What is the treatment for lymphedema?

Treatment of Lymphedema

Manual lymphatic drainage and compression bandaging are the primary recommended treatments for lymphedema, with manual lymphatic drainage being particularly beneficial for patients who have sensitivity to bandaging. 1

Understanding Lymphedema

Lymphedema is a chronic condition characterized by the accumulation of lymph fluid in tissues, causing swelling. It occurs when parts of the lymphatic system become damaged or blocked, preventing proper drainage of lymph fluid. 1

• Lymphedema commonly affects the arms or legs but can also impact other body parts 1
• For breast cancer survivors, lymphedema most frequently affects the upper extremities, sometimes extending to the breast and chest wall 1
• The condition can develop up to 30 years following cancer treatment 1
• Incidence of arm lymphedema after breast cancer treatment ranges from 8% to 56% 1
• Lymphedema significantly impacts quality of life and increases psychological distress and disability 1

Treatment Approaches

First-Line Treatments (Grade C Evidence)

• Manual lymphatic drainage (MLD): Specialized massage technique that stimulates lymph flow 1
• Compression bandaging: Multi-layer wrapping to reduce swelling and prevent fluid reaccumulation 1, 2
• Low-level laser therapy: Can be considered for reducing arm volume and improving lymphedema-related quality of life 1

Complete Decongestive Therapy (CDT)

CDT is considered the most comprehensive approach and consists of four components:

1. Manual lymphatic drainage (MLD): Specialized massage technique 3, 4
2. Compression therapy: Using bandages or garments 5, 6
3. Decongestive exercises: To promote lymph flow 3, 4
4. Meticulous skin care: To prevent infections 5, 7

CDT is typically delivered in two phases:

• Phase I (Initial/Attack Phase): Intensive treatment in a clinical setting using multilayer inelastic bandaging and MLD 5, 6
• Phase II (Maintenance Phase): Home-based management using elastic compression garments (stockings or sleeves), possibly with continued MLD 5, 6

Additional Treatment Considerations

• Intermittent pneumatic compression: May be used as an adjunctive therapy 5, 6
• Weight management: Recommended for overweight or obese patients to reduce lymphedema risk 2
• Supervised progressive resistance training: Safe and potentially beneficial for lymphedema patients 2
• Prompt treatment of infections: Essential to prevent worsening of lymphedema 2, 5

Treatment Algorithm

1. Initial assessment: Refer patients with clinical symptoms or swelling to a specialized lymphedema therapist 2
2. Begin Phase I therapy: Implement complete decongestive therapy with all four components 3, 4
3. Transition to Phase II: Once volume reduction plateaus, transition to maintenance phase with compression garments 5, 6
4. Regular monitoring: Evaluate effectiveness through objective measurements of limb perimeters or volumes 5

Common Pitfalls to Avoid

• Delayed treatment: Can lead to progression and increased complications 2
• Inadequate infection management: Infections can significantly worsen lymphedema 2, 5
• Using diuretics: Generally ineffective for lymphedema management 2
• Poor compression technique: Ineffective bandaging can limit treatment success 6
• Inadequate patient education: Leads to poor compliance with home management 6

Special Considerations

• Manual lymphatic drainage is particularly beneficial for patients who cannot tolerate compression bandaging due to allergies or discomfort 1
• Truncal clearance plays a key role in facilitating lymphatic drainage from affected limbs 6
• Surgery is rarely indicated except in cases of genital lymphedema 5

While lymphedema is considered a chronic condition that requires lifelong management, proper implementation of complete decongestive therapy can significantly improve symptoms and quality of life 5, 4.