We can make a huge difference to the quality of life for patients suffering from lymphoedema after cancer - Lucie Casserley

Lucie Casserley, senior physiotherapist and lymphoedema specialist

Lucie Casserley

There’s something fundamentally fascinating about the mechanics of the human body and what you can do with it.

This captures the essence of why I chose to be a physiotherapist. The human body is an amazing thing. It’s a very finely tuned machine, like a car. But things can go wrong with the body, just like with a car. Wear and tear can be a problem and when things go wrong you need to call the mechanics in! 

I always wanted to work with people, but why physiotherapy? It’s a profession where you work so closely with people both physically and mentally and push them to reach their full potential which often can cause a clash of wills. It requires the patient to put a huge amount of trust in you, especially here at The Christie, and when a patient does that it’s an absolute honour. 

The best thing is I get to do this everyday, I’m not sure there’s a better job to have. I’m literally doing what I love and helping people - you can’t ask for more than that! 

Having been at The Christie for seven years I developed a keen interest in one particular area of physiotherapy, lymphoedema treatment. For those of you who don’t know what this is, it’s a chronic condition often caused as a side effect of cancer treatment, usually lymph node removal or radiotherapy. 

The lymphatic system is a network of vessels, it very much resembles a motorway network but lies just under the skin (as well as deeper). Its job is to collect excess fluid from around the body and return it to the blood via the lymph nodes. Think of these as recycling centres, of which you have hundreds at various motorway junctions around your body.  

Now when there’s an accident at one of these junctions, for example caused by the side effects of radiotherapy, debris covers the road and blocks the pathway. As a result traffic builds up as it can’t exit the motorway. That’s what lymphoedema is in a nutshell.  

In the past the swellings caused by lymphoedema could become so severe that they were labelled elephantitis and could cause major disfigurements. The so-called ‘elephant man’ was a very extreme example of this, but thankfully treatment is vastly improved today so this is now a thing of the past.

Here at The Christie I’m lucky to be part of an amazing team with three specialists, Julie, Paula and me plus our glamorous assistant Chris. We treat all patients with suspected lymphoedema caused by cancer or as a result of cancer treatment in any part of the body; be it arms, legs, breasts, genitals or the head and neck.

So if we go back to the motorway analogy, what exactly do I do when it comes to helping patients? 

Well I’m the traffic officer or your trusty sat nav. I redirect the traffic through smaller roads and breakdown or clear away any debris causing blockages. In the human body this means the lymph can flow freely once more.

Unfortunately, lymphoedema is not curable. We can assist in reducing the volume of lymphoedema to very mild, but there is always the potential for it to flare up again because the junction at that exit point is missing.

The light at the end of the tunnel for lymphoedema patients is that treatments are developing all the time and research is ongoing. A fairly new treatment is lymph node transplants. I was lucky enough to watch Mr Oudit, a plastic surgeon here at The Christie do one very recently, it was the first of its kind in the NHS  in this country. It was awe inspiring to watch.  

Mr Oudit has also done a liposuction recently to help a lymphoedema patient, because when lymph fluid stays in the same place for a prolonged period it can turn into fatty tissue. 

Both patients in these cases are ecstatic with the early results.

So what else can be done to help patients with lymphoedema? There are four key things that can help to control and mitigate the effects of lymphoedema.

1. Skincare is paramount. Dry cracked skin is an entry point for bacteria and infections which can worsen lymphoedema.
2. Exercise. Exercise encourages the contraction and relaxing of muscles and creates a pump effect pulling fluid into the body, although too much repetitive movement can overload the body and make the lymphoedema worse. So slow and graduated exercise is the key.
3. Compression. Specialist garments or bandaging for intensive treatment increase the pressure in the body’s tissues. This makes the muscle pump harder, moving fluid out of the affected areas and minimising further build-up or reflux.
4. Manual lymphatic drainage. This is a specialist form of massage completed by specialists. It works by increasing the rate at which lymph moves around the body and moves fluid from the swollen areas into working lymph nodes, where it can be drained. It also helps to break down fibrosis.

We have a wide range of other techniques that work alongside these treatments including deep oscillation therapy (DOT), kinesio taping, lymphotouch and soft tissue massage. 

Lymphoedema seems to be more in the spotlight at the moment and this is helping to raise awareness of the struggles cancer survivors with lymphoedema face. This is helping to bring investment into new services for patients. With the extra funding provided, we’ve been able to set up new satellite clinics at Bolton Hospice, Beechwood Cancer Care in Stockport and Cornerstones health centre in North Manchester to bring our patients more holistic and patient centred care, closer to their homes.

Since becoming a physio I’ve often heard us referred to as ‘physio-terrorists’. I guess some people dread having to see us because some of the treatments we do can be uncomfortable, as anyone who has ever had a bad back and seen a physio will know! 

But remember, we just want to help patients reach their full potential and that we regard their trust in us as a great honour. For patients suffering from lymphoedema after being treated for cancer what we do can make a huge difference to their quality of life. And when we help patients to achieve their full potential and results they never thought possible, we feel just as great about it as they do.

So don’t think of me as your physio, think of me as your mechanic!