Causes and types of lymphoedema

Primary lymphoedema is a rare condition caused by inadequate development of the lymphatic system from birth, due to genetic factors. 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.

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.

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

• 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 in women and with prostate cancer in men. 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.
• Tumor regression: localized or advancing tumors may block the local lymphatic drainage.
• Wound or skin infections such as cellulitis, especially in case of repeated infections.
• Filariasis: a parasitic disease found mostly in African and 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.
• Trauma: e.g. severe crushing, burning, scarring, large wounds.

• Obesity can add additional stress to the lymphatic system putting pressure onto lymph nodes and vessels.
• Reduced or limited movement, for example 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.
• 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.