Lymphedema Network of Excellence

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For appointment information please contact 206-598-6222. A knowledgeable team member will assist you.

The Lymphedema Network at University of Washington is comprehensive, with services provided at both the UW Medical Center Montlake and Northwest Campuses as well as Seattle Cancer Care Alliance. The full range of lymphedema management is offered, including both conservative and surgical approaches.

LYMPHATIC SYSTEM

We produce approximately 3 liters of lymph per day in our bodies. Lymph is a fluid that comes from the circulatory system and its function is to clear the soft tissues of any impurities, such as bacteria, cancer cells and many other cell types. Lymph is collected in lymphatic channels, which are small vessels, akin to but smaller than arteries and veins. The lymph is then transported to the regional lymph nodes. Lymph nodes are part of our immune system and are essentially filters. These filters trap whatever the lymphatic fluid brings to them and the body’s immune system deals with these products. This is why, for example, lymph nodes are targeted in cancer treatment: cancer cells can be transported to lymph nodes and these nodes are sometimes removed or radiated to kill the cancer cells.

Lymphedema is a condition in which the lymphatic system is compromised. This can happen for many different reasons. The most common cause world-wide is a condition called Filariasis, an infestation by a type of worm, a nematode, that is endemic in certain parts of the world. In the United States, the two most common causes are congenital, meaning someone is born with the condition, or acquired, when the condition arises from anything that impacts the lymphatic system. There are several different presentations of congenital lymphedema: Milroy Disease or TYPE 1, Lymphedema, and Type 2 lymphedema, which can present in the teen years as Lymphedema Praecox, and Lymphedema Tarda, which presents in the 30’s or later.

The most common type of acquired lymphedema is related to surgery in cancer patients, often when combined with radiation. The most common types of cancer patients we see are breast cancer, pelvic cancers, head and neck cancers, and melanoma.

There is also an association between morbid obesity and lymphedema, particularly as it applies to the lower extremities. The first priority for these patients is to lose weight, either through diet and exercise or bariatric surgery.

Milroy Disease Type 1 Lymphedema

Milroy Disease
This is due to a protein receptor mutation. Pictured is a seven-year-old boy with lymphedema of his right leg, present since birth

Type 2 Lymphedema

Type 2 Lymphedema
Lymphedema Praecox appears most commonly in the lower extremities in teenaged patients who otherwise were healthy and had no other symptoms before then. Lymphedema Tarda usually occurs in a previously normal individual when they are in their 30’s though we have seen it appear much later in life. Pictured is a 39yr old lady who, at the age of 30, was in good health with no other symptoms. She now has extreme lymphedema extending from her mid abdomen into her lower extremities. Note her upper body is spared.

Bio-Impedence Spectroscopy: This test measures the time taken for the passage of a low electrical current through the tissues. The rationale is that the more fluid is in the tissues, the less  resistance or impedence there will be to that electrical current. This is measured on a Sozo Machine and is non-invasive.

Nuclear Medicine Lymphoscintigraphy: This test involves the injection of a filtered sulphur colloid called Technetium, into the limb (arm or leg). The patient is then scanned so that we can see how that marker is transported through the lymphatic system. It picks up abnormalities in the lymphatic system The picture shows a patient post breast cancer with axillary node dissection and radiation. The technetium has been injected into her arms and feet. On the upper left of the picture the axillary nodes can be seen as black dots. There are no such dots on the right side indicating that there is blockage of lymphatic drainage on that side.

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