Understanding Stage 3 Lymphedema

Stage three lymphedema is the most advanced stage of this chronic condition. In this stage, the affected body part might display one or more symptoms, such as significant swelling, alterations in the skin, or recurring episodes of infection. While this stage can be challenging to manage, understanding your condition and working with healthcare professionals can help you maintain your quality of life and prevent complications.

Let’s explore what you need to know about managing stage 3 lymphedema and the treatment options available.

• Key Takeaways
• What Is Stage 3 Lymphedema?
• What Are Signs and Symptoms of Stage 3 Lymphedema
• What are the Causes of Stage 3 Lymphedema?
• How Do You Diagnose Stage 3 Lymphedema?
• How Is Stage 3 Lymphedema Treated?
• Wrapping Up: Living with Stage 3 Lymphedema
  

Key Takeaways

• Stage 3 lymphedema is the most advanced form of lymphedema caused by a malfunctioning lymphatic system. It is characterized by irreversible changes to the affected area and requires ongoing management to prevent complications.
• Regular monitoring and professional medical care are crucial, as this stage carries the highest risk of developing infections and other complications that can impact your daily activities.
• While not all tissue changes can be reversed, various treatment options, such as complete decongestive therapy and compression garments for lymphedema, can help manage symptoms and maintain quality of life.
• Early intervention and consistent treatment adherence are vital to prevent further progression and maintain the affected area’s functionality.
• With proper care and support, many people with stage 3 lymphedema can continue their daily activities and maintain a good quality of life.

What Is Stage 3 Lymphedema?

The third stage of lymphedema is the most advanced phase of this progressive condition of the lymphatic system. At this stage, the affected body part can experience severe, chronic swelling, leading to permanent changes in the tissue and skin. However, not every patient with stage 3 lymphedema will experience limb overgrowth and/or disfiguration, which can make it difficult for doctors to diagnose. This means stage 3 lymphedema can also be defined by tissue changes and fibrosis, infection, and ulceration, and may or may not occur with a largely edematous limb.

Unlike earlier stages, stage 3 lymphedema is characterized by hardened tissue and significant changes in the size and shape of the affected area.¹

This advanced stage differs from earlier phases of lymphedema. Stage 1 is generally characterized by mild swelling that subsides with elevation and is reversible, whereas stage 2 exhibits more consistent swelling along with some tissue alterations. In stage 3, however, irreversible and significant changes occur with progressive swelling, skin changes and infection.²

What Are Signs and Symptoms of Stage 3 Lymphedema?

Understanding the signs of lymphedema at this advanced stage ensures proper management and care. The symptoms of stage 3 lymphedema are more severe and noticeable than in earlier stages and may include one or several of the following symptoms in combination:

• Severe and irreversible swelling: The affected area becomes permanently enlarged, with significant changes in size that don’t improve with elevation or overnight rest. This chronic swelling can substantially increase the weight of the affected limb, sometimes doubling or tripling its normal size. Unlike earlier stages, where swelling might fluctuate throughout the day, stage 3 swelling remains constant.
• Misshapen appearance: The limb or affected area can become dramatically different in shape, making it difficult to wear regular clothing or shoes. The tissue may develop deep folds or creases that require special attention during cleaning and care to decrease the risk of skin breakdown and infection. These changes can affect the limb’s overall appearance and proportions compared to the unaffected side.
• Increased infection risk: Due to compromised skin integrity, people living with stage 3 lymphedema are at the highest risk of developing cellulitis and other serious infections. The buildup of protein-rich fluid creates an ideal environment for bacterial growth. Even minor cuts, scratches, or insect bites can quickly develop into serious infections requiring immediate medical attention.
• Hardened tissue: Unlike in earlier stages of the condition, the affected area becomes very firm and doesn’t respond to pressure with pitting. This hardening occurs due to chronic inflammation and the buildup of fibrous tissue over time.
• Skin changes: The skin may become darker, thicker, or develop a leathery texture, often with visible changes in color and texture. These changes can occur unevenly across the affected area, creating patches of different textures and appearances. The skin may also become dry and prone to cracking, requiring careful moisturizing and protection.
• Severe discomfort: People with lymphedema typically experience significant pain, heaviness, and tightness in the affected area. This discomfort can vary from a constant dull ache to sharp pains during movement. The weight and pressure of the swollen tissue can also cause fatigue and strain on surrounding muscles and joints.
• Skin complications: The affected area may develop edema blisters, lymphatic cysts, or wartlike projections called papillomas. These skin changes can happen anywhere on the affected limb and may require special care to prevent infection. Some people also experience small blisters that leak lymph fluid, requiring careful management and protection.
• Limited mobility: The combination of swelling and tissue changes can significantly restrict movement and affect daily activities. Simple tasks like bending a joint or reaching for objects may become challenging or impossible. This reduced range of motion can impact work, self-care, and recreational activities, often requiring adaptations to maintain independence.³
  

What are the Causes of Stage 3 Lymphedema?

Understanding the causes of lymphedema can help explain how the condition progresses to stage 3. Two main types of lymphedema exist: primary and secondary lymphedema.

Primary lymphedema is a result of genetic factors that result in malformation of the lymphatics during the systems development in the embryo. This results in either too few, too many or simply dysfunctional lymphatic vessels that cannot properly drain fluid from the tissues. The effects can be present at birth or develop later in life. If not properly managed, people born with primary lymphedema can progress to having more severe lymphedema over time.

Secondary lymphedema is more common and develops after direct trauma or damage to the lymphatic system. This damage can result from a number of causes, but typically include cancer and its treatment, chronic venous insufficiency, trauma, obesity, or infection. Understanding lymphedema risk factors is crucial, as early intervention can help prevent progression to stage 3.³

How Do You Diagnose Stage 3 Lymphedema?

Accurate diagnosis ensures proper treatment planning and management of stage 3 lymphedema. Healthcare providers use several methods to confirm the condition and rule out other conditions:

• Physical examination: Healthcare providers will thoroughly examine the affected area, noting skin changes, tissue texture, and the extent of swelling. They’ll also check for the presence or absence of pitting and assess your range of motion.
• Medical history: Your doctor will examine your medical history, including any previous surgeries, cancer treatments, vascular insufficiencies, or family history of lymphedema. This information helps determine whether the condition is primary or secondary.
• Diagnostic imaging: Imaging may include lymphoscintigraphy to visualize the lymphatic system and identify blockages or abnormal flow patterns, ultrasound to evaluate tissue changes and rule out blood clots or other conditions, and MRI or CT scans to see the extent of tissue changes and help plan treatment.

How Is Stage 3 Lymphedema Treated?

Learning how to treat lymphedema is crucial once you reach stage 3. While earlier intervention is ideal, implementing a comprehensive treatment plan at any stage can help manage symptoms and prevent complications. A combination of various therapeutic approaches can help control swelling, maintain skin health, and improve your quality of life. Here’s a detailed look at each treatment method:⁴

• Complete decongestive therapy (CDT) is an intensive treatment approach that combines multiple therapies and is the gold standard for lymphedema management. It typically involves a two-phase treatment program: an initial intensive reduction phase with a certified lymphedema therapist followed by a long-term maintenance phase that you’ll continue at home.
• Compression garments for lymphedema: These specially designed garments provide graduated pressure to help prevent fluid accumulation and maintain the affected area’s size. Pneumatic compression devices may also be recommended by your doctor, which delivers intermittent pressure to stimulate the lymphatics and encourage the flow of lymphatic fluid to reduce swelling.
• Lymphedema exercises: Specific exercises help maintain joint mobility and promote lymph fluid movement. These typically include gentle stretching, range-of-motion exercises, and light resistance training designed to enhance lymph flow without overexerting the affected area.
• Skin care: Taking certain lymphedema precautions can also help manage the condition. Maintaining healthy skin becomes especially important in stage 3 lymphedema. This includes daily inspection, gentle cleansing, moisturizing, and prompt attention to any cuts or scratches to prevent infection.
• Lymphatic drainage: This specialized massage technique, performed by trained professionals, helps move fluid from congested areas to functioning lymph vessels. The gentle, rhythmic movements stimulate lymph flow and, when combined with other treatments, can help reduce swelling.
• Elevation: Properly elevating the affected limb when resting or sleeping can help reduce swelling by using gravity to assist lymph fluid movement. Your healthcare provider will demonstrate the correct positioning techniques for maximum benefit.
• Healthy diet: Maintaining a balanced diet and healthy weight is crucial for managing lymphedema. Additional weight can stress the lymphatic system and exacerbate swelling.
• Surgery: In severe cases where conservative treatments aren’t providing adequate relief, surgical options might be considered. These can include:
  • Liposuction to remove excess fat and tissue that has developed due to chronic lymphedema.
  • Vascularized lymph node transfer, where healthy lymph nodes are transplanted to the affected area.
  • Lymphaticovenular anastomosis, which is a microsurgical procedure that creates new connections between lymphatic vessels and small veins.⁵
    

Wrapping Up: Living with Stage 3 Lymphedema

While living with stage 3 lymphedema comes with unique challenges, maintaining a consistent treatment routine can help you manage symptoms effectively and prevent complications.

For many people with lymphedema, at-home treatment options can complement professional care. Tactile Medical’s lymphedema products, including the Flexitouch Plus and Nimbl systems, are doctor-prescribed pneumatic compression devices that you can use in the comfort of your own home. These systems provide consistent, effective compression therapy to help manage symptoms. Remember, while stage 3 lymphedema is a chronic condition, you can continue to live an active and fulfilling life with proper care and support.

References:
1. “NCI Dictionary of Cancer Terms.” Comprehensive Cancer Information – NCI, www.cancer.gov/publications/dictionaries/cancer-terms/def/stage-iii-lymphedema.
2. “Lymphedema Stages.” Breastcancer.Org – Breast Cancer Information and Support, Breastcancer.org, 15 Aug. 2023, www.breastcancer.org/treatment-side-effects/lymphedema/stages.
3. “Ask the Doctors: Lymphedema Symptoms and Causes with Doctors Sacks and Anolik.” Department of Surgery, 3 July 2023, surgery.wustl.edu/ask-the-doctors-lymphedema-symptoms-and-causes/.
4. “Treating Lymphedema.” Johns Hopkins Medicine, 1 Aug. 2024, www.hopkinsmedicine.org/health/treatment-tests-and-therapies/treating-lymphedema
5. Park, Kitae E, et al. “Surgical Management of Lymphedema: A Review of Current Literature.” Gland Surgery, U.S. National Library of Medicine, Apr. 2020, pmc.ncbi.nlm.nih.gov/articles/PMC7225501/.