Exercise and metabolic disease/BCRL/Diagnosis

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For many years diagnosis of lymphoedema has been by the comparison of limb size. In current literature there is a clear difference in diagnostic thresholds[1]. An example of the approaches to diagnose lymphoedema is the measurement of interlimb volume differences and interlimb circumference differences. These methods may not diagnose a person due to the reported thresholds, they also do not take into consideration tissue tone and texture which can result in functional problems for a patient, such as a small amount of swelling in the hand, that may result in fine motor problems.[2]

A more current set of diagnostic standards have been developed, which include tissue tone and texture. This table has been developed using participants in clinical trials and can be viewed on-line at; http://ctep.cancer.gov/protocolDevelopment/electronic_applications/docs/ctcv20_4-30-992.pdf

There are no guidelines yet published on timelines for acute swelling and chronic swelling in the diagnosis of breast cancer related lymphoedema, this may be an issue if a person is diagnosed too early or too late. The majority of the literature states that 3 months after treatment for diagnosis is the most common and accepted timeframe used by specialists and clinicians.

There are some reported frustrations from breast cancer lymphoedema sufferers, most commonly that their diagnosis were delayed by clinicians. [3] Delays in treatment for the symptoms experienced by a patient may not be ideal, studies have reported that if treatment options are sort early enough a patient may have better outcomes, which include less severe lymphoedema. [4]

Reports suggest that the majority of cases of breast cancer lymphoedema display only mild symptoms.[5] Preventing progression and decreasing the severity of chronic lymhoedema is important to ensure women can carry out their daily activities and feel better about themselves with less obvious symptoms.

For more information on the diagnosis and treatment of lymphoedema from the National Lymphedema Network's Medical Advisory Committee see http://www.lymphnet.org/pdfDocs/nlntreatment.pdf

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References <references> <reference/s>

  1. Armer JM, Stewart BR. A comparison of four diagnostic criteria for lymphedema in a post-breast cancer population. Lymphat Res Biol 2005;3:208–217. [PubMed: 16379589]
  2. Cheville AL, McGarvey CL, Petrek JA, Russo SA, Thiadens SR, Taylor ME. The grading of lymphedema in oncology clinical trials. Semin Radiat Oncol 2003;13:214–225. [PubMed: 12903011]
  3. Johansson K, Holmstrom H, Nilsson I, Ingvar C, Albertsson M, Ekdahl C. Breast cancer patients’ experiences of lymphoedema. Scand J Caring Sci 2003;17:35–42. [PubMed: 12581293]
  4. Stout Gergich NL, Pfalzer LA, McGarvey C, Springer B, Gerber LH, Soballe P. Preoperative assessment enables the early diagnosis and successful treatment of lymphedema. Cancer 2008;112:2809–2819. [PubMed: 18428212]
  5. Norman SA, Localio AR, Potashnik SL, et al. Lymphedema in breast cancer survivors: incidence degree, time course, treatment, and symptoms. J Clin Oncol 2009;27:390–397. [PubMed: 19064976]