Management Options for Lymphedema
Complete Decongestive Therapy (CDT) is the gold standard treatment for lymphedema, consisting of manual lymphatic drainage, compression therapy, exercise, skin care, education, and self-management components. 1, 2
First-Line Treatment Components
Manual Lymphatic Drainage (MLD)
- Specialized massage technique that stimulates lymph flow and is recommended as a first-line treatment for lymphedema 1
- Particularly beneficial for patients who have sensitivity to compression bandaging 1, 3
- Should be performed by certified lymphedema therapists with specialized training 2
Compression Therapy
- Multi-layer compression bandaging to reduce swelling and prevent fluid reaccumulation 1, 4
- Compression garments for maintenance phase after initial volume reduction 1
- Essential component that may be effective even without MLD in some cases 5
Exercise
- Supervised progressive resistance training is safe and potentially beneficial 1, 3
- Include breathing and range of motion (ROM) exercises as part of treatment 6
- Tailored exercises based on affected area (e.g., scapular and rotator cuff strengthening for breast cancer-related lymphedema) 6
Skin Care
- Essential for preventing infections which can worsen lymphedema 1, 3
- Patient education on proper skin hygiene and moisturizing 6
- Prompt treatment of any skin infections with antibiotics 3
Treatment Phases
Phase I (Intensive Treatment)
- Clinic-based treatment provided by certified lymphedema therapists 2, 4
- Typically includes daily or frequent sessions of MLD, compression bandaging, exercise, and skin care 4
- Can achieve 45-70% reduction in lymphedema volume 7
Phase II (Maintenance)
- Home-based self-management program 4
- Includes self-MLD, compression garments, continued exercise, and skin care 4
- May be supported by intermittent pneumatic compression devices for home use 4
Special Considerations by Cancer Type
Breast Cancer-Related Lymphedema
- Use compression sleeve during exercise if lymphedema is present 6
- Include neck, rotator cuff, and posterior shoulder girdle strengthening 6
- Monitor for musculoskeletal pain from aromatase inhibitors 6
Gynecologic Cancer-Related Lymphedema
- Early intervention is critical to prevent progression 6
- Address pelvic floor issues before beginning exercise training 6
- Additional supervision may be required for morbidly obese patients during aerobic activity 6
Head and Neck Cancer-Related Lymphedema
- Include breathing exercises as part of treatment 6
- Treatment of cervical shoulder asymmetry and malalignment 6
- Address post-surgical adhesions and scar sensitivity 6
Prostate Cancer-Related Lymphedema
- May require scrotal or penis bandaging or compressive underwear 6
- Include pelvic floor exercises and continence assessment 6
Adjunctive Treatments
Low-Level Laser Therapy
- Can be considered for reducing arm volume and improving quality of life 1
- Evidence level is Grade C according to the American College of Surgeons 1
Intermittent Pneumatic Compression (IPC)
- May support successful home management by addressing treatment barriers 4
- Advanced programmable devices that provide truncal and proximal clearance are preferred 4
Weight Management
- Recommended for overweight or obese patients to reduce lymphedema risk 1, 3
- Important component of long-term management 6
Common Pitfalls to Avoid
- Delaying treatment can lead to progression and increased complications 1, 3
- Inadequate infection management can significantly worsen lymphedema 1, 3
- Using diuretics is generally ineffective for lymphedema management 1, 3
- Poor patient compliance with home care regimens can result in loss of gains achieved in clinic 4