Diagnosis and Treatment
You will be diagnosed by your doctor upon a thorough history and physical examination. Diagnosis is usually readily established when clinical features are in line with lymphedema and asymmetric limb measurements have been identified.
Remember, that the common findings to look for on history and physical exam include: history of cancer treatment or trauma (i.e., surgery, lymph node dissection, radiation); the absence of generalized edema, edema that is typically unilateral; cutaneous and subcutaneous thickening in advanced stages of lymphedema, and the presence of nonpitting edema.
The severity of lymphedema can be performed using a staging tool that is based on both subjective symptoms and imaging modalities if needed.
- Stage 0: There is some damage to the lymphatic vessels, but not sufficient enough as of yet to have any presentation of lymphedema.
- Stage 1: Swelling will increase throughout the day and disappear at night as the patient lies flat in bed. There is very little pitting present.
- Stage 2: The swelling will not disappear overnight. The skin has a soft, spongy consistency and is considered non-pitting. Fibrosis or hardening of the skin has just begun.
- Stage 3: The swelling is now irreversible, and the affected limb has become very large. The tissue has become very hard.
- Stage 4: The size and the circumference of the limb has become extremely large compared to the non-affected limb. Bumps and lumps start to appear on the skin.
- Stage 5: The skin has become grossly large; and there are one or more deep skin folds present now.
- Stage 6: The bumps start to cluster together; mobility of the patient has become extremely difficult.
- Stage 7: The patient is now handicapped and is unable to perform independent activities of daily living.
Lymphedema is chronic condition that can be managed, but it is typically not cured. Moreover, if it has progressed to the later stages, it may be more difficult to treat. The current recommended treatments focus on reducing swelling and controlling pain. Treatment options include:
- Diet and Exercise: It is important to maintain an ideal body weight as obesity can contribute to the development of lymphedema and can limit the effectiveness of compression sleeves (discussed later). Exercise and general weight training are encouraged to help encourage fluid drainage. Exercises do not need to be overly strenuous but should incorporate some degree of muscular contraction in your arms and legs.
- Vasoactive medications: Oral agents such as rutosides, diosmin and micronized purified flavonoid fraction (MPFF), have been shown to reduce the signs and symptoms of lymphedema, perhaps by reducing inflammation and improving lymphatic drainage.
- Limb elevation: Elevation of the swollen limb can help to decrease swelling, especially at earlier stages of lymphedema.
- Massage: A trained physical therapy will massage your affected limb to encourage fluid movement throughout the limb.
- Compression bandaging: Bandaging your limb can help to encourage lymph fluid to flow out of your arm or leg and back into the lymphatic system. The bandage should be most tight around the fingers or toes and should be looser as it moves up your arm or leg. It is used more so in the earlier stages of lymphedema.
- Compression garments: Similarly to compression bandaging, compression garments are made to facilitate the flow of lymph fluid out of the affected limb. It is used more for the later stages of lymphedema. Seek professional advice when choosing a garment of correct fit. They should be worn during exercise.
- Complete decongestive therapy: This is a two phase treatment program to reduce the degree of lymphedema. In phase 1 (treatment phase), patients participate in therapeutic exercise, massages, limb compression with bandages, and therapy five days per week. In phase 2 (maintenance phase), patients will optimize the benefit they obtained from phase 1, by wearing a compression garment throughout the day.
- Surgery: Surgical referral is made in patients who have failed conservative measures such as the ones mentioned previously. The surgeons will remove excess tissue from the affected limb to reduce swelling. Newer treatments will transplant lymph nodes into the affected limb to help facilitate drainage of fluid.