Assessment

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.

Conduct a physical examination of:

1. The affected limb or body part

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.

2. The original site of cancer treatment, including recent medical imaging, to exclude tumour recurrence.

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.