NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Survivorship

Preventing Cancer-Related Lymphedema

Before we talk about techniques to prevent lymphedema, it’s important to look at the lymphatic system, a network of vessels that runs throughout your body to remove waste from your system. Waste products are collected in the form of lymphatic fluid by lymphatic vessels that connect to lymph nodes and empty into blood vessels to be removed from your body.

When lymph nodes are damaged, the system can become disrupted, causing the lymphatic fluid to build up. This condition, called lymphedema, can lead to painful and sometimes debilitating swelling, as well as infections and hospitalizations.

Types of lymphedema

Lymphedema can be either primary or secondary. Primary lymphedema occurs on its own, usually as a result of a genetic condition. Secondary lymphedema—the most common type—occurs as a response to another condition, such as an infection, injury, trauma, cancer or cancer treatment.

Risk of lymphedema

Advances in medical treatment have dramatically improved cancer care and survivorship. However, of the nearly 17 million cancer survivors living in the U.S., it is estimated that one in three of those treated for the cancers below will develop lymphedema.1,2

Those most at risk are patients who undergo surgery, radiation therapy or Taxane-based chemotherapy to treat:

  • Breast cancer
  • Colorectal cancer
  • Melanoma
  • Genital cancers
  • Urinary cancers

Preventing cancer-related lymphedema

Like many medical conditions, secondary, cancer-related lymphedema develops in stages and if caught early, progression can be prevented. At Stage 0, lymphedema is reversible. The lymphatic system is impaired but there is not enough fluid buildup for patients to notice symptoms. At Stage 1, fluid accumulation usually results in noticeable swelling and discomfort. Treatment at this stage can alleviate symptoms and sometimes reverse progression. At Stages 2 and 3, lymphedema is irreversible.

Stage 0 - Subclinical

Lymphatic transport capacity is reduced, setting the stage for an overload of the lymphatic system.

Stage 1 - Pitting Edema

Accumulation of fluid and protein causing swelling; pitting edema may be evident.

Stage 2 - Irreversible

Spongy tissue consistency, tissue fibrosis causing hardness and increase in size.

Stage 3 - Elephantiasis

The affected limb becomes very large and misshapen and the skin takes on a leathery appearance.

Know your L-Dex® score

Previously, cancer survivors were not routinely monitored, but with a new technology called L-Dex, your healthcare provider has a tool that aids in early detection of lymphedema. L-Dex is a measurement of fluid buildup in your at-risk limb compared to a healthy limb. It uses noninvasive bioimpedance spectroscopy (BIS), which is capable of detecting fluid changes as small as 2.4 tablespoons (36 ml) and takes less than 30 seconds to complete. For best results, at-risk patients receive a baseline measurement before cancer treatment begins and are then monitored regularly after treatment.

Early intervention

Your healthcare provider will monitor your L-Dex score for signs of subclinical lymphedema. If subclinical lymphedema is detected, you will be instructed on at-home therapy using standard compression garments. A recent study showed that early detection combined with standard compression therapy can reduce the progression of lymphedema by 95%.3

Personal stories

1 in 3

One third of cancer survivors develop lymphedema.1,2

95% reduction

BIS has demonstrated up to a 95% reduction in clinical breast cancer-related lymphedema (BCRL).3

< 30 seconds

SOZO produces a detailed reading in less than 30 seconds.

Find a L-Dex provider

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  1. NIH, National Cancer Institute: accessed April 30, 2019.
  2. Shaitelman SF, et al. Recent progress in the treatment and prevention of cancer-related lymphedema. CA Cancer J Clin 2015;65:55-81.
  3. Ridner SH, et al. A randomized trial evaluating bioimpedance spectroscopy versus tape measurement for the prevention of lymphedema following treatment for breast cancer: interim analysis. Ann Surg Oncol 2019;