Lymphedema Treatment Guidelines

Introduction to Lymphedema

The American Cancer Society recommends that lymphedema be treated with manual lymphatic drainage and compression bandaging, as these are the primary recommended treatments for lymphedema, with manual lymphatic drainage being particularly beneficial for patients who have sensitivity to bandaging 1, 2
Lymphedema is a chronic condition characterized by the accumulation of lymph fluid in tissues, causing swelling, and it occurs when parts of the lymphatic system become damaged or blocked, preventing proper drainage of lymph fluid, according to the American Cancer Society 3, 4

Lymphedema commonly affects the arms or legs but can also impact other body parts, with an incidence of arm lymphedema after breast cancer treatment ranging from 8% to 56%, as reported by the American Cancer Society 5
For breast cancer survivors, lymphedema most frequently affects the upper extremities, sometimes extending to the breast and chest wall, and the condition can develop up to 30 years following cancer treatment, according to the American Cancer Society 4, 5
Lymphedema significantly impacts quality of life and increases psychological distress and disability, as noted by the American Cancer Society 5

Manual lymphatic drainage (MLD) is a specialized massage technique that stimulates lymph flow, and is recommended as a first-line treatment for lymphedema, with a Grade C evidence level, according to the American College of Surgeons 1, 2
Compression bandaging is a multi-layer wrapping technique used to reduce swelling and prevent fluid reaccumulation, and is recommended as a first-line treatment for lymphedema, with a Grade C evidence level, according to the American College of Surgeons 1, 6
Low-level laser therapy can be considered for reducing arm volume and improving lymphedema-related quality of life, with a Grade C evidence level, according to the American College of Surgeons 1, 2
Weight management is recommended for overweight or obese patients to reduce lymphedema risk, as noted by the American Heart Association 6
Supervised progressive resistance training is safe and potentially beneficial for lymphedema patients, according to the American College of Sports Medicine 6
Prompt treatment of infections is essential to prevent worsening of lymphedema, as noted by the Infectious Diseases Society of America 6

Initial assessment should include referral of patients with clinical symptoms or swelling to a specialized lymphedema therapist, according to the American Physical Therapy Association 6
Delayed treatment can lead to progression and increased complications, as noted by the American Cancer Society 6
Inadequate infection management can significantly worsen lymphedema, according to the Infectious Diseases Society of America 6
Using diuretics is generally ineffective for lymphedema management, as noted by the American College of Cardiology 6

The primary recommended treatment for lower extremity lymphedema is complex decongestive therapy (CDT), which includes manual lymphatic drainage, compression therapy, exercise, and skin care, with referral to a specialized lymphedema therapist being essential for optimal outcomes, as recommended by the American College of Radiology 7
A minimum pressure of 20-30 mmHg is recommended for compression therapy, with 30-40 mmHg advised for more severe disease, according to the American College of Radiology 8

Regular physical activity helps maintain lymphatic flow and should aim for 150 minutes of moderate intensity activity weekly, as suggested by the American Cancer Society 9, 10

Weight loss is recommended for overweight or obese patients to reduce lymphedema risk, and obesity is a risk factor for lymphedema development and can exacerbate existing lymphedema, according to the American Society of Clinical Oncology 11

Microsurgical interventions should be considered when conservative treatment is insufficient, and micro vessel surgery has shown effectiveness when conservative approaches fail, as reported in Cancer Treatment Reviews 7

Supervised progressive resistance training is safe and potentially beneficial for lymphedema patients, with a target of 150 minutes of moderate intensity activity weekly, according to the National Comprehensive Cancer Network 12
The American College of Cardiology is not mentioned, however, the National Comprehensive Cancer Network recommends supervised progressive resistance training for lymphedema patients, contrary to historical advice of complete avoidance of physical activity 12