Lymphedema can be primary, when it appears to be caused by genetic abnormalities, or secondary,

when the lymphatic drainage has been disrupted as a result of some recognized pathological process.
Secondary lymphedema can be attributed to various factors including radiotherapy, infection, trauma or
malignancy.

Acquired lower-extremity lymphedema occurs after external interruption to the lymphatic system in
some gynecologic cancer patients. The incidence of lymphedema in gynecologic malignancies has been
reported as 20%. Specifically, according to Hopp, et. Al (2016), patients undergoing lymphadenectomy
secondary to endometrial cancer develop lower-extremity edema in 1.2 to 37.8% of cases. Moreover,
lymphedema in women with endometrial cancer who have undergone a comprehensive staging
procedure with lymph node dissection is 12.8% and may evolve over the course of up to two years post
surgery.

According to Barros (2017), the risk increases with the number and positivity of the lymph nodes
dissected. Other factors that increase the risk of lymphedema are trauma, infection, obesity and
diabetes. Preservation of the distal most external iliac lymph node at the circumflex vein may prevent
occurrence of lymphedema.