Lymphedema Management in Cancer Survivorship

Lymphedema is a chronic and progressive condition arising from impaired lymphatic drainage, most commonly affecting cancer survivors who have undergone lymph node dissection or radiotherapy. It manifests as tissue swelling, fibrosis, recurrent infections and functional impairment, with profound impacts on quality of life and healthcare costs worldwide. Modern management adopts a multimodal approach. Conservative measures include complex decongestive therapy—comprising manual lymphatic drainage, compression bandaging, exercise and skin care—to reduce limb volume and prevent complications. Emerging diagnostic methods, such as bioimpedance spectroscopy and indocyanine green lymphography, facilitate early detection and individualised surveillance programmes. Surgical interventions, including lymphovenous anastomosis, vascularised lymph node transfer and liposuction, target anatomical restoration or volume reduction in refractory cases. Risk stratification based on body mass index, extent of nodal surgery and adjuvant radiotherapy informs personalised prevention pathways. Recent advances in microsurgical techniques, pharmacological modulation of lymphangiogenesis and consensus-based guidelines are shaping a more proactive and patient-centred standard of care.

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Lymphedema Management in Cancer Survivorship publication trend

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Technical terms

Lymphovenous anastomosis: Direct microsurgical connection between lymphatic vessels and venous channels to reroute lymphatic fluid and alleviate congestion.

Vascularised lymph node transfer (VLNT): Transplantation of lymph nodes with their arterial and venous supply to restore lymphatic drainage pathways in affected limbs.

Indocyanine green (ICG) lymphography: Near-infrared fluorescence imaging technique that visualises superficial lymphatic vessels in real time following injection of a tracer dye.

Prospective surveillance: Structured programme of regular assessments and limb measurements to enable early detection and intervention for subclinical lymphedema.

References

1. Multinational Association of Supportive Care in Cancer (MASCC) clinical practice guidance for the prevention of breast cancer-related arm lymphoedema (BCRAL): international Delphi consensus-based recommendations. EClinicalMedicine (2024).
2. Vascularized lymph node flaps can survive on venous blood without an arterial inflow: an experimental model describing the dynamics of venous flow using indocyanine green angiography (With video). Burns & Trauma (2023).
3. The influence of axillary surgery and radiotherapeutic strategy on the risk of lymphedema and upper extremity dysfunction in early breast cancer patients. The Breast (2023).