A Patient With Uterine Cancer Who Recently Had a Hysterectomy and Irradiation Experiences Swelling in the Right Ankle Greater Than the Left. What Is the MOST Likely Cause?

• A. Secondary Lymphedema
• B. Right-Sided Heart Failure
• C. Left-Sided Heart Failure
• D. Cyclic Idiopathic Edema

Answer: (A)

Lymphedema from disrupted lymphatic drainage is the most likely cause. Pelvic lymph node dissection and pelvic irradiation can damage the lymphatic pathways that drain the lower extremities. When lymph flow is impaired, fluid accumulates in the tissues, producing swelling that is often unilateral and more pronounced in the affected leg—in this case, the right ankle.

This pattern helps distinguish it from heart failure, which typically causes bilateral edema and is accompanied by other signs (shortness of breath, JVD, fatigue). Cyclic idiopathic edema usually affects both legs and varies with time of day and hormonal cycles, not with cancer therapy.

So the unilateral right ankle swelling after hysterectomy and irradiation points to secondary lymphedema from lymphatic damage.