Lymphedema: Responding to Our Patients' Needs

Esther Muscari

ONF 2007, 31(5), 905-912. DOI: 10.1188/04.ONF.905-912
Download PDF
Lymphedema is greatly misunderstood in every possible circle—from healthcare providers to patients at risk. Lymphedema is a collection of excess water, interstitial fluid, plasma proteins, bacteria, and cellular waste products in the interstitial tissues as a result of an impaired lymphatic system (Cheville, McGarvey, Petrek, Russo, Taylor, et al., 2003; International Society of Lymphology [ISL], 2003). Ninety percent of interstitial fluid is removed by the circulatory system with the remaining 10% managed by the lymphatic vessels (Ridner, 2002). The lymphatic system is extensive throughout each of us. It begins as a fine network just under the skin surface and converges to become larger vessels deeper in the tissue. Fluid from the lower extremities moves up through the thoracic duct, running up the abdomen, and is affected by diaphragmatic pressures. Lymphatic fluid moves up through the nodal beds and dumps into the vascular system at the entrance of the superior vena cava.

Jump to a section

    References

    Armer, J.M., & Porock, D. (2002). Self-management of fatigue among women with lymphedema. Lymphology, 35(Suppl.), 208-213.
    Armer, J.M., Radina, M.E., Porock, D., & Culbertson, S.D. (2003). Predicting breast cancer-related lymphedema using self-reported symptoms. Nursing Research, 52, 370-379.
    Brennan, M.J., & Miller, L.T. (1998). Overview of treatment options and review of the current role and use of compression garments, intermittent pumps, and exercise in the management of lymphedema. Cancer, 83(12, Suppl.), 2821-2827.
    Brewer, V.H., Hahn, K.A., Rohrbach, B.W., Bell, J.L., & Baddour, L.M. (2000). Risk factor analysis for breast cellulitus complicating breast conservation therapy. Clinical Infectious Diseases, 31, 654-659.
    Brown, J. (2004). A clinically useful method for evaluating lymphedema. Clinical Journal of Oncology Nursing, 8, 35-38.
    Casley-Smith, J., & Casley-Smith, J. (1997). Modern treatment for lymphedema (5th ed). Adelaide, Australia: Bowden Printing.
    Cheville, A.L., McGarvey, C.L., Petrek, J.A., Russo, S.A., Taylor, M.E., & Thiadens, S.R. (2003). Lymphedema management. Seminars in Radiation Oncology, 13, 290-301.
    Cheville, A.L., McGarvey, C.L., Petrek, J.A., Russo, S.A., Thiadens, S.R., & Taylor, M.E. (2003). The grading of lymphedema in oncology clinical trials. Seminars in Radiation Oncology, 13, 214-225.
    Foldi, E. (1998). The treatment of lymphedema. Cancer, 83(12, Suppl.), 2833-2834.
    Gerber, L.H. (1998). A review of measures of lymphedema. Cancer, 83(12, Suppl.), 2803-2804.
    Harris, R., & Piller, N. (2003). Three case studies indicating the effectiveness of manual lymph drainage on patients with primary and secondary lymphedema using objective measuring tools. Journal of Bodywork and Movement Therapies, 7, 213-221.
    Hull, M.M. (2000). Lymphedema in women treated for breast cancer. Seminars in Oncology Nursing, 16, 226-237.
    International Society of Lymphology. (2003). The diagnosis and treatment of peripheral lymphedema: Consensus document of the International Society of Lymphology. Lymphology, 36(2), 84-91.
    Kasseroller, R.G. (1998). The Vodder school: The Vodder method. Cancer, 83(12, Suppl.), 2840-2842.
    Ko, D., Lerner, R., Klose, G., & Cosimi, A. (1998). Effective treatment of lymphedema of the extremities. Archives of Surgery, 133, 452-458.
    Kwan, W., Jackson, J., Weir, L.M., Dingee, C., McGregor, G., & Olivotto, I.A. (2002). Chronic arm morbidity after curative breast cancer treatment: Prevalence and impact on quality of life. Journal of Clinical Oncology, 20, 4242-4248.
    Leduc, O., Leduc, A., Bourgeois, P., & Belgrado, J.P. (1998). The physical treatment of upper arm limb edema. Cancer, 83(12, Suppl.), 2835-2839.
    Leitch, A.M., Meek, A.G., Smith, R.A., Boris, M., Bourgeois, P., Higgins, S., et al. (1998). Treatment of the axilla with surgery and radiation—Preoperative and postoperative risk assessment. Cancer, 83(12, Suppl.), 2877-2879.
    Lerner, R. (1998). Complete decongestive physiotherapy and the Lerner Lymphedema Services Academy of Lymphatic Studies. Cancer, 83(12, Suppl.), 2861-2863.
    Meek, A.G. (1998). Breast radiotherapy and lymphedema. Cancer, 83(12, Suppl.), 2788-2796.
    Mondry, T.E., & Johnstone, P.A. (2002). Manual lymphatic drainage for lymphedema limited to the breast. Journal of Surgical Oncology, 81, 101-104.
    Mortimer, P.S. (1998). The pathophysiology of lymphedema. Cancer, 83(12, Suppl.), 2798-2802.
    Passik, S.D., & McDonald, M.V. (1998). Psychosocial aspects of upper extremity lymphedema in women treated for breast carcinoma. Cancer, 83(12, Suppl.), 2817-2820.
    Pressman, P.I. (1998). Surgical treatment and lymphedema. Cancer, 83(12, Suppl.), 2782-2787.
    Ridner, S.H. (2002). Breast cancer lymphedema: Pathophysiology and risk reduction guidelines. Oncology Nursing Forum, 29, 1285-1293.
    Rockson, S.G. (1998). Precipitating factors in lymphedema: Myths and realities. Cancer, 83(12, Suppl.), 2814-2816.
    Rockson, S.G., Miller, L.T., Senie, R., Brennan, M.J., Casley-Smith, J., Foldi, E., et al. (1998). Diagnosis and management of lymphedema. Cancer, 83(12, Suppl.), 2882-2885.
    Werner, R.S., McCormick, B., Petrek, J., Cox, L., Cirrincione, C., Gray, J., et al. (1991). Arm edema in conservatively managed breast cancer: Obesity is a major predictive factor. Radiology, 180, 177-184.