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Consider details of the patient’s history including:

  • cancer treatment
    - surgery
    - lymph node removal
    - radiotherapy
    - complications (e.g. post-operative infection)
  • trauma to limb
  • cellulitis, infection and ulcers
  • travel history.

Physical evaluation

Conduct a physical examination of:

1. The affected limb or body part

2. The original site of cancer treatment, including recent medical imaging, to exclude tumour recurrence.

    • subcutaneous tissue
      - pitting/non-pitting odedema
      - tissue zone
    • presence and severity of swelling
    • condition of skin
      - dry
      - cracked
      - infection/tinea
      - bruising
      - flaking
    • presence of Stemmer's sign - thickened skin at the base of the second toe or middle finger, compared with the unaffected limb
    • body mass index
    • cardiac and respiratory parameters
    • joint mobility
    • axillary cording.
    • If swelling is not detected, see » Early intervention
    • If swelling is detected, see » General management principles
    • If symptoms are severe, early referral is appropriate. See » Specialised treatment
    • Patients with cellulitis require urgent antibiotic treatment. See » Cellulitis for details
    • Patients with acute onset or rapid exacerbation of lymphoedema should be assessed for tumour recurrence or deep vein thrombosis (DVT) and referred as appropriate.
      Investigations include:
      - CT scan — to exclude masses or tumours
      - Duplex scan — to exclude venous insufficiency or DVT.