American Cancer Society Lymphedema Workshop Supplement to Cancer Workgroup III Diagnosis and Management of Lymphedema Stanley G. Rockson, M.D. (Co-Chair) Linda T. Miller, P.T. (Co-Chair) Ruby Senie, Ph.D. (Rapporteur) Michael J. Brennan, M.D.* Judith R. Casley-Smith, M.D., Ph.D.* Ethel Fo ¨ ldi, M.D.* Michael Fo ¨ ldi, M.D.* Gail L. Gamble, M.D.* Renato G. Kasseroller, M.D.* Albert Leduc, Ph.D.* Robert Lerner, M.D.* Peter S. Mortimer, M.D.* Sandra A. Norman, Ph.D.* Chester L. Plotkin, M.D.* Margaret E. Rinehart-Ayres, Ph.D., P.T.* Arnold L. Walder, M.D., Ph.D.* * Workgroup participant. Presented at the American Cancer Society Lymphedema Workshop, New York, New York, February 20 –22, 1998. Address for reprints: Robert A. Smith, Ph.D., Amer- ican Cancer Society, Inc., 1599 Clifton Rd. NE, Atlanta, GA 30329. Received October 26, 1998; accepted October 28, 1998. The purpose of this workshop was to derive a consensus statement regarding the diagnosis and treatment of lymphedema following breast carcinoma therapy. The need for such a position statement arises, on the one hand, from a tendency toward therapeutic neglect of this rather prevalent disorder 1 and, on the other, from the recog- nition that there are currently several broadly practiced schools of lymphedema therapy. In practice, the treatment methods that are promulgated are not always consonant with one another. Thus, it is important to emphasize greater physician awareness of this condition and its prompt recognition, as well as to promote universally appli- cable approaches to disease management. Several important con- cepts arose from the workshop discussions: the importance of the patient’s subjective presentation with early changes in the trunk or upper extremity, which may presage the clinician’s ability to docu- ment lymphatic dysfunction objectively; the importance of early management of patients during the first months after breast carci- noma therapy; and the importance of a multidisciplinary approach to the therapy of lymphedema, with differentiation among those modal- ities that achieve volume reduction of the involved limb from those that maintain long term beneficial therapeutic effects. RECOMMENDATIONS Diagnosis In most cases, the diagnosis of lymphedema following breast carci- noma therapy will be established on the basis of clinical criteria. In this regard, it is important to underscore the value of the patient’s subjective awareness of the symptoms or physical changes that ac- company the appearance of lymphedema. These subjective com- plaints may herald the presence of pathology and may, at times, precede the ability of the clinician to detect objective changes of lymphedema on the physical examination. Early detection of pathol- ogy can promote the prompt institution of educational and other interventions. Special considerations should apply to symptoms re- ported by patients during the first 12 weeks following cancer therapy vide infra (v.i.). In addition to subjectively perceived swelling of the involved extremity, patients may report such sensations as “fullness,” “tight- ness,” or “heaviness” of the limb, shoulder girdle, or thoracic regions. All such symptomatic concerns are potentially worthy of attention in these patients and should not be ignored; specifically, any new pre- sentation of pain and immobility of the limb or the shoulder girdle should be promptly evaluated. In addition to noting the patient’s spontaneous complaints, 2882 © 1998 American Cancer Society