Aetiology and prevalence of lower limb lymphoedema following treatment for gynaecological cancer

OBJECTIVE: To determine the prevalence and incidence of lower limb lymphoedema (LLL) in a cohort of women who had treatment for gynaecological cancer between May 1995 and April 2000. DESIGN: A retrospective survey. SETTING: The study took place at an urban referral centre in an Australian tertiary referral women's hospital. SAMPLE: The data collection was based on 66% of 743 women on the database of the Gynaecological Cancer Centre. METHODS: Interviews and assessments were conducted to determine the status of lower limbs; medical records were reviewed for age, weight, site and type of cancer and treatment. MAIN OUTCOME MEASURES: Leg swelling, diagnosed lower limb lymphoedema, no swelling of the legs and type of surgery were determined as the main outcome measures. RESULTS AND CONCLUSIONS: The diagnosis of lower limb lymphoedema was made in 18% of the total sample: 53% of these were diagnosed within 3 months of treatment, a further 18% within 6 months, 13% within 12 months and the remaining 16% up to 5 years following treatment. Women most at risk for developing LLL were those who had treatment for vulvar cancer with removal of lymph nodes and follow up radiotherapy. For this subsample, the prevalence was 47%. The finding that LLL occurs within the first year is earlier than hitherto generally believed. It is therefore imperative for all health professionals to include care and assessment of the legs particularly during the immediate pre- and postoperative period.