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Stages of Lymphedema

There are three basic stages active of lymphedema. The earlier lymphedema is recognized and diagnosed, the easier it is to successful treat it and to avoid many of the complications.

It is important as well to be aware that when you have lymphedema, even in one limb there is always the possibility of another limb being affected at some later time. This "inactive" period referred to as the latency stage. Historically, it has been generally  associated with hereditary forms of lymphedema or primary lymphedema.   Now however, there is growing recognition that perhaps those who acquire secondary lymphedema from damage to the lymph system may actually have been born with an "at eisk" system to begin with.

Latent - Stage 0

Lymphatic transport capacity is reduced
No visible/palpable edema
Subjective complaints are possible

In the future, it may be possible to detect individuals with at risk lymph systems.  There is a relatively new procedure called bioimpedance. It is a measure of the oppostion to the flow of that electric current through the tissues, the opposite of electrical conductivity. The measurement of the bioimpedance (or bioelectrical impedance) of the humans and animals has proved useful as a non-invasive method for measuring such things as blood flow (often referred to as bioimpedance plethysmography) and body composition ( known as bioelectrical impedance analysis or simply BIA).  use of this technology enables doctors to detect interstitial tissue fluid levels before an arm or leg actually begins swelling.

Cancer patients, before any biopsy, node removal or radiation could be given a bioimpedance test to determine the ability of their lymph system to conduct fluids.  For those who are found to be constricted, actions could be taken in advance to help prevent lymphedema..  For extensive information on this technique, click on the highlighted "bioimpendance" link above.

Stage I
(Reversible Lymphedema)
Accumulation of protein rich edema fluid
Pitting edema
Reduces with elevation (no fibrosis)

Stage 2
(Spontaneously Irreversible Lymphedema)
Accumulation of protein rich edema fluid
Pitting becomes progressively more difficult
Connective tissue proliferation (fibrosis)

Stage  3
(Lymphostatic Elephantiasis)
Accumulation of protein rich edema fluid
Non pitting
Fibrosis and sclerosis (severe induration)
Skin changes (papillomas, hyperkeratosis, etc.)

While complications can arise in all stages of lymphedema, it is Stage 3 that presents with the most significant and severe  complications. Another very important reason for early diagnosis and immediate treatment.



Stage 1 (mild) - Upon waking in the morning the limb or affected area is almost a normal size. The tissue is still in a "pitting stage" ( when pressed by a finger the area indents and holds the indentation).

Stage 2 (moderate) - The tissue is "non-pitting" (when pressed by a finger the tissue bounces back without leaving an indentation). The tissue has a spongy consistency.

Stage 3 (severe) - The tissue at this stage is hard (fibrotic) and will be only slightly responsive to the touch. The swelling is almost irreversible and the limb is very large and swollen. Infections are possible at any stage of lymphedema but occurrence becomes greater as stages progress. A swollen limb, left untreated, becomes hard (fibrotic) and full of lymph fluid which is high in protein and a perfect medium for bacteria and infections.  


03/10/04 Proposed

Discussion Stage Four:

There have been some voices raised about a Stage Four classification for lymphedema. From my personal experiences, I concur. Both my legs are classified as Stage Three, yet the difference between the two is very dramatic.

Stage Four Classification

The limb is so densely fibrotic that it is not possible to make any indentation when pressed. It becomes impossible for ultrasound testing to pick even the blood pulse. The skin becomes brittle and
even the slight of bumps causes a serious, extensively weeping wound.
Because of the hardness of the tissue, it has become a total septic foci for bacteria and constant cellulitis and systemic infections become the norm. The only treatment for cellulitis is an extended period of IV antibiotics.

There is no treatment option for Stage Four. The complete focus is on management, containment of lymphedema.


Stages of Lymphedema

Pre-Stage: Latency Stage


External Links


AUTHOR: Salvador Nieto, M.D, FICA.

SALVADOR NIETO FOUNDATION “for the development of lymphedematology”.
Av. Santa Fe 2679, 2º “D”; (1425) Buenos Aires. Argentina.


Diagnosis of an early (latent) stage of secondary lymphedema of the arm - a necessary condition for its successful treatment

Stages may be used to describe lymphedema.


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Lymphedema Glossary


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Lipedema Lipodema Lipoedema

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Support group for parents, patients, children who suffer from all forms of lymphangiectasia. This condition is caused by dilation of the lymphatics. It can affect the intestinal tract, lungs and other critical body areas.



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While we have a number of support groups for lymphedema... there is nothing out there for other lymphatic disorders. Because we have one of the most comprehensive information sites on all lymphatic disorders, I thought perhaps, it is time that one be offered.


Information and support for rare and unusual disorders affecting the lymph system. Includes lymphangiomas, lymphatic malformations, telangiectasia, hennekam's syndrome, distichiasis, Figueroa
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Lymphedema People New Wiki Pages

Have you seen our new “Wiki” pages yet?  Listed below are just a sample of the more than 140 pages now listed in our Wiki section. We are also working on hundred more.  Come and take a stroll! 

Lymphedema Glossary 


Arm Lymphedema 

Leg Lymphedema 

Acute Lymphedema 

The Lymphedema Diet 

Exercises for Lymphedema 

Diuretics are not for Lymphedema 

Lymphedema People Online Support Groups 



Lymphedema and Pain Management 

Manual Lymphatic Drainage (MLD) and Complex Decongestive Therapy (CDT) 

Infections Associated with Lymphedema 

How to Treat a Lymphedema Wound 

Fungal Infections Associated with Lymphedema 

Lymphedema in Children 


Magnetic Resonance Imaging 

Extraperitoneal para-aortic lymph node dissection (EPLND) 

Axillary node biopsy

Sentinel Node Biopsy

 Small Needle Biopsy - Fine Needle Aspiration 

Magnetic Resonance Imaging 

Lymphedema Gene FOXC2

 Lymphedema Gene VEGFC

 Lymphedema Gene SOX18

 Lymphedema and Pregnancy

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Page Updated: Nov. 28, 2011