Most often those who undergo a treatment for cancer are generally offered a lymphedema assessment as general part of their after-care therapy or treatment program. This often includes education on what to look for if lymphedema develops in the limb or area. Many times preemptive treatment for these patients includes fitting for garments and training on how to perform MLD or CDT on themselves.
For those who have not experienced a traumatic event such as cancer, a diagnosis of lymphedema becomes more difficult. In most cases evaluating an individual that is either at risk for or has symptoms of lymphedema must be evaluated. Often this will require the doctor to rule out other possibilities of the swelling. These possibilities may include blood clots, small tumor nodules, or an infection that does not involve the lymph nodes. Should the doctor feel that the patient is at risk (such as having recent cancer surgery or treatments, a traumatic injury or treatment involving the lymph nodes) or that the symptoms reasonably point towards lymphedema, the doctor mt diagnose the condition as lymphedema. Often times, a medical history along with a physical examination will be completed in order to help the doctor make the correct diagnosis so treatment of the affected limb or area can begin immediately. The medical history should include any past surgeries, problems after surgery, and the time between surgery and the onset of symptoms of edema. Any changes in the edema should be determined, as should any history of injury or infection.
If there is not an obvious cause for the lymphedema or the doctor wants a full medical diagnosis they may order diagnostic imaging tests to determine what is causing the swelling in addition to the leading symptoms.
MRI (magnetic resonance imaging) scan – this device uses a magnetic field and radio waves to create detailed 3-D images of the inside of the body. The doctor can get a better look at the limb tissues, and possibly identify characteristics of lymphedema. MRI and some other scans are also useful in ruling out lipedemia; another condition in which the limbs swell due to abnormal fat deposits.
CT (computerized tomography) scan – this device employs tomography. Tomography is the process of generating a two-dimensional image of a slice or section through a 3-dimensional object (a tomogram). The medical device (the machine) is called a CTG scanner; it is a large machine and uses X-rays. This type of scan can reveal areas in the lymphatic system that may be blocked.
Doppler ultrasound. This variation of the conventional ultrasound looks at blood flow and pressure by bouncing high-frequency sound waves (ultrasound) off red blood cells. Ultrasound can be helpful in finding obstructions.
There are very few medical tests that are valuable in the diagnosis of lymphedema. In some cases therapists or treating doctors may ask for a lymphoscinitgraphy to be performed. In this test, radioactive labeled protein is injected beneath the surface of the skin, and the uptake and transport of the labeled protein is observed over several hours. This test can characterize the impairment of the lymphatic system’s ability to transport proteins and fluid, but is rarely necessary to plan and provide appropriate treatment.
Once medically diagnosed there are a number of ways to determine the extent and severity of the swelling of the lymphedema.
The most basic and common way is the measurement of the arm or leg and has long been the standard way of detecting lymphedema and determining the extent and severity of swelling.
Water displacement method requires the patient to place the affected limb in water. The amount of water displaced is measured. The doctor then knows what the volume of the limb is.
Perometery – A perometery is a machine that uses infra-red light to measure the volume in an affected body part.
Bioimpedance test – During a bioimpedance test electrodes are placed on different parts of your body, which then release a small and painless electric charge. The charge is then measured using a hand-held device. Changes in the strength of the current can indicate the presence of fluid within your tissue.