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Lymphedema Stages


Once a patient has been diagnosed as having lymphedema, it is important that the physician, or a qualified lymphedema therapist, determine the current stage of this chronic condition. The sooner lymphedema is identified, and treatment is started, the better the chances are that the condition can be improved and controlled.

The International Society of Lymphology (ISL) has established a staging system for identifying the progression, or severity, of this disease. through the use of a  system to identify the progression of the condition and the potential for successful treatment and improvement.

This staging system applies only to the limbs (arms and legs) is based on details about the amount of swelling and the condition of the skin and tissues at each stage. Previously a three stage system was used in which signs and symptoms were identified for each stage. Now that there is improved understanding of lymphedema, and the benefits of very early treatment, a fourth stage has been added and currently the ISL lymphedema staging system consists of four levels being numbered from 0 to 3.


Stage O lymphedema, which is also known as the latent or preclinical stage, is the newly added classification. At this stage the patient is at risk of developing lymphedema; however no swelling or other visible evidence of impaired lymph transport is present. Stage 0 can be present for months, or years, before any more serious signs appear.

Studies have indicated that through the use of bioimpedance it is possible to identify changes in the at risk limb before they become visible. When changes develop, if specialized treatment is started immediately, it may be possible to prevent the development of further stages of lymphedema. (Bioimpedance is a non-invasive method of determining the composition of body tissues to evaluate the presence of body fluids such as lymphedema. Such measurements have been studes to establish a baseline at the time of breast cancer treatment.)


Stage I lymphedema is an early accumulation of fluid that is relatively high in protein content.

  • There is visible swelling with this protein-rich lymph.
  • This swelling can be temporarily reduced by elevation of the limb; however, the swelling soon returns when the limb is returned to a normal position.
  • The swollen tissues are soft and pitting edema is present. See Diagnosing Lymphedema

Lmphedema treatment should be begun as soon as signs are early detected. Waiting for the swelling to increase, or for an infection to develop, only makes the condition more difficult to treat. Prompt treatment of this stage can often control the condition and may prevent it from becoming more severe.

Stage I lymphedema -- before the swelling becomes extreme.


Stage II lymphedema is an increase in the swelling and a change in the tissues.

  • Elevation of the limb will not reduce the swelling.
  • The tissues become increasing firm due to fibrosis. Fibrosis is the formation of fine scar-like structures within the tissues that cause them to harden.
  • Pressure against the limb produces only a slight indentation or in indentation at all.
  • The tissue changes at this stage increase the risks of even greater swelling, fibrosis, infections, and skin problems.
  • Stage II lymphedema can usually be improved with intense treatment.


Stage 3 lymphedema after debulking surgery,

Stage III lymphedema, which is also known as lymphostatic elephantiasis, is a condition in which the tissue becomes extremely swollen and thickened due to a blockage in the flow of lymph and a buildup of fluid in tissues.

  • The tissues become increasingly fibrotic (hardened). Pressure does not produce any pitting.
  • Normal elasticity is lost and the skin hangs in folds.
  • The skin may change color.
  • Papillomas are small solid benign tumors that project above the surrounding tissue, may develop.
  • Hyperkeratosis is an increase in the thickness of the outer layer of the skin, can develop.
  • These changes in the texture of the skin are disfiguring and can limit mobility.
  • Infections become more common because of increased risks of breaks in the skin. These infections include fungal infections and open wounds that form within the folds of skin.

With intense therapy, Stage III lymphedema can be improved and potentially be prevented from becoming worse; however, it is rarely reversed to an earlier stage.

One treatment to reduce the size of the limb is surgical debulking. Healing from this surgery can be difficult and, because the skin is still hardened, it still hangs in folds and deep creases are still present. These areas remain at risk for infections and open wounds


  • The Diagnosis and Treatment of Peripheral Lymphedema.
    2009 Consensus Document of the International Society Of Lymphology
    Lymphology 42, June 2009, pages 53-54.

© LymphNotes.com 2012.This information does not replace the advice of a qualified health care professional.

Got a question or comment? Post in the 'How Lymphedema is Treated' forum.
Category: How Lymphedema is Treated Updated: 2015-02-26


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