Can lymphedema be localized?

From the Guidelines

Yes, lymphedema can be localized to specific areas of the body, such as an arm or leg, due to damage or blockage of the lymphatic system in that particular region. Lymphedema most commonly affects a single limb, though it can also occur in the face, neck, abdomen, or genitals. This localization happens because lymphedema develops when the lymphatic system is damaged or blocked in a particular region, preventing proper drainage of lymph fluid from that area, as noted in the american cancer society/american society of clinical oncology breast cancer survivorship care guideline 1. Primary lymphedema (caused by genetic abnormalities) and secondary lymphedema (resulting from damage to lymph nodes or vessels) both typically manifest as swelling in specific body parts rather than generalized swelling. For example, breast cancer patients who undergo axillary lymph node dissection often develop lymphedema only in the affected arm, as discussed in the guideline 1. Similarly, patients with lower extremity lymphedema following gynecological cancer treatment experience swelling limited to one or both legs.

Key Points

• Lymphedema can be localized to specific areas of the body, such as an arm or leg
• The localization of lymphedema occurs due to damage or blockage of the lymphatic system in that particular region
• Management of localized lymphedema includes complete decongestive therapy focused on the affected area, compression garments specifically fitted for the swollen limb, and exercises targeting the affected region to promote lymph drainage from that specific part of the body, as recommended in a systematic review of rehabilitation and exercise recommendations in oncology guidelines 1
• Manual lymphatic drainage and compressive bandaging are considered treatment options for lymphedema, with manual lymphatic drainage being considered for those who have sensitivity to bandaging, as noted in clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment 1

Management

• Complete decongestive therapy focused on the affected area
• Compression garments specifically fitted for the swollen limb
• Exercises targeting the affected region to promote lymph drainage from that specific part of the body
• Manual lymphatic drainage and compressive bandaging, as recommended in clinical practice guidelines 1 and a systematic review of rehabilitation and exercise recommendations in oncology guidelines 1

From the Research

Lymphedema Localization

• Lymphedema can be localized, as it is described as a "localized form of tissue swelling" resulting from excessive retention of lymphatic fluid in the interstitial compartment and caused by impaired lymphatic drainage 2.
• Localized regions of the skin can be affected by lymphedema, and it can also be clinically silent but histologically evident, denoted by dilated lymphangiectases (latent lymphedema) 3.
• Lymphedema typically affects a whole limb, but it can also affect localized areas, leading to chronic lymph stasis and its consequences, including lipogenesis, fibrosis, inflammation, lymphangiogenesis, and immunosuppression 3.

Characteristics of Localized Lymphedema

• Localized lymphedema can be primary or secondary, with primary lymphedema caused by developmental lymphatic vascular anomalies and secondary lymphedema acquired as a result of an underlying systemic disease, trauma, or surgery 2.
• The diagnosis of localized lymphedema is made by evaluating the history and physical examination, and can be confirmed with lymphoscintigraphy 4.
• Conservative management of localized lymphedema consists of compression regimens, while operative interventions aim to address the underlying lymphatic anomaly or excess tissue 4.

Treatment of Localized Lymphedema

• Compression therapy is an effective approach to managing localized lymphedema, with various types of compression therapy available, including compression stockings and adjustable compression wraps 5, 6.
• The choice of compression therapy depends on the severity of the lymphedema and the individual patient's needs, with some cases requiring the use of non-elastic leg binders or a combination of compression garments 6.