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What are the stages of lymphoedema?

Stages of lymphoedema

The stages of lymphoedema illustrated in different patients.

The stages of lymphoedema describe how severe your lymphoedema is.

There are several staging scales used around the world. One of the most common is the scale by the International Society of Lymphology (2016). This scale applies to any type of lymphoedema such as of the arm, leg, genitals or head and neck.

Stage 0: Latent or Subclinical Stage

In stage 0, the swelling is not visible or detectable using a tape measure even though there is a problem with lymphatic drainage. You may feel general achiness or heaviness in the body area. This stage may exist for months or years before you notice any swelling.

Stage 1: Mild Stage

In stage 1, fluid starts to collect in the affected area and causes swelling. You may notice that the affected area looks puffy. Putting your arm or leg up high to help drain the fluid away (known as elevating) will help to decrease the swelling. The swelling is soft and may leave an impression when you push on the skin, called ‘pitting oedema’.

Stage 2: Moderate Stage

With stage 2, you will notice that limb elevation alone rarely reduces swelling. The area becomes harder and more swollen. Later in stage 2 the limb may not pit as excess subcutaneous fat forms and tissue fibrosis (hardening of the skin) develops.

Stage 3: Severe stage

In stage 3, there is extensive swelling. The tissue is fibrotic (hard) and pitting no longer occurs. Skin changes, such as thickening, hyperpigmentation (change of colour), increased skin folds, fat deposits, and wart-like growths can develop. The skin becomes susceptible to deep, poorly healing wounds and is in danger of infection.

What does this mean for me as a person with lymphoedema?

At each stage of lymphoedema there are different types of treatments and assessments that will be suitable for you.

If you have any symptoms of swelling you should see your Doctor and discuss referral for a qualified lymphoedema therapist.

In stage 0, for example, it is important to see a lymphoedema therapist for early intervention and screening. Bioimpedance spectroscopy is the main assessment tool that can detect lymphoedema at this stage. If a tape measure is picking up signs of swelling this means you have progressed onto stage 1 lymphoedema or beyond.

Early treatment can support the proper management of your symptoms. It aims to stop and/or slow your lymphoedema from progressing, improves the limb shape, skin condition and reduces the risk of infection. If treatment is successful, your condition may also return to a less severe stage.

REFERENCES:

Executive Committee of the International Society of Lymphology.. The diagnosis and treatment of peripheral lymphedema: 2016 consensus document of the International Society of Lymphology. Lymphology. 2016 Mar 21;49(4):170-84.

Executive Committee of the International Society of Lymphology. The diagnosis and treatment of peripheral lymphedema: 2020 Consensus Document of the International Society of Lymphology. Lymphology. 2020;53(1):3-19.