodes get surgically removed.

Take away the nodes, and all the lymph has nowhere to go so it just pools around there. Imagine what happens if you take out a node from an armpit or the groin? Lymph drains into the arm or the leg, hence limb lymphoedema.

Is it really that bad?

That’s what researchers from the Herlev Gentofte Hospital, Denmark, tried to find out.

They surveyed over 400 patients with melanoma who had a lymph node biopsy and/or complete lymph node surgery at least a year before the study. All of their lymph nodes were either under their armpit or in the groin. Patients whose cancer came back were excluded so that their symptoms won’t confuse the results.

The surveys were validated quality-of-life and psychological symptom assessments. The acronyms read like an alphabet soup (EORTC QLQ-C30, EORTC QLQ-BR23, FACT-G SWB, HADS).

They found that patients who unfortunately experienced limb lymphoedema had significantly worse quality of life than those who didn’t experience this complication.

The negative impact on their quality of life was mainly due to reduced physical and social functioning, fatigue, constipation, and pain. On top of this, lymphoedema was tied to anxiety and depression.

They also found that younger patients with lymphoedema had more financial difficulties.

Bottom line

We knew limb lymphoedema was unpleasant, and now there’s data that give hints about its physical, psychological, and potential financial impacts.

The silver lining? The researchers point to evidence supporting prevention strategies, early diagnosis, as well as conservative and surgical treatment of lymphoedema.

“The negative impact of melanoma-related limb lymphoedema on quality of life emphasizes the importance of…increasing awareness and improving prevention and treatment of lymphoedema.”

- Gjorup CA, et al.

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