Iranian Society of Gynecology Oncology


1 Department of Gynecology Oncology, Shahid Beheshti University of Medical Sciences, Tehran, Iran

2 Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

3 Cellular and Developmental Biology Department, Oolom Tahghighat University, Tehran, Iran


Lymphedema is an unusual and specific type of peripheral edema resulting from obstruction or disruption of lymphatic system. The present review was conducted on PubMed, UpToDate, and ClinicalKey databases before 2016. The keywords included lymphedema or leg edema AND advanced malignancy. The primary review revealed 104 full text publications, of which 24 relevant articles were selected and another 17 relevant articles from the reference list of the selected articles were added, as well. Practical points in diagnosis and treatment of lymphedema in gynecologic malignancies are presented in the below subtitles: -basic descriptions, classifications, and epidemiology; -clinical presentation and diagnostic tests; -differential diagnosis; -non-surgical management; -surgical management.


  1. Sterns RH. General principles of the treatment of edema in adults [Internet] [updated 2015 Sep 4 cited 2017 Nov 15]. Available from:
  2. Sterns RH. Pathophysiology and etiology of edema in adults [Internet] [updated 2016 Jul 25 cited 2017 Nov 15]. Available from:
  3. Chang VT. Approach to symptom assessment in palliative care [Internet] [updated 2017 Oct 12 cited 2017 Nov 15]. Available from:
  4. American Society of Clinical Oncology (ASCO) . Lymphedema [Inter-net] 2017 Aug [cited 2017 Nov 15]. Available from:
  5. Kerchner K, Fleischer A, Yosipovitch G. Lower extremity lymphedema update: pathophysiology, diagnosis, and treatment guidelines. J Am Acad Dermatol. 2008;59(2):324-31. [DOI:10.1016/j.jaad.2008.04.013] [PMID]
  6. Lyons OTA, Modarai B. Lymphoedema. Surgery (Oxford). 2013;31(5):218-23. [DOI:10.1016/j.mpsur.2013.02.003]
  7. Mehrara B. Clinical features and diagnosis of peripheral lymphedema [Internet] [updated 2017 Sep 01 cited 2017 Nov 15]. Available from:
  8. Brayton KM, Hirsch AT, O. Brien PJ , Cheville A, Karaca-Mandic P, Rockson SG. Lymphedema prevalence and treatment benefits in cancer: impact of a therapeutic intervention on health outcomes and costs. PLoS One. 2014;9(12):e114597. [DOI:10.1371/journal.pone.0114597] [PMID]
  9. Cormier JN, Askew RL, Mungovan KS, Xing Y, Ross MI, Armer JM. Lymphedema beyond breast cancer: a systematic review and meta-analysis of cancer-related secondary lymphedema. Cancer. 2010;116(22):5138-49. [DOI:10.1002/cncr.25458] [PMID]
  10. Meric F, Buchholz TA, Mirza NQ, Vlastos G, Ames FC, Ross MI, et al. Long-term complications associated with breast-conservation surgery and radiotherapy. Ann Surg Oncol. 2002;9(6):543-9. [DOI:10.1007/BF02573889] [PMID]
  11. Warren AG, Brorson H, Borud LJ, Slavin SA. Lymphedema: a comprehensive review. Ann Plast Surg. 2007;59(4):464-72. [DOI:10.1097/] [PMID]
  12. Mohler III ER, Mehrara B, Eidt JF, Berman RS, Mills Sr JL, Collins KA, et al. Clinical staging and conservative management of peripheral lymphedema. ; 2016.
  13. National Cancer Institute . Lymphedema (PDQ®): Health Professional Version [Internet] 2015 Jul 17 [cited 2017 Nov 15]. Available from:
  14. Ely JW, Osheroff JA, Chambliss ML, Ebell MH. Approach to leg edema of unclear etiology. J Am Board Fam Med. 2006;19(2):148-60. [DOI:10.3122/jabfm.19.2.148] [PMID]
  15. Tiwari A, Cheng KS, Button M, Myint F, Hamilton G. Differential diagnosis, investigation, and current treatment of lower limb lymphedema. Arch Surg. 2003;138(2):152-61. [DOI:10.1001/archsurg.138.2.152] [PMID]
  16. Szuba A, Shin WS, Strauss HW, Rockson S. The third circulation: radionuclide lymphoscintigraphy in the evaluation of lymphedema. J Nucl Med. 2003;44(1):43-57.
  17. Weissleder H, Weissleder R. Lymphedema: evaluation of qualitative and quantitative lymphoscintigraphy in 238 patients. Radiology. 1988;167(3):729-35. [DOI:10.1148/radiology.167.3.3363131] [PMID]
  18. Notohamiprodjo M, Weiss M, Baumeister RG, Sommer WH, Helck A, Crispin A, et al. MR Lymphangiography at 3.0 T: Correlation with Lymphoscintigraphy. Radiology. 2012;264(1):78-87. [DOI:10.1148/radiol.12110229] [PMID]
  19. Stewart FW, Treves N. Lymphangiosarcoma in Postmastectomy Lymphedema: A Report of Six Cases in Elephantiasis Chirurgica. Cancer J Clin. 1981;31(5):284-99. [DOI:10.3322/canjclin.31.5.284] [PMID]
  20. Tomita K, Yokogawa A, Oda Y, Terahata S. Lymphangiosarcoma in postmastectomy lymphedema (Stewart-Treves syndrome): Ultrastructural and immunohistologic characteristics. J Surg Oncol. 1988;38(4):275-82. [DOI:10.1002/jso.2930380415] [PMID]
  21. Gorman WP, Davis KR, Donnelly R. ABC of arterial and venous disease. Swollen lower limb-1: general assessment and deep vein thrombosis. BMJ. 2000;320(7247):1453-6. [DOI:10.1136/bmj.320.7247.1453] [PMID]
  22. Zweizig S, Korets S, Cain JM. Key concepts in management of vulvar cancer. Best Pract Res Clin Obstetr Gynaecol. 2014;28(7):959-66. [DOI:10.1016/j.bpobgyn.2014.07.001] [PMID]
  23. International society of lymphology . The diagnosis and treatment of peripheral lymphedema. 2013 consensus Document of the international society of Lymphology. Lymphology. 2013 ;46(1):1-11.
  24. Swedborg I, Norrefalk JR, Piller NB, Asard C. Lymphoedema postmastectomy: is elevation alone an effective treatment? Scand J Rehabil Med. 1993;25(2):79-82.
  25. Mortimer PS. Managing lymphoedema. Clin Exp Dermatol. 1995;20(2):98-106. [DOI:10.1111/j.1365-2230.1995.tb02665.x] [PMID]
  26. Rockson SG. Lymphedema. Curr Treat Options Cardiovasc Med. 2006;8(2):129-36. [DOI:10.1007/s11936-006-0005-y] [PMID]
  27. Ko DSC. Effective Treatment of Lymphedema of the Extremities. Arch Surg. 1998;133(4):452. [DOI:10.1001/archsurg.133.4.452] [PMID]
  28. Lawenda BD, Mondry TE, Johnstone PA. Lymphedema: a primer on the identification and management of a chronic condition in oncologic treatment. CA Cancer J Clin. 2009;59(1):8-24 [DOI:10.3322/caac.20001] [PMID]
  29. Badger CM, Peacock JL, Mortimer PS. A randomized, controlled, parallel-group clinical trial comparing multilayer bandaging followed by hosiery versus hosiery alone in the treatment of patients with lymphedema of the limb. Cancer. 2000;88(12):2832-7.<2832::AID-CNCR24>3.0.CO;2-U [DOI:10.1002/1097-0142(20000615)88:123.0.CO;2-U]
  30. Partsch H, Flour M, Smith PC, International Compression C. Indications for compression therapy in venous and lymphatic disease consensus based on experimental data and scientific evidence. Under the auspices of the IUP. Int Angiol. 2008;27(3):193-219.
  31. Foldi E, Foldi M, Weissleder H. Conservative treatment of lymphoedema of the limbs. Angiology. 1985;36(3):171-80. [DOI:10.1177/000331978503600306] [PMID]
  32. Yasuhara H, Shigematsu H, Muto T. A study of the advantages of elastic stockings for leg lymphedema. Int Angiol. 1996;15(3):272-7.
  33. Cheville AL, McGarvey CL, Petrek JA, Russo SA, Taylor ME, Thiadens SR. Lymphedema management. Semin Radiat Oncol. 2003;13(3):290-301. [DOI:10.1016/S1053-4296(03)00035-3]
  34. Mehrara B. Surgical treatment of primary and secondary lymphedema [Internet] [updated 2017 Mar 16 cited 2017 Nov 15]. Available from:
  35. Cormier JN, Rourke L, Crosby M, Chang D, Armer J. The surgical treatment of lymphedema: a systematic review of the contemporary literature (2004-2010). Ann Surg Oncol. 2012;19(2):642-51. [DOI:10.1245/s10434-011-2017-4] [PMID]
  36. Browse N, Burnand K, Mortimer P, editors. Diseases of the Lymphatics. London: Amold; 2003. pp. 179-204.
  37. Granzow JW, Soderberg JM, Kaji AH, Dauphine C. Review of current surgical treatments for lymphedema. Ann Surg Oncol. 2014;21(4):1195-201. [DOI:10.1245/s10434-014-3518-8]