Short commentary on Lymphedema after Treatment for Endometrial Cancer
Madelene Wedin1*, Emma Lindqvist2, Mats Fredrikson3,4 and Preben Kjølhede1
1Department of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
2Department of Obstetrics and Gynecology, the Highland Hospital, Eksjö, Sweden
3Forum Östergötland, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
4Occupational and Environmental Medicine, Department of Experimental and Clinical Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
- *Corresponding Author:
- Dr. Madelene Wedin, MD
Department of Obstetrics and
University Hospital, S-58185 Linköping, Sweden
Received date: June 21, 2017; Accepted date: June 27, 2017; Published date: June 30, 2017
Citation: Wedin M, Lindqvist E, Fredrikson M, Kjølhede P (2017) Short
commentary on Lymphedema after Treatment for Endometrial Cancer. Gynecol
Obstet (Sunnyvale) 7:442. doi: 10.4172/2161-0932.1000442
Copyright: © 2017 Wedin M, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Lymphedema development after cancer treatment in women with
endometrial cancer is a poorly explored complication and there is
a substantial gap in the knowledge of this troublesome treatmentrelated
adverse effect. Endometrial cancer is the most common gynecological cancer. The majority of the women diagnosed with endometrial cancer will be long-term survivors. The primary treatment
of endometrial cancer most often comprises hysterectomy and bilateral
salpingo-oophorectomy. Pelvic and para-aortic lymphadenectomy is
recommended in prognostic high-risk groups of endometrial cancer.
Lymphedema development is associated with lymphadenectomy.
This short commentary presents a summary of the recently published
systematic review article entitled Lymphedema after Treatment for
Endometrial Cancer-a review of prevalence and risk factors . The
review comprised the sub-items: Prevalence of lower limb lymphedema;
Methods for determining the lower limb lymphedema diagnosis; Risk
factors for lower limb lymphedema; Follow-up time and onset of
symptoms of lower limb lymphedema; and -Impact on quality of life after
surgical treatment of endometrial cancer including lymphadenectomy.
The review  is a descriptive meta-analysis of literature published
on lymphedema development after surgery of endometrial cancer.
The review reveals several essential weaknesses in the knowledge
of lymphedema after treatment of endometrial cancer. So far, no
randomized controlled trials with lymphedema as primary endpoint
after treatment of endometrial cancer have been published. The reported
prevalence of lymphedema after endometrial cancer treatment are
mainly based on retrospective or cross-sectional studies. The reported
prevalence vary between zero  and 50% . Many of the retrospective
studies do not include objective measurements of lymphedema, but
report patient complain over swelling legs as lymphedema. Thus,
the true prevalence of lower limb lymphedema after treatment of
endometrial cancer remains to be established. Several methods to
evaluate and categorize lymphedema have been presented but these
are not consistently used in studies of endometrial cancer treatment.
In addition, in most studies the base line measurement of lymphedema
is lacking. The methods used in the studies include subjective scoring
systems based on questionnaires, various clinical rating systems, directly
or indirectly objective measurement of limb volume, bioimpedance
measurements and various imaging techniques such as CT-scan, MRI,
lymphoscintigraphy or fluorescent lymphography. Still there seems to
be no universally used standardization for how to measure or report
lymphedema in scientific contexts, which make comparison of studies
difficult. Risk factors remains to be evaluated in correctly designed and
sufficiently powered studies. However, lymphadenectomy per se [4-7], number of lymph nodes removed [6,8-16] and radiotherapy [3,7-11,14,17-20] seem to be established risk factor. Lymphedema onset
may begin immediately after surgery or may be delayed for many years.
Long-term follow-up is therefore necessary in order to establish reliable
results on time of onset of lymphedema and to detect lymphedema in
order to start early treatment. All published research seems unanimously to conclude that lymphedema is an important factor with adverse effect
on quality of life [7,11,21]. We found that much of the shortcomings are
based on a fundamental lack of well-designed research and that there
is a lack of standardization of terminology and methods of measuring
lower limb lymphedema in research.
We conclude that there is a need for unanimous evidence-based
international guidelines of terminology and methodology for diagnosis
and treatment recommendations of lymphedema. We suggest
and encourage the international scientific societies who deal with
lymphedema to assemble and agree on international guidelines.
From a clinical point of view it is very important to emphasize that
lymphedema is a chronic and progressive condition that, if untreated,
can affect the quality of life adversely. It may bring years of suffering to
the woman affected and established lymphedema is a serious condition
that may be lethal. Today more women with gynecologic cancer become
long-term survivors. This strongly increases the demand on the health
care to provide adequate and reliable information concerning diagnosis,
treatment and outcome including side effects and consequences, and to
minimize the adverse impact of side effects of treatment on the health
related quality of life.
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