Management of Lymphedema

Diagnosis and Assessment

Regular examination is required even among patients without lymph node dissection to facilitate early diagnosis and intervention 1, 2

The American Cancer Society recommends referring patients with clinical symptoms or swelling suggestive of lymphedema to a specialized therapist knowledgeable about lymphedema diagnosis and treatment 3
Early detection and intervention are critical as lymphedema may be reversible or more effectively managed with early physiotherapy 2
Complete decongestive therapy consisting of manual lymphatic drainage, compression therapy, exercise, skin care, and education for self-management is the primary treatment approach 1, 2
The principle of treatment is decongestive therapy with physiotherapy and compression therapy that must be regularly repeated to maximize treatment effect 1, 2

The American Cancer Society recommends counseling patients on risk reduction strategies, including weight management for patients who are overweight or obese 3
Infection risk minimization is crucial, and prompt treatment of infections with antibiotics is recommended 2

If conservative treatment is not sufficient, consider referral for microsurgical procedures, which have shown to be an effective treatment method 1, 2

For neuropathy associated with lymphedema, consider supportive care such as physiotherapy, physical activity, referral to podiatrists, patient education, acupuncture, and support in daily activities 1, 2
For pain management related to lymphedema, vitamin B supplementation can be considered, and patients with chronic pain may be referred to a neurologist 2

Contrary to historical advice, complete avoidance of physical activity and heavy lifting with the affected limb is not necessary; supervised progressive resistance training has been shown to be safe 3

Lymphedema can occur due to primary causes, such as congenital abnormalities of the lymphatic system 4
Secondary causes of lymphedema include cancer treatments, particularly lymph node dissection and radiation therapy, with a higher risk associated with axillary lymph node dissection compared to sentinel lymph node biopsy 5, 4, 6

Weight management is recommended for patients who are overweight or obese to reduce the risk of lymphedema 7, 5, 4
Prompt treatment of infections with antibiotics is essential to prevent worsening of lymphedema 5

Patients with clinical symptoms or swelling suggestive of lymphedema should be referred to a therapist knowledgeable about lymphedema diagnosis and treatment, such as a physical therapist 8, occupational therapist 5, or specialized lymphedema therapist 5, 9, 10

Manual lymphatic drainage and compression bandaging are considered equivalent treatment options, with MLD being preferred for patients with sensitivity to bandaging 11, 12
Supervised, progressive resistance training is safe and may be beneficial for patients with lymphedema 5, 8

Delaying treatment can lead to progression of lymphedema and increased risk of complications 4
Failing to treat infections promptly can worsen lymphedema 5
Using diuretics is generally ineffective for lymphedema management 4

The American College of Oncology recommends referring patients with clinical symptoms or swelling suggestive of lymphedema to a therapist knowledgeable about lymphedema diagnosis and treatment, specifically a physical therapist, occupational therapist, or certified lymphedema specialist 13
Patients with lymphedema should be referred to physical therapists with lymphedema certification, occupational therapists with lymphedema training, or certified lymphedema specialists/therapists for complete decongestive therapy (CDT) 13

For head and neck lymphedema, refer to a rehabilitation specialist for treatment consisting of manual lymphatic drainage and, if tolerated, compressive bandaging, and develop a collaborative strategy between the primary care physician and head and neck cancer specialist 14, 15, 16

The American College of Oncology suggests referring patients with lymphedema to a registered dietitian for weight management counseling, particularly for overweight or obese patients, as obesity is a significant risk factor for lymphedema development and progression 13

The American Cancer Society recommends referring patients with clinical symptoms or swelling suggestive of lymphedema to a therapist knowledgeable about lymphedema diagnosis and treatment, including physical therapists with lymphedema certification, occupational therapists with lymphedema training, or certified lymphedema specialists/therapists, for patients with all cancer types, including breast, prostate, gynecologic, and head and neck cancers 17, 18

Complete decongestive therapy, including breathing and ROM exercises, must be delivered by trained specialists, and may include compression sleeves during exercise if lymphedema is present 17, 18
Manual lymphatic drainage can be considered for reducing arm volume and improving quality of life, but only when performed by appropriately trained specialists, particularly for patients unable to tolerate compression bandaging due to allergies or discomfort 19

Supervised progressive resistance training has been shown to be safe and may even improve lymphedema symptoms, but this should be coordinated with the lymphedema specialist and may require use of compression garments during exercise 17, 18, 20