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


The water displacement method is another way to evaluate arm edema. A volume difference of 200 mL or more between the affected and opposite arms is typically considered to be a cutoff point to define lymphedema.[34]

One common method of lymphedema classification uses three stages based on severity.[5] Stage I is spontaneously reversible and typically is marked by pitting edema, increase in upper-extremity girth, and heaviness. Stage II is characterized by a spongy consistency of the tissue without signs of pitting edema. Tissue fibrosis can then cause the limbs to harden and increase in size.[5] Stage III, also called lymphostatic elephantiasis, is the most advanced stage, but is rarely seen following breast cancer treatment.[5]

Another commonly used approach to classifying lymphedema is the Common Terminology Criteria for Adverse Events v3.0 (CTCAE), which were developed for grading adverse events in the context of clinical trials.[35] A key advantage of the CTCAE approach is that it includes both objective measures (interlimb discrepancy) and subjective, clinical assessments in diagnosing lymphedema. This allows for the very real possibility that a patient could have clinically meaningful, treatable lymphedema isolated to a segment of his or her limb that would not meet objective interlimb discrepancy criteria, but which could still be graded according to severity by signs and symptoms, as follows:

  • Grade 1: 5% to 10% interlimb discrepancy in volume or circumference at point of greatest visible difference; swelling or obscuration of anatomic architecture on close inspection; pitting edema.
  • Grade 2: More than 10% to 30% interlimb discrepancy in volume or circumference at point of greatest visible difference; readily apparent obscuration of anatomic architecture; obliteration of skin folds; readily apparent deviation from normal anatomic contour.
  • Grade 3: More than 30% interlimb discrepancy in volume; lymphorrhea; gross deviation from normal anatomic contour; interfering with activities of daily living.
  • Grade 4: Progression to malignancy (e.g., lymphangiosarcoma); amputation indicated; disabling lymphedema.


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WebMD Public Information from the National Cancer Institute

Last Updated: February 25, 2014
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