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Assessment

History

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.