Lower Leg Lymphedema in Patients with Gynecologic Cancer

Cervical, endometrial, and ovarian cancers are treated with surgery, radiation, or chemotherapy, depending on the treatment strategy. Gynecologic surgeons traditionally perform hysterectomy and pelvic lymphadenectomy with or without paraaortic lymphadenectomy in cervical, endometrial, and ovarian cancer. Lymphedema results from excess lymphatic fluid in the lymphatic system and interstitial space with diminished transport capacity. The main components of lymphatic fluid are interstitial water and solid filtrate, which only drain into the lymphatic system, not the arteriovenous capillary system. Primary lymphedema develops without a definitive cause, whereas, secondary lymphedema results from exogenous causes such as surgery, radiation, infection, and cancer metastasis. Based on the CTCAE v4.0, the degree of lymphedema was divided into three categories. Risk factors for lower leg lymphedema (LLL) in gynecologic cancer have included vulva cancer, radiotherapy, high number of lymph nodes dissected and BMI. In this paper, pathophysiology and risk factors for LLL in gynecologic cancer was evaluated based on the previous literature review. More interventional trials are necessary to decrease the development of LLL in gynecologic cancer.