Lymphoedema Clinical Research Unit at Flinders Medical Centre

The Lymphoedema Clinical Research Unit is involved in a range of clinical research related to lymphoedema and other forms of “swelling” such as lipoedema and chronic oedemas. Its focus is the provision of information regarding techniques and strategies related to improving the objectivity and accuracy of measurement and assessments of these swellings.  It’s members are involved in the conduct of a range of clinical trials, including those testing the efficacy of various treatment and management strategies for lymph and other oedema.

The current trials revolve around the objective determination of the impact of machine delivered massage, a phase 1 trial of a medication which may help control lymphoedemas and the determination of baseline and normative values regarding fluids and other tissue parameters in participants across the age spectrum so we can be better aware of the changes that pathophysiological changes cause and thus be better able to respond to them.

Please note: treatment services are not currently provided within the clinic unless they are part of a clinical trial. You may however be eligible to participate in these trials and gain details of them.

Assessment and treatment services including garment provision for lymphoedemas are available in Flinders Medical Centre in the Lymphoedema Clinic.

Interested in participating in a clinical trial?

You may be eligible to participate. For details on current trials please call (08) 820 44711 or (08) 8204 4903.

Basic information

The lymphatic system

The lymphatic system is a bit like a sewerage system. It helps remove fluid and its contents (which may include bacteria, viruses, cell wastes etc) from the tissues and transports it to the lymph nodes and then back to the venous system.  In the lymph nodes the fluids and its contents are scanned for bacteria and cancer cells etc and mounts a defensive response to them, most often resulting in their destruction. This is called an immune response.  When its working well your body and its normal compliment of cells is protected. However, if it is not working well then disorder or disease may occur.  No matter what has happened to it, it can be made to work better by appropriate targeted and sequenced treatment and management.  The knowledge associated with that is what our Clinical Research Unit is focused on.

The two types of lymphoedemas

Secondary Lymphoedema

Secondary Lymphoedema is caused when delicate lymphatic vessels or lymph nodes are damaged or destroyed. Generally this is associated with:

  • surgery as part of treatment for cancers
  • radiotherapy associated with surgery
  • wide area and superficial burns
  • soft tissue injury.

Symptoms include:

  • heaviness, tension and a feeling of fullness in the at-risk limb or area in early stages
  • a tendency of the skin to leave an indent mark on application of pressure (called 'pitting')
  • an increased volume or circumference of the affected limb
  • increasing hardness of the limb (called 'fibrosis') as the lymphoedema progresses.

Not every one who has surgery or radiotherapy for the treatment of cancers will get lymphoedema. In fact, as our abilities improve and through earlier detection of cancers, only about 20% of people will get lymphoedema after breast cancer surgery involving taking the lymph nodes from the armpit (called an axillary clearance), while if only a few lymph nodes are removed (sentinel node removal) only about 3% will develop lymphoedema.

For those who have had lymph nodes taken from the groin area due to bowel and other lower body cancers, the risk of getting lymphoedema can be a little higher due to the dependant position of the legs. 

Generally (but not always) the lymphoedema will appear within the first two to three years after the damage to the lymphatic system, but there is still a life time risk (mainly associated with infection, body mass etc) and in some cases it may not occur for many years. Recognising early signs is key. The reason for this is that in the early stages the changes are mostly related to fluid accumulation in the tissues.

Primary lymphoedemas

Primary lymphoedemas have a genetic basis and develop due to poor formation of the lymphatic system. They can be present at birth, develop at puberty or later in life. Recent information indicated they may underly many secondary lymphoedemas. Primary lymphoedemas can appear at birth or any time afterwards, depending on the functional status of the lymphatic system. Symptoms are similar to those above for secondary lymphoedema. Again, early detection of changes and a response to them is important.

Other swellings like lymphoedema

Lipoedemas

Lipoedemas are due to problems with fat metabolism and related to subsequent inflammatory events. There is a genetic component to them. They are mainly confined to the lower limb but the trunk and whole body can be effected. The term 'lipoedema' is not an entirely correct one though as a pure lipoedema has no fluids in the affected tissue, just fatty tissues.

Symptoms can include:

  • skin tenderness
  • fat pads prominent at the thighs and medical knees
  • pain when any point or pressure is applied
  • spider veins
  • a tendency to bruise easily
  • hyper-flexibility.

Those suffering may have areas symmetrical in nature (ie both legs affected similarly) and have relatively normal feet (except in later stages) unlike lymphoedemas which include swelling of the feet and hands when the legs or arms are involved.

Lipoedema is generally treated and managed differently to lymphoedemas.

Lymphoedema assessment

Assessment techniques used by the unit in our trials (and which are commonly available to assess lymphoedemas in larger centres) include:

  • perometry to measure limb volumes and circumferences
  • fibrinometry, indurometry and tonometry to measure the hardness or fibre of a limb
  • bio-impedance spectroscopy to measure whole and segmental limb fluids
  • di-electric constants to measure local skin and superficial tissue fluids
  • infra red photography to measure temperature to detect infections/inflammation.

Assessment techniques used by the unit include:

  • opto-electronic perometry to measure limb volumes and circumferences
  • indurometry and tonometry to measure the hardness or fibre of a limb
  • bio-impedance spectroscopy to measure whole and segmental limb fluids
  • di-electric constants to measure local skin and superficial tissue fluids
  • infra red photography to measure temperature to detect infections/inflammation.

Please note: referrals are not currently being taken.

Clinical trials

The Lymphoedema Clinical Research Unit regularly undertakes a range of clinical trials.
For details of current trials or to register your details for future trials that match your condition, please phone (08) 8204 4711.

Treatment

We do not undertake treatment in the clinic area (other than that associated with clinical trials). Anyone requiring treatment is recommended to qualified private practitioners specialising in lymphoedema management. Details of these can be found in the National Lymphoedema Practitioners
Register which can be found within the Australian Lymphoedema Association website. Please be aware that not all practitioners have registered, so other lists or Yellow Pages may need to be consulted.

More information about lymphoedemas

In South Australia there is the Lymphoedema Association of South Australia (LASA). On this website you can find details about our new SA Health supported Garment subsidy scheme and the support they provide.

There is also an Australia wide lymphoedema support group called the Lymphoedema Association of Australia who also have a very useful web site listing services and education and awareness promoting events given face to face and virtually.

More information about lymphoedema

Lymphoedema Australia website 

Flinders Clinical Research Unit Contact details (for clinical trials)
Telephone: (08) 8204 4903
Email: LCRU@flinders.edu.au
Director: Professor Neil Piller
Telephone: (08) 8024 4711

Lymphoedema Clinic at Flinders Medical Centre

(For lymphoedema assessment, garment fitting as part of the SA Garment Subsidy Scheme and treatment)

Physiotherapy Department, Level 2 (near Northern Entrance)
Flinders Medical Centre
Phone: (08) 8204 5498
Fax: 8204 3040 (for referrals)
Hours: Monday to Friday 8.00am to 4.30pm