Lymphoedema – Diagnosis – NHS

See a GP if you have symptoms of lymphoedema. If you’re being treated for cancer and are at risk of developing lymphoedema, you’ll be monitored for the condition afterwards.

In many cases, it’s possible to diagnose lymphoedema by:

• asking about your symptoms and medical history
• examining the affected limb and measuring the distance around it to see if it’s enlarged

The GP may refer you to a specialist lymphoedema treatment centre for further assessment.

Early diagnosis and treatment can help prevent the condition from getting worse.

In most cases, further tests are not necessary, but they may occasionally be used to assess and monitor your condition.

Measuring limb volume

In some cases, tests to calculate the volume of an affected limb may be carried out.

These may include:

• using a tape measure – to measure the circumference of the limb at certain intervals to calculate its volume
• water displacement – where the affected limb is placed in a tank of water and the amount of water that’s displaced is measured to calculate the volume of the limb
• perometry – where infrared light is used to measure the outline of an affected limb and calculate its volume

Bioimpedance testing

During a bioimpedance test, small metallic discs called electrodes are placed on different parts of your body.

The electrodes release a small, painless electric charge that’s measured using a handheld device. Changes in the strength of the current can indicate the presence of fluid in your tissue.

Imaging tests

Imaging tests may also be used if there’s uncertainty around the diagnosis or to rule out other causes of swelling.

These include:

• a lymphoscintigram – where you’re injected with a radioactive dye that can be tracked by a scanner; this shows how the dye moves through your lymphatic system and can check for any blockages
• a MRI scan – a strong magnetic field and radio waves are used to produce detailed images of the inside of your body
• an ultrasound scan – high-frequency sound waves are used to create an image of the inside of your body
• a CT scan – X-rays and a computer create detailed images of the lymph nodes

These scans can be used to create a clearer picture of the affected tissue.

Page last reviewed: 29 March 2023
Next review due: 29 March 2026

Diagnosis of Lymphedema – LymphCare

There is no specific test or tool to diagnose lymphedema. This makes the diagnosis difficult and a lot of patients struggle without a correct diagnosis for a long time. There are two main types of lymphedema – primary and secondary lymphedema.

Primary lymphedema is a rare disease that occurs when the lymphatic system has not developed adequately (or is not functioning as it should) from birth due to a genetic reason. Although the symptoms of primary lymphedema often occur in early life, symptoms may also occur after years and it may not be the first diagnosis that healthcare professionals (HCPs) think about. Secondary lymphedema is caused by injuries or diseases and is more common than primary lymphedema.

Who makes the diagnosis of lymphedema?

Your general practitioner (GP) or a nurse is likely to be your first contact person when you notice any signs or symptoms of lymphedema. The first step is to rule out any other reasons for your swelling.

Your Health Care Professional (HCP) will do a general check-up that includes a complete exam of your body, including your skin and soft tissues, lymph nodes, the function of your arteries and veins and any swollen areas. In addition, blood samples provide information about the function of your heart, kidneys, your thyroid glands and blood count.

A complete physical exam and your medical history are important in determining the type of your lymphedema.

After that, your HCP should refer you to a specialist for lymphedema to confirm the diagnosis and to develop a holistic treatment plan with you.

How is lymphedema diagnosed?

Basic diagnostics

Your medical history and the physical exam of your body are the main elements in the diagnosis of lymphedema.

Here are some typical questions that your HCP will ask you:

• When did you first notice any signs or symptoms?
• Do your swellings improve overnight?
• Did you have any infections in the affected area?
• Do you take any medications at the moment and if so, what kind of medication do you take?
• Is there someone in your family with the same signs and symptoms?

Your HCP will examine your affected limb as well. This usually includes the following steps:

1. Check-up of your skin to rule out any injuries or infections
2. Palpation of your tissue (is it hard or soft?) and lymph nodes (are they larger than usual or painful?)
3. Check your body for other swollen areas
4. Measurement of the affected area to monitor the size over time
5. Measurements of your blood vessels (veins and arteries) to check your blood circulation

Advanced diagnostics

Your medical history and the examination of your affected limb are often enough for the diagnosis of lymphedema. Your HCP may need further information, for example when you have other diseases that can cause swelling or in the very early stages of lymphedema. Several diagnostic tools can be useful in such a case:

• Ultrasound scan – uses high-frequency waves that create a picture of your tissue from the outside
• Lymphography – uses a radiocontrast agent that visualizes your lymphatic system under X-ray
• Lymphoscintigraphy – uses a nuclear medicine that visualizes the lymph drainage and your lymph nodes
• MRI (Magnetic Resonance Imaging) scans – uses a magnetic field to create pictures from the inside of your body
• CT (Computed Tomography) scans – uses X-ray to create a detailed picture across your body.

An early diagnosis of lymphedema is important for effective treatment and to prevent progression of your lymphedema. Be aware of your body and stay in contact with your HCP when you notice any changes or new signs and symptoms.

Find the right HCP here

Facial lymphedema

Head and neck lymphedema is a very common late treatment side effect for head and neck cancer. It is a chronic disease with potentially severe consequences for quality of life. Unfortunately, knowledge of the condition is poor and clinical studies are rare. Here we present an overview of the current clinical understanding of the condition and how it can be managed.

Want to know more about how your experience compares to other patients? Check: “Is my head and neck lymphedema “normal”?”

Contents [hide]
1 Part 1. Clinical features of head and neck lymphedema
1.1 what is lymphedema?
1.2 What is head and neck lymphedema and how does it happen?
1.3 What are the symptoms of head and neck lymphedema?
1. 4 How is head and neck lymphedema diagnosed?
1.5 Risk factors for head and neck lymphedema after cancer treatment
1.6 Prevalence of head and neck lymphedema after cancer treatment
2 Part 2: Prevention and treatment of secondary head and neck lymphedema
2.1 Prevention and self-regulation of head and neck lymphedema after cancer treatment
2.2 Professional management of head and neck lymphedema after cancer treatment
2.2.1 gold standard treatment
2.2.2 Surgical options
2.2.3 Pharmaceuticals and supplements
3 comments or questions?
4 references
Part 1: clinical features of head and neck lymphedema
what is lymphedema?

Lymphedema is a chronic condition of swelling caused by damage to the lymphatic system (“secondary lymphedema”) or malformation of the lymphatic system (“primary lymphedema”). A disruption in the normal function of the lymphatic system in an area of ​​the body results in insufficient clearance of the lymphatic fluid (lymph) from that area. As the blood transports oxygen and nutrients to the cells of the body and collects waste products for excretion, 80% of the fluid returns to the bloodstream while 20% enters the lymphatic system as lymph, the colorless liquid that makes up the bulk. Eventually the lymph returns to the bloodstream in the heart.

More than just a fluid collection system, the lymphatic system is an essential component of the immune system, transporting immune cells around the body. Consequently, the blockage of lymphatic flow causes fluid buildup as well as other deleterious changes, including localized immune depression. Lymphedema is usually seen in the extremities (arms and legs) but is also very common in people treated for head and neck cancer. Learn more about lymphedema here.

what is head and neck lymphedema and how is it caused?

Secondary lymphedema of the head and neck usually results from damage to the local lymphatic system during cancer biopsy or treatment (see Figure 1 for an illustration of some of the lymph nodes and vessels of the head and neck). Removal of lymph nodes during cancer biopsy or tumor resection is the main cause of secondary lymphedema in patients with head and neck cancer. This is a direct consequence of the essential role of the lymph nodes in collecting lymphatic fluid from small lymphatic vessels and draining it into larger vessels leading to the heart.

Radiation therapy can also cause damage to any remaining lymph nodes and lymph vessels located in the radiation field, another potential cause of lymphedema. Unfortunately, the large number of nodes in the head and neck area makes radiation-induced damage more difficult to avoid. Stimulation of the normal lymphatic flow in the head and neck leads to a buildup of lymphatic fluid and then a chronic and progressive swelling that can affect various areas of the head, neck and face.

Lymph glands and vessels-of-the-head-and-neck Figure 1. Superficial lymph glands (nodes) and lymphatic vessels of the head and neck (Ref. 1).
As with arm or leg, head and neck lymphedema, lymphedema should be caught and treated early to relieve symptoms and prevent or delay the progression of the disease.

Uncontrolled edema causes additional damage by overstressing the remaining normal lymphatic vessels, and may also initiate a cascade of deleterious events, including localized inflammation, immune system impairment, and eventually hardening of the edema (which is termed “non-punctate lymphedema”) , further exacerbating the problem.

Hardening is the result of compositional changes occurring in tissue, including fibrosis (scarring), connective tissue proliferation, and fat (and to a lesser extent muscle and bone) accumulation, possibly the result of altered stem cell behavior. This advanced stage of the disease is less responsive to typical treatments and may require surgery (see below).

what are the symptoms of head and neck lymphedema?

The main symptom of head and neck lymphedema is swelling, usually developing 2-6 months after cancer treatment. In the early stages of swelling, head and neck lymphedema can be difficult to observe. Head and neck lymphedema can develop internally in the larynx and pharynx (which are the various structures that make up the mouth and throat), or externally in the neck and face, or a combination of both, depending on which lymphatic channels are obstructed.

More rarely, the tumor may progress to the point where it creates serious functional problems such as difficulty breathing and swallowing, as well as obvious problems with body image and associated social output arising from deformity of the neck and face (art. 2). Overall, head and neck lymphedema has the potential to seriously impair the quality of life of patients. To see how your symptoms compare to a group of 1,202 head and neck cancer patients at the M.D. Anderson Cancer Center (MDACC) in Texas, check out our post: “Is my head and neck lymphedema ‘normal’?“.

Symptoms of mild to moderate lymphedema of the head and neck may include:

Visible swelling under the chin, in the neck, or in the face, including the eyes and lips.
Feeling of tightness or limited movement in these areas, including the jaw or shoulders.
Symptoms of moderate to severe lymphedema of the head and neck may include:

Severe swelling of the face and neck
Swelling feels hard and hard to the touch
Visual or auditory impairment
Difficulty breathing, swallowing, eating, or speaking
Nasal congestion, chronic ear pain
How is head and neck lymphedema diagnosed?

Lymphoscintigraphy or other imaging modalities involving injections of contrast agents to visualize lymphatic fluid flow pathology may lead to a definitive diagnosis of lymphedema, but this is usually diagnosed by mild means. The presence of lymphedema is usually assessed based on observations, the results of the physical examination, the patient’s symptoms, and a review of the patient’s history. Alternative causes of the tumor need to be identified. Accordingly, the early stages of the disease can be particularly difficult to diagnose.

The patient’s subjective findings (such as feeling “tight” or “heavy”) are often the earliest indications, while objective measurements of volume change may be more difficult to obtain. This is especially true for early internal lymphedema and early external lymphedema in areas such as the chin, where there is no symmetrical counterpart that can be compared (as opposed to swelling on one side of the face that can be compared to the other unaffected side).

External lymphedema is often classified into one of four common weights. However, standardization is lacking, and this scale appears to be imperfectly suited for capturing the stage of head and neck lymphedema (Model Number/Ref. 3).

Modification of the Foldy scale for categorizing extrinsic lymphedema does a good job of capturing the range of soft tissue changes seen with progression of untreated head and neck lymphedema (see Table 1), although further validation of the scale is warranted (see Table 1). 4).

Lymphedema Feldi score modified for head and neck Lymphedema Table 1: Modified Feldi score for head and neck clients (ref. 5). This is beyond the time that normal acute post-treatment edema is usually seen.

External lymphedema is identified by visible swelling of the face or neck, and can be best quantified using a “composite facial score” consisting of seven measurements, as well as a “composite neck score” consisting of 3 measurements (model number / Ref. 4) . Measurements are needed to establish baselines, monitor changes, and improve tracking.

In contrast to internal edema, swelling of the mucous membrane and soft tissues of the pharynx and larynx is visible. Internal lymphedema is more difficult to quantify. An endoscopy or examination mirror by an experienced practitioner can be used to measure 11 internal anatomical sites and two Patterson scale sites (art. 5).

risk factors for head and neck lymphedema after cancer treatment

Fundamentally, the risk of lymphedema increases as a function of lymphatic damage. Perhaps the best predictor of likelihood is the number of lymph nodes that were removed during surgery; the more nodes removed, the more likely it is to develop head and neck lymphedema. Studies on head and neck lymphedema show that the total dose of radiotherapy as well as the number of days of radiotherapy also increase the risk of developing lymphedema (Ref. 6).

In addition to the number of lymph nodes removed, additional factors may change your chances of developing head and neck lymphedema. A study of arm lymphedema secondary to breast cancer shows that the chance of lymphedema increases for patients who:

Received chemotherapy before or after surgery (ref. 7),
Have a high Body Mass Index (BMI) of
Have genetic factors associated with lymphedema
Report about lower general health indicators (see 7)

Lymphedema – diagnosis and treatment

Lymphedema of the extremities is a visible and palpable swelling of the legs resulting from stagnant lymphatic fluid. Lymph is a pale yellow or colorless fluid that contains blood plasma and lymphocytes (white blood cells).

There are many causes of the disease. Often, this is a blockade of the lymph nodes. The pressure in the vessels rises, and the lymph protrudes from the lymphatic channels, filling the tissues. The second reason is heredity. The patient may have too few lymphatic vessels or they may be different from the norm, so they cannot perform their function properly. At the same time, the risk of inheriting the disease is 50%.

The disease is rare. Women suffer from it 9 times more often than men. Usually, lymphedema manifests itself in the return of 15 to 20 years. And even less often the disease occurs in patients older than 35 years.

Diagnosis of Lymphedema of the Lower Extremities

Diagnosis for the presence of lymphedema of the legs begins with a physical examination of the patient. An anamnesis is collected, that is, the patient’s memories of his lifestyle, when he first noticed changes in the lower extremities, past diseases, operations, injuries, allergic reactions, chronic diseases and heredity. All this information helps the doctor determine the possible source of provoking the disease.

Lymphedema has primary and secondary forms. In primary, the patient’s toes will be square in shape. This bright distinguishing feature immediately excludes venous edema.

Imaging is not required to make a diagnosis. It is needed when determining the degree of tissue involvement in the pathological development of the disease. That is, to determine how much tissue has been damaged.

The main tests that are prescribed for lymphedema:

1. X-ray Needed to rule out bone anomalies.
2. Computed tomography. Usually prescribed for suspected malignancy.
3. Magnetic resonance imaging.
4. Indocyanine green lymphography.
5. Ultrasonography. Evaluation of the condition of the lymphatic and venous vessels for damage.
6. Lymphoscintigraphy. The state of the lymphatic system is being assessed.

Secondary lymphedema is characterized by an association with some previous disease, injury or operation. It is important to establish the cause and determine the extent of the disease in order to prescribe the correct treatment.

After getting acquainted with the clinical symptoms, the stage of the course of the disease is determined:

Stage 1 – edema is not visible from the outside, but the natural ability of the lymphatic system to circulate the lymph is already reduced;
Stage 2 – swelling of the legs occurs in the evening;
stage 3 – onset of inflammation and irreversible symptoms;
Stage 4 Abnormal swelling of parts of the body.

At stages 1 and 2, the disease can be cured. Lymphedema is completely eliminated. In stages 3 and 4, the disease is irreversible.

Treatment of lymphedema

Lifestyle recommendations should be followed if diseased. For example, if you have stage 3 or 4 lymphedema, then you need to undergo therapy to reduce external pressure on the body. Do not wear tight, tight or tight clothing. You need to protect yourself as much as possible from possible injuries. At the first signs of inflammation, such as fever, chills, redness, you should immediately consult a doctor.

Treatment of primary lymphedema

In case of hereditary lymphedema, complex therapy is prescribed: lymphatic drainage, drugs (diuretics, benzopyrones), compresses, gymnastics, foot skin care to prevent ulcers or injuries, surgery.

Treatment of secondary lymphedema

If the patient has a secondary form of the disease, then the cause of the lymphedema should be treated.