Lymphedema is a condition resulting from an abnormal amount of protein-rich fluid accumulating in the subcutaneous tissues due to a compromised lymphatic system. It can occur in the limbs, head and neck, trunk, and genitalia. Lymphedema is a life-long, chronic condition that may have a negative impact on quality of life. Primary Lymphedema is lymphatic insufficiency caused by congenital abnormalities. Secondary lymphedema is the result of damage to the lymphatic system. Cancer, medical treatment, and surgical treatment for cancer are risk factors for secondary lymphedema. Most notably, radiation therapy and lymph node dissection increase risk. The incidence of lymphedema across all cancer survivors is 15.5%. Additionally, patients who have undergone radiation therapy have an even higher incidence of Lymphedema at 31.0%.

In this presentation, we will cover an overview of the physiology of the lymphatic system. Review the pathophysiology, risk factors, and clinical presentation of secondary lymphedema in oncology to aid in early identification of cancer patients at risk. We will review the diagnosis and natural history of secondary lymphedema, staging, and its impact on quality of life. Educate the role of the physical therapist as part of an interdisciplinary team to manage the condition and improve patient outcomes. While lymphedema has no cure, it can be managed with early recognition and referral to therapists with advanced training. We will review the evidence for conservative treatment for lymphedema including Complete Decongestive Therapy (CDT,) with special considerations in oncological lymphedema across the lifespan.

By understanding and identifying risk factors for secondary lymphedema and its clinical presentation, physical therapists who work in oncology, we'll have the opportunity to educate patients and families, promote risk reduction, monitor symptom progression, and recommend timely referral for patients' optimal treatment. Physical therapists have the ability to change the outcome by maximizing function, mitigating risk of disease progression, and improving the quality of life of patients with secondary lymphedema. Finally, this presentation will review case studies of patients with secondary lymphedema. Information on therapist certification, resources, and educational materials will be included for those interested in further study.

Upon completion of this course, the participant will - 

• Understand anatomy of the lymphatic system as well as the pathophysiology and natural history of oncological secondary lymphedema.
• Evaluate clinical presentation of secondary lymphedema.
• Analyze risk factors and patients who are at increased risk for secondary lymphedema.
• Understand patient and family education and treatment for secondary lymphedema including components of treatment, goals of treatment and evidence supporting treatment.
• Be familiar with Pediatric Lymphedema resources.