Lymphedema in gynecologic cancer survivors: an area for exploration?

There is a paucity of research on the incidence and impact of lower body lymphedema in the gynecologic cancer population. The cornerstone of management for gynecologic cancer is cytoreductive surgery. Depending on the site of the cancer, surgery traditionally involves removal of the ovaries, fallopian tubes, uterus and cervix, accompanied with extensive node dissection throughout the pelvic cavity, and, in the case of ovarian cancer, removal of the omentum. Resection of pelvic lymph nodes and vessels, compounded by gravitational influences on lymphatic flow, can lead to lymphatic congestion that impairs mobility, raises intra-abdominal pressure, and increases abdominal and extremity girth. Lymphedema can be an indicator of recurrence and is frequently associated with toxicities such as skin breakdown, pain, neuropathy, and myopathy. Physical changes, role changes, and psychosocial issues are common symptoms reported by breast cancer survivors with lymphedema. Assessment and management strategies for upper extremity lymphedema following treatment of breast cancer cannot be directly transferred to lower extremity lymphedema affecting women with cancer of the ovary, cervix, uterus, and vulva because of limb size, volume, and location. Clinicians have anecdotally reported the presence of lower body lymphedema in many gynecologic cancer patients. Survivors have described tightness, swelling, and heaviness. Despite these clinical findings, no systematic study of lower body lymphedema in women with gynecologic cancer has been conducted. Whether lower body lymphedema is as debilitating and long-term as post-mastectomy lymphedema is not empirically known.