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Lymphedema (PDQ®): Supportive care - Health Professional Information [NCI] - Overview

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Patients with and at risk for lymphedema should be evaluated by a certified lymphedema therapist to ensure it is safe to proceed with exercise of the affected body part. (See the Lymphology Association of North America Web site for referrals to certified lymphedema therapists in locations across the United States.)

Patients who have lymphedema should wear a well-fitting compression garment during all exercise that uses the affected limb or body part. If there are questions regarding whether lymphedema is present, there is no evidence as to whether use of a garment will be helpful or harmful. Garments must be well fitted to be useful, are costly, may not be covered by insurance without a clear diagnosis, and must be replaced every 6 months. Among women with an unclear diagnosis, it is likely that the risk of avoiding upper-body activity outweighs the risk of engaging in slowly progressive upper-body activity without a garment. Patients without lymphedema do NOT need to wear a garment while doing exercise with the at-risk limb.

Evidence from studies with breast cancer survivors suggests that upper-body exercise among women with and at risk for lymphedema should start at a very low intensity and progress slowly and according to symptom response.[26];[29][Level of evidence: I] There should be a certified lymphedema specialist to whom these women can be referred if there is a need for evaluation of possible flare-ups or onsets. If there is a break in exercise of a week or longer, it is strongly recommended that women decrease the intensity of activity with the upper body and then increase it again gradually. Changes in symptoms (increased heaviness, achiness, puffiness, swelling) that last a week or longer should be evaluated for possible onsets or flare-ups. It is likely that starting at low intensity and progressing slowly is better for the affected limb than is avoiding activity.

Diagnosis and Evaluation

Lymphedema is typically evident by clinical findings such as nonpitting edema, usually with involvement of the digits, in a patient with known risk factors such as previous axillary dissection. Other causes of limb swelling, including deep venous thrombosis, malignancy, and infection, should be considered in the differential diagnosis and excluded with appropriate studies, if indicated.

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