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

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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.

References:

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  2. Hewitt M, Ganz PA, eds.: From Cancer Patient to Cancer Survivor - Lost in Transition: An American Society of Clinical Oncology and Institute of Medicine Symposium. Washington, DC: The National Academies Press, 2006.
  3. Petrek JA: Commentary: prospective trial of complete decongestive therapy for upper extremity lymphedema after breast cancer therapy. Cancer J 10 (1): 17-9, 2004.
  4. Horsley JS, Styblo T: Lymphedema in the postmastectomy patient. In: Bland KI, Copeland EM, eds.: The Breast: Comprehensive Management of Benign and Malignant Diseases. Philadelphia, Pa: Saunders, 1991, pp 701-6.
  5. Bicego D, Brown K, Ruddick M, et al.: Exercise for women with or at risk for breast cancer-related lymphedema. Phys Ther 86 (10): 1398-405, 2006.
  6. Meek AG: Breast radiotherapy and lymphedema. Cancer 83 (12 Suppl American): 2788-97, 1998.
  7. Roberts CC, Levick JR, Stanton AW, et al.: Assessment of truncal edema following breast cancer treatment using modified Harpenden skinfold calipers. Lymphology 28 (2): 78-88, 1995.
  8. Pyszel A, Malyszczak K, Pyszel K, et al.: Disability, psychological distress and quality of life in breast cancer survivors with arm lymphedema. Lymphology 39 (4): 185-92, 2006.
  9. Ridner SH: Quality of life and a symptom cluster associated with breast cancer treatment-related lymphedema. Support Care Cancer 13 (11): 904-11, 2005.
  10. Paskett ED, Naughton MJ, McCoy TP, et al.: The epidemiology of arm and hand swelling in premenopausal breast cancer survivors. Cancer Epidemiol Biomarkers Prev 16 (4): 775-82, 2007.
  11. Shaw C, Mortimer P, Judd PA: Randomized controlled trial comparing a low-fat diet with a weight-reduction diet in breast cancer-related lymphedema. Cancer 109 (10): 1949-56, 2007.
  12. Petrek JA, Senie RT, Peters M, et al.: Lymphedema in a cohort of breast carcinoma survivors 20 years after diagnosis. Cancer 92 (6): 1368-77, 2001.
  13. Beesley V, Janda M, Eakin E, et al.: Lymphedema after gynecological cancer treatment : prevalence, correlates, and supportive care needs. Cancer 109 (12): 2607-14, 2007.
  14. Norman SA, Localio AR, Potashnik SL, et al.: Lymphedema in breast cancer survivors: incidence, degree, time course, treatment, and symptoms. J Clin Oncol 27 (3): 390-7, 2009.
  15. Purushotham AD, Bennett Britton TM, Klevesath MB, et al.: Lymph node status and breast cancer-related lymphedema. Ann Surg 246 (1): 42-5, 2007.
  16. Borup Christensen S, Lundgren E: Sequelae of axillary dissection vs. axillary sampling with or without irradiation for breast cancer. A randomized trial. Acta Chir Scand 155 (10): 515-9, 1989.
  17. Liljegren G, Holmberg L: Arm morbidity after sector resection and axillary dissection with or without postoperative radiotherapy in breast cancer stage I. Results from a randomised trial. Uppsala-Orebro Breast Cancer Study Group. Eur J Cancer 33 (2): 193-9, 1997.
  18. Lucci A, McCall LM, Beitsch PD, et al.: Surgical complications associated with sentinel lymph node dissection (SLND) plus axillary lymph node dissection compared with SLND alone in the American College of Surgeons Oncology Group Trial Z0011. J Clin Oncol 25 (24): 3657-63, 2007.
  19. Celebioglu F, Perbeck L, Frisell J, et al.: Lymph drainage studied by lymphoscintigraphy in the arms after sentinel node biopsy compared with axillary lymph node dissection following conservative breast cancer surgery. Acta Radiol 48 (5): 488-95, 2007.
  20. Wilke LG, McCall LM, Posther KE, et al.: Surgical complications associated with sentinel lymph node biopsy: results from a prospective international cooperative group trial. Ann Surg Oncol 13 (4): 491-500, 2006.
  21. Francis WP, Abghari P, Du W, et al.: Improving surgical outcomes: standardizing the reporting of incidence and severity of acute lymphedema after sentinel lymph node biopsy and axillary lymph node dissection. Am J Surg 192 (5): 636-9, 2006.
  22. Jemal A, Siegel R, Ward E, et al.: Cancer statistics, 2009. CA Cancer J Clin 59 (4): 225-49, 2009 Jul-Aug.
  23. Sagen A, Kåresen R, Risberg MA: Physical activity for the affected limb and arm lymphedema after breast cancer surgery. A prospective, randomized controlled trial with two years follow-up. Acta Oncol 48 (8): 1102-10, 2009.
  24. Ridner SH, Dietrich MS, Stewart BR, et al.: Body mass index and breast cancer treatment-related lymphedema. Support Care Cancer 19 (6): 853-7, 2011.
  25. Radak Z, Chung HY, Koltai E, et al.: Exercise, oxidative stress and hormesis. Ageing Res Rev 7 (1): 34-42, 2008.
  26. Schmitz KH: Balancing lymphedema risk: exercise versus deconditioning for breast cancer survivors. Exerc Sport Sci Rev 38 (1): 17-24, 2010.
  27. Cheema B, Gaul CA, Lane K, et al.: Progressive resistance training in breast cancer: a systematic review of clinical trials. Breast Cancer Res Treat 109 (1): 9-26, 2008.
  28. McKenzie DC, Kalda AL: Effect of upper extremity exercise on secondary lymphedema in breast cancer patients: a pilot study. J Clin Oncol 21 (3): 463-6, 2003.
  29. Ahmed RL, Thomas W, Yee D, et al.: Randomized controlled trial of weight training and lymphedema in breast cancer survivors. J Clin Oncol 24 (18): 2765-72, 2006.
  30. Courneya KS, Segal RJ, Mackey JR, et al.: Effects of aerobic and resistance exercise in breast cancer patients receiving adjuvant chemotherapy: a multicenter randomized controlled trial. J Clin Oncol 25 (28): 4396-404, 2007.
  31. Schmitz KH, Ahmed RL, Troxel AB, et al.: Weight lifting for women at risk for breast cancer-related lymphedema: a randomized trial. JAMA 304 (24): 2699-705, 2010.
  32. Rockson SG: Lymphedema. Am J Med 110 (4): 288-95, 2001.
  33. Ridner SH, Montgomery LD, Hepworth JT, et al.: Comparison of upper limb volume measurement techniques and arm symptoms between healthy volunteers and individuals with known lymphedema. Lymphology 40 (1): 35-46, 2007.
  34. Mondry TE, Riffenburgh RH, Johnstone PA: Prospective trial of complete decongestive therapy for upper extremity lymphedema after breast cancer therapy. Cancer J 10 (1): 42-8; discussion 17-9, 2004 Jan-Feb.
  35. Cheville AL, McGarvey CL, Petrek JA, et al.: The grading of lymphedema in oncology clinical trials. Semin Radiat Oncol 13 (3): 214-25, 2003.
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WebMD Public Information from the National Cancer Institute

Last Updated: February 25, 2014
This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.
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