Your doctor will look at your medical history and examine the affected area. They will assess the level of swelling and any pitting, thickening or damage to the skin. If the lymphoedema is in an arm or leg, your doctor will compare the size of the affected limb to the other limb, and measure any differences.
Many doctors will refer you to a trained lymphoedema practitioner for a full assessment.
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Tests for lymphoedema
You may have some of the following tests:
- Volume measurement – Having your limbs measured before treatment for cancer can help you determine the extent of any change after treatment. It can also help track changes to swelling over time and in response to treatment. If you have lymphoedema in an arm or leg, it will become larger (increase in volume) because of the additional lymph fluid trapped in the tissue. This increase in volume is usually measured with a tape measure or through bioimpedance spectroscopy.
- Bioimpedance spectroscopy – This painless test uses very mild electrical signals to calculate how much fluid is in one limb compared to the other.
- Photographic record – Some areas of the body (such as the head, neck, trunk and genitals) are difficult to measure. Photos may be taken, with your consent, as a way of assessing changes in swelling.
- Doppler ultrasound – This test is used to rule out a blood clot (deep vein thrombosis) as the cause of your swelling.
- Imaging tests – Tests such as magnetic resonance imaging (MRI), computed tomography (CT) or an ultrasound can show extra fluid in tissues or skin thickening. These tests are not commonly used to detect lymphoedema following cancer treatment.
Following a thorough physical assessment, your lymphoedema practitioner will assign a stage to the lymphoedema. This stage can be used to recommend appropriate treatment and management strategies. If left untreated, lymphoedema will continue to get worse and become more difficult to treat successfully.
- Stage 0 (latent) – Circulation and drainage of lymph fluid is affected but there is no swelling.
- Stage I (mild) – Fluid gathers and causes mild swelling that subsides when the affected limb is elevated (raised); there may be pitting of the swollen skin (pitting is when an indentation or mark remains in the skin after pressure is applied).
- Stage II (moderate) – Swelling does not reduce when the affected limb is elevated; pitting of the skin is present; tissues begin to harden.
- Stage III (severe) – There is a large amount of fluid; tissue in the affected area is hard (fibrotic); there is no pitting of the skin; the appearance of the skin changes (e.g. thickened areas, dark patches and wart-like bumps can appear).
Who will provide treatment?
- Doctors – your GP, oncologist or a vascular surgeon may diagnose the condition, oversee your medical treatment and refer you to a trained lymphoedema practitioner.
- Lymphoedema practitioners – may be a doctor, occupational therapist, physiotherapist or nurse with specialist training in lymphoedema management. They assess people with lymphoedema, develop treatment plans and provide ongoing care.
- Lymphoedema services – these specialist centres have expert teams who manage lymphoedema on a regular basis. They can provide education and advice, assess symptoms, develop treatment plans, and prescribe compression garments. They may also provide treatment such as manual lymphatic drainage and compression bandaging.
How to find a lymphoedema practitioner
The Australasian Lymphology Association maintains a national directory of trained lymphoedema practitioners. Use their ‘Find a practitioner‘ service to search the registry for a practitioner in your area, or talk to your doctor about a referral to a lymphoedema service. Public hospitals may assess and treat lymphoedema through physiotherapy or occupational therapy departments.