Home

Search

Pathway AI

Account ⋅ Sign Out

Table of contents

Lymphedema

Key sources
The following summarized guidelines for the evaluation and management of lymphedema are prepared by our editorial team based on guidelines from the European Society of Gynaecological Oncology (ESGO 2023), the European Association of Urology (EAU/ASCO 2023), the Public Health Agency of Northern Ireland (PHA/HSE/LNNI 2022), the American Vein and Lymphatic Society (AVLS/SVM/AVF 2022), the Society for Integrative Oncology (SIO 2017), the American Cancer Society (ACS/ASCO 2016), the American Cancer Society (ACS 2016), the American Society of Clinical Oncology (ASCO 2014), and the American Academy of Family Physicians (AAFP 2013).
1
2
3
4
5
6
7
8
9

Guidelines

1.Screening and diagnosis

Diagnosis
Perform clinical examination for the diagnosis of lymphedema.
E
Regard all patients with chronic venous insufficiency (C3-C6) as having lymphedema.
E
Create free account

2.Classification and risk stratification

Staging: use the International Society of Lymphology classification system for staging lymphedema.
B

3.Diagnostic investigations

Evaluation of limb swelling: as per AVF 2022 guidelines, obtain quantification of swelling in patients with lymphedema.
E

More topics in this section

  • Evaluation of head and neck swelling

  • Radionuclide lymphoscintigraphy

  • Genetic testing

4.Medical management

Pharmacotherapy: do not offer routine pharmacological treatment for lymphedema.
D
Show 2 more

5.Nonpharmacologic interventions

Physical activity
Advise increasing physical activity levels gradually in patients at risk of lymphedema.
B
Encourage exercising with gradual, progressive resistance and aerobic exercise in at-risk patients.
A
Advise patients that they are not required to limit their physical activity or limit the use of their at-risk limb.
B

More topics in this section

  • Compression therapy

  • Manual lymphatic drainage

  • Complex decongestive therapy

6.Surgical interventions

Indications for surgery: consider performing surgery after failing conservative treatment in patients with stage > 2 lymphedema.
E

More topics in this section

  • Liposuction

  • Lymphovenous anastomosis

7.Specific circumstances

Patients with breast cancer: as per SIO 2017 guidelines, consider offering low-level laser therapy, manual lymphatic drainage, and compression bandaging to improve lymphedema in breast cancer survivors.
C

More topics in this section

  • Patients with head and neck cancer

  • Patients with vulvar cancer

  • Patients with penile cancer

8.Preventative measures

Prophylactic compression therapy: do not offer compression garments prophylactically for air travel in patients at risk of developing lymphedema. Offer prophylactic compression garments only if there is a diagnosis of subclinical lymphedema.
D