Staging System for Lymphedema

Last Modified: August 13, 2006

Dear OncoLink "Ask The Experts,"
Is there a staging system for lymphedema?

Linda McGrath Boyle PT, DPT CLT-LANA, Cancer Rehab Specialist and OncoLink Lymphedema Team Editor, responds:

The International Society of Lymphology has established a staging system for persons with lymphedema.

For persons with lymphedema of the limbs, the following stages apply:

Stage 0	Subclinical lymphedema No swelling or pitting of the skin Symptom of heaviness in the limb due to excess fluid May be present for months or years before progressing
Stage I	Swelling that is present can be "reversed" by elevating the swollen area The first visible symptoms may occur during this stage Pressing a finger into the swollen area leaves an indent. This is called "pitting edema" No swelling is present in the morning, but gradually increases throughout the day.
Stage II	The amount of swelling increases and is not reduced by elevating the involved area. The tissue feels thick and firm when compared to the uninvolved side. There is still pitting edema, but the indent is often harder to create due to scarring of the tissues. There is an increased risk of cellulitis (infection)
Stage III	The skin is hard and swelling cannot be reduced without treatment. Typically the affected area is large and very full. Chronic skin inflammation is evident. Skin is thick and tough. Lymph may leek through damaged skin.

The following stages apply for lymphedema of the head and neck:

Stage 0	Local swelling No changes in normal function (range of motion, eating, speaking)
Stage I	Local swelling Does affect normal function
Stage II	General swelling of the face and neck Does affect normal function
Stage III	Severe swelling with skin ulcers or brain swelling Unable to eat effectively

The following stages apply for lymphedema of the trunk and genitals:

Stage 0	Swelling present Difficulty seeing bony areas Pitting of the skin
Stage I	Bony areas are difficult to identify Natural skin folds are not apparent The body part changes shape due to swelling
Stage II	Lymph fluid weeps through the skin Normal function is affected Drastic changes occur in the shape of the body part
Stage III	Lymphedema becomes disabling Loss of normal function