Consider details of the patient’s history including:
- lymph node removal
- complications (e.g. post-operative infection)
- trauma to limb
- cellulitis, infection and ulcers
- travel history.
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.
- pitting/non-pitting odedema
- tissue zone
- presence and severity of swelling
condition of skin
- 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.
- CT scan — to exclude masses or tumours
- Duplex scan — to exclude venous insufficiency or DVT.
- subcutaneous tissue