Condition: Lymphedema is a progressive condition in which abnormal levels of fluid accumulate in the body tissues of the upper and lower limbs.
Background: Between 24% and 49% of patients develop lymphedema after a mastectomy, and between 4% and 28% develop the condition after a lumpectomy. After pelvic surgery or radiation treatment, its incidence is between 1% and 47%. Only 2% of cases are due to infection.
Risk Factors: There are several risk factors for lymphedema. These include primary disorders (associated with genetic mutations or age) or secondary causes, which are typically associated with cancer (breast, gynecologic, urologic, melanoma and lymphoma) and/or cancer treatments, such as radiation, mastectomy, lumpectomy or lymph node dissection. Trauma, infection and obesity are other risk factors.
History and Symptoms: Patients may complain of a feeling of “fullness” or “heaviness” in the affected limb. Other symptoms include inflammation, disfigurement, decreased mobility and limb function, skin breakdown or infection, and fat deposits.
Physical Exam: Patients typically provide a medical history and undergo a physical exam and functional assessment.
Diagnostic Process: To diagnose lymphedema, healthcare providers assess a patient’s inflammation and swelling, skin condition, range of motion, limb circumference, walking ability and activities of daily living.
Rehab Management: A physician who specializes in physical medicine and rehabilitation (PM&R) may be able to help diagnose and identify appropriate treatment methods. Functional evaluation may also be performed by a PM&R physician to determine limitations to walking and daily activities based on severity and type of lymphedema. Treatments include therapy to remove lymph fluid from the affected limbs and to reduce swelling. This may involve physical or occupational therapy; compression devices, low-stretch or inelastic compression bandaging or compression garments; skin hygiene to minimize infection risk; and exercises to improve range of motion. Long-term self-management, including proper skin care, compression garments, weight control and exercise, is key to prevent reaccumulation of lymph fluid and complications. Some patients may need surgery to manage their symptoms.
Other Resources for Patients and Families: Patient and family education information is available through the National Lymphedema Network and the American Cancer Society.