J Korean Med Assoc.  2013 Dec;56(12):1115-1122. 10.5124/jkma.2013.56.12.1115.

The diagnosis and treatment of lymphedema

  • 1Department of Family Medicine, Yonsei University College of Medicine, Seoul, Korea. hope@yuhs.ac


Lymphedema is not uncommon, but it can often be undiagnosed until discomfort or complications occur. It tends to develop slowly, but is progressive without proper treatment. Lymphedema occurs when the lymphatic fluid load is greater than the ability of transport, resulting not only in excessive accumulation of tissue fluid but also in deformity of appearance, immobility, and more serious consequences. Stage I lymphedema can be improved by simply promoting drainage with elevation and compression garments. Stage II or III lymphedema should be managed intensively with complete decongestive therapy using a combination of skin care, exercise, elevation, manual lymph drainage, intermittent pneumatic compression, multilayer lymphedema bandaging and weight reduction. The safety and effectiveness of other treatment modalities for lymphedema such as liposuction, microsurgical lymphatic reconstruction, needle aspiration, stem cells, laser therapy, and iliac vein stenting should further be investigated. Since lymphedema is progressive, the diagnosis and treatment of lymphedema at the earliest possible stage is very important. Complete decongestive therapy is principal, and psychosocial support is an important element of the treatment of lymphedema.


Lymphedema; Diagnosis; Complete decongestive therapy

MeSH Terms

Congenital Abnormalities
Iliac Vein
Laser Therapy
Skin Care
Stem Cells
Weight Loss


  • Figure 1 Management of lymphedema. ISL, International Society of Lymphology; SLD, simple lymphatic drainage; MLD, manual lymph drainage; MLLB, multi-layer lymphedema bandaging.

Cited by  2 articles

Lower Limb Lymphedema and Quality of Life in Gynecologic Cancer Patients
Sun Young Yu, Jeong Hye Kim
Asian Oncol Nurs. 2017;17(1):20-28.    doi: 10.5388/aon.2017.17.1.20.

Diagnostic Significance of Fibrin Degradation Products and D-Dimer in Patients With Breast Cancer-Related Lymphedema
Sang Hyeong Ryu, Sang Won Min, Jae Ho Kim, Ho Joong Jeong, Ghi Chan Kim, Dong Kyu Kim, Young-Joo Sim
Ann Rehabil Med. 2019;43(1):81-86.    doi: 10.5535/arm.2019.43.1.81.


1. International Society of Lymphology. The diagnosis and treatment of peripheral lymphedema. Consensus document of the International Society of Lymphology. Lymphology. 2003; 36:84–91.
2. Dale RF. The inheritance of primary lymphoedema. J Med Genet. 1985; 22:274–278.
3. Moffatt CJ, Franks PJ, Doherty DC, Williams AF, Badger C, Jeffs E, Bosanquet N, Mortimer PS. Lymphoedema: an underestimated health problem. QJM. 2003; 96:731–738.
4. Chang SB, Askew RL, Xing Y, Weaver S, Gershenwald JE, Lee JE, Royal R, Lucci A, Ross MI, Cormier JN. Prospective assessment of postoperative complications and associated costs following inguinal lymph node dissection (ILND) in melanoma patients. Ann Surg Oncol. 2010; 17:2764–2772.
5. DiSipio T, Rye S, Newman B, Hayes S. Incidence of unilateral arm lymphedema after breast cancer: a systematic review and meta-analysis. Lancet Oncol. 2013; 14:500–515.
6. Cormier JN, Askew RL, Mungovan KS, Xing Y, Ross MI, Armer JM. Lymphedema beyond breast cancer: a systematic review and meta-analysis of cancer-related secondary lymphedema. Cancer. 2010; 116:5138–5149.
7. Lymphoedema Framework. Best practice for the management of lymphedema: an international consensus. London: Medical Education Partnership;2006. p. 6–29.
8. Kissin MW, Querci della Rovere G, Easton D, Westbury G. Risk of lymphedema following the treatment of breast cancer. Br J Surg. 1986; 73:580–584.
9. Burnand KG, McGuinness CL, Lagattolla NR, Browse NL, El-Aradi A, Nunan T. Value of isotope lymphography in the diagnosis of lymphoedema of the leg. Br J Surg. 2002; 89:74–78.
10. Stout Gergich NL, Pfalzer LA, McGarvey C, Springer B, Gerber LH, Soballe P. Preoperative assessment enables the early diagnosis and successful treatment of lymphedema. Cancer. 2008; 112:2809–2819.
11. Suehiro K, Morikage N, Murakami M, Yamashita O, Samura M, Hamano K. Significance of ultrasound examination of skin and subcutaneous tissue in secondary lower extremity lymphedema. Ann Vasc Dis. 2013; 6:180–188.
12. Ferrell RE, Kimak MA, Lawrence EC, Finegold DN. Candidate gene analysis in primary lymphedema. Lymphat Res Biol. 2008; 6:69–76.
13. Lasinski BB, McKillip Thrift K, Squire D, Austin MK, Smith KM, Wanchai A, Green JM, Stewart BR, Cormier JN, Armer JM. A systematic review of the evidence for complete decongestive therapy in the treatment of lymphedema from 2004 to 2011. PM R. 2012; 4:580–601.
14. Firas AN, Neil C. Cellulitis and lymphoedema: a vicious cycle. J Lymphoedema. 2009; 4:38–42.
15. Cohen SR, Payne DK, Tunkel RS. Lymphedema: strategies for management. Cancer. 2001; 92:4 Suppl. 980–987.
16. Shaw C, Mortimer P, Judd PA. A randomized controlled trial of weight reduction as a treatment for breast cancer-related lymphedema. Cancer. 2007; 110:1868–1874.
17. Andersen L, Hojris I, Erlandsen M, Andersen J. Treatment of breast-cancer-related lymphedema with or without manual lymphatic drainage: a randomized study. Acta Oncol. 2000; 39:399–405.
18. De Godoy JM, Batigalia F, Godoy Mde F. Preliminary evaluation of a new, more simplified physiotherapy technique for lymphatic drainage. Lymphology. 2002; 35:91–93.
19. Roztocil K, Prerovsky I, Oliva I. The effect of hydroxyethylrutosides on capillary filtration rate in the lower limb of man. Eur J Clin Pharmacol. 1977; 11:435–438.
20. Miller TA, Wyatt LE, Rudkin GH. Staged skin and subcutaneous excision for lymphedema: a favorable report of long-term results. Plast Reconstr Surg. 1998; 102:1486–1498.
21. Brorson H. Liposuction gives complete reduction of chronic large arm lymphedema after breast cancer. Acta Oncol. 2000; 39:407–420.
22. Campisi C, Boccardo F, Zilli A, Macció A, Napoli F. The use of vein grafts in the treatment of peripheral lymphedemas: long-term results. Microsurgery. 2001; 21:143–147.
23. Raju S, Furrh JB 4th, Neglen P. Diagnosis and treatment of venous lymphedema. J Vasc Surg. 2012; 55:141–149.
24. Yang GH, Kwak SW, Kim SH, Shin YT, Hwang HJ, Park NH, Yeom CH. Effect of a needle aspiration in patients with lymphedema. Korean J Hosp Palliat Care. 2009; 12:27–31.
25. Maldonado GE, Perez CA, Covarrubias EE, Cabriales SA, Leyva LA, Perez JC, Almaguer DG. Autologous stem cells for the treatment of post-mastectomy lymphedema: a pilot study. Cytotherapy. 2011; 13:1249–1255.
26. Omar MT, Shaheen AA, Zafar H. A systematic review of the effect of low-level laser therapy in the management of breast cancer-related lymphedema. Support Care Cancer. 2012; 20:2977–2984.
27. Sander AP, Hajer NM, Hemenway K, Miller AC. Upper-extremity volume measurements in women with lymphedema: a comparison of measurements obtained via water displacement with geometrically determined volume. Phys Ther. 2002; 82:1201–1212.
28. Stanton AW, Northfield JW, Holroyd B, Mortimer PS, Levick JR. Validation of an optoelectronic limb volumeter (Perometer). Lymphology. 1997; 30:77–97.
29. Gjorup C, Zerahn B, Hendel HW. Assessment of volume measurement of breast cancer-related lymphedema by three methods: circumference measurement, water displacement, and dual energy X-ray absorptiometry. Lymphat Res Biol. 2010; 8:111–119.
Full Text Links
  • JKMA
export Copy
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr