Lymphedema: Diagnosis and Therapy
Third, completely revised and extended edition
Horst Weissleder and Christian Schuhhardt (eds)
ISBN 3-934371-24-8, 428 pp.
Viavital Verlag GmbH, Koeln, 2001

Reviewed by Joanne Young;
LAO Board member and lymphedema patient.

This book offers both an overview as well as detailed coverage of the entire realm of disorders of the lymphatic system. It opens with a fundamental anatomical description of the lymphatic system, describing its physical characteristics, and then moves into physiology, or how the mechanics responsible for the transport of lymph actually work. From physiology, the book progresses into pathophysiology, or a thorough description of all the things that can go wrong with the lymphatic system., as well as the staging or grading of lymphedema according to secondary tissue changes, as well as other complications of chronic lymphedema. Examination methods, such as lymphoscintigraphic function and indirect lymphangiography are described in detail, and are given approval as the most useful examination methods to confirm the diagnosis of early forms of lymphedema, including borderline cases. From there, each subsequent chapter offers a through description of the various types of lymphedema, ranging from primary, to post-traumatic; including a chapter titled “Lymphedema of the Arm Following Breast Cancer Therapy”; as well as many other types. One interesting assertion in the opening paragraph of that chapter states that patients that undergo mastectomy develop secondary lymphedema of various severity in the upper extremity in approximately one-third of cases. It goes on to state that “radical lymph node dissection with prostate cancer causes lymphedema of one or both legs…in more than 70% of the patients. Less aggressive surgery in the last few years and refined radiation techniques have reduced the severity of secondary lymphedema but not the incidence.” (Italics mine). Included in the chapter are charts and bar graphs citing the incidence of chronic secondary lymphedema after breast cancer treatment as a function of the number of resected axillary lymph nodes (1-10 nodes = 38%), incidence of arm lymphedema after breast cancer therapy, using different treatment methods (for example, lumpectomy and axillary node dissection of 12 nodes = 25%).

The final chapter of the book deals with various therapy concepts, and states as its opening sentence “physical decongestive therapy is a successful method for treating primary and secondary lymphostatic edema (lymphedema)”. There follows a very thorough description of the therapeutic goal of CDT, as well as its technique. The authors were not supportive of the use of intermittent pneumatic compression pumps, citing several studies to support their claim for its lack of effectiveness, as well as pointing out risks associated with their use.

One of the strongest features of this book is its graphics – each type of lymphedema, its manifestations and possible complications is illustrated with photographs of actual patients.

To me, this book is clearly written with health care professionals in mind – a lot of its terminology would be unfamiliar to the average layperson. I found a lot of the photographs were; well, frankly, kind of disturbing. They make a heck of an argument for being totally compliant in the management of lymphedema. While knowing how to watch for the signs is certainly valuable, there may be too much information here. On the other hand, it was kind of neat to get a peek at what the doctors are reading. Or, if they're not, maybe they should.

One comment worth adding might be that this book could be a potentially useful tool in dealing with either doctors or insurance companies -–the information and images are a compelling argument for support for patients who present with even mild forms of lymphedema.