Labial swelling, clear discharge? Suspect genital lymphedema.(After Pelvic, Gyn. Surgery)

MONTREAL -- Unusual gynecologic complaints of labial swelling or clear labial/vaginal discharge could be symptoms of genital lymphedema, especially if the patient has had previous pelvic or gynecologic surgery or radiation affecting lymph nodes or vessels.

Awareness of this phenomenon is slowly growing among gynecologic oncologists, but until recently "there was [little recognition] that gynecologic lymphedema could complicate their treatments," Dr. Andrea Cheville, director of the University of Pennsylvania Cancer Center's Lymphedema Program, said at a meeting sponsored by the World Federation for Ultrasound in Medicine and Biology.

"I have found limited receptivity regarding lymphedema on the part of gynecologic oncologists. This reflects the general emphasis in cancer care on disease and worrying about recurrence. Historically, there hasn't been emphasis on addressing the non-life-threatening sequelae," she said in an interview.

Lymphedema can occur after treatment of gynecologic malignancies such as ovarian, endometrial, or cervical cancer, because of the extensive use of pelvic lymph node dissection and radiation therapies. In addition, treatments for bladder, colon, and renal cancer also have potential to compromise the deep lymphatic structures, increasing the risk of gynecologic lymphedema, she said.

The incidence of genital lymphedema is not known, largely because it often goes undiagnosed, but it has been estimated to occur following 10%-20% of all gynecologic oncology surgery and radiation therapy. Like other forms of lymphedema, it most commonly occurs in the first 3-4 years after cancer treatment, but can occur up to 30 years later.

"For patients with this history, if they have any genital swelling; changes in the skin texture; changes in hair ...