October is Breast Cancer Awareness Month. On this occasion, we invite you to discover the role played by physiotherapy professionals in women with this disease.
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Physiotherapy and breast cancer: why?
When talking about breast cancer, the link with physiotherapy is not always obvious. We also note that many people do not know the role of the professional physiotherapy as part of this disease.
However, the latter is involved in the treatment of many issues that may arise after surgery, or for some, following radiotherapy treatments. The problems most commonly treated by the physiotherapy professional are problems with shoulder mobility, adherent scars, axillary web syndrome or lymphedema.
Professionals can provide valuable assistance and effective solutions. The treatment will be longer or shorter, but it is important to keep in mind that these problems can be solved.
Loss of mobility in the shoulder
After surgery (post-surgery) or radiation treatments, the patient may have a mobility problem in the shoulder. This stiffness is often due to the fact that patients do not dare to move enough after surgery because of pain or fear of impairing healing. This can also occur during and after radiotherapy treatments that may cause inflammation in the operated area, resulting in discomfort during arm lift movements.
Moreover, in the months following the end of the radiotherapy treatments, internal scar tissue (not visible) is created in the irradiated region, which can also create a certain stiffness in the shoulder area, depending on the irradiated areas (example: in the armpit).
Is it treated?
Yes. The physiotherapy professional can help the patient to prevent and manage these issues. In terms of treatment, it will be possible to use joint mobilizations or any other manual therapy technique that can help to soften the affected area. He will also teach the patient an exercise program that will keep him active and mobile while controlling and decreasing secondary pain.
Exercise training during radiation therapy and in the following months is a good way to prevent shoulder ankylosis and maintain good tissue flexibility.
At the time of healing after surgery, adhesions may form in the scars. Although often benign, the latter sometimes cause discomfort during certain movements (scar pulling) or at rest. They can also be harmful to future breast reconstruction if they are too important.
Is it treated?
Yes. Adherent scars will be treated if they limit movement or cause discomfort. The physiotherapy professional can then proceed to a soft tissue treatment (massage techniques), a myofascial therapy or the use of a manual scar pump to mobilize the tissues of the scar and its periphery. Generally, the professional will also teach the patient self-massage techniques to help her continue treatment.
These techniques are also taught immediately, as a preventive measure, following surgery. They must be done twice a day as soon as the scar is closed.
Axillary web syndrome (axillary web syndrome)
Axillary cord (or cord) syndrome may occur in the first few months after surgery when armpit surgery was required during surgery (eg, to remove one or more lymph nodes). This problem has the appearance of one or more strings stretched under the skin. They are most often seen in the armpit, but can also be seen on the inside of the arm, in the crook of the elbow or even on the wrist.
The causes of the appearance of this cord are still unknown, but the hypotheses tend towards venous or lymphatic origins.
They usually cause tension, stiffness and pain (burning sensation during certain movements) which will often cause a loss of mobility in the shoulder, especially in the movements of the arm elevation.
Is it treated?
Yes. To solve this problem, the physiotherapy professional can opt for myofascial therapy, stretching exercises or soft tissue techniques (massage techniques). He will also teach the patient an appropriate exercise program to continue treatment once back home (flexion, extension, rotation, etc.). We add that patient education and teaching good exercises are often sufficient to have excellent results and solve the problem.
Lymphedema is a possible consequence of removal of one or more ganglia (axillary) during surgery for breast cancer. It can also be caused by radiotherapy treatments that are likely to damage the remaining vessels and lymph nodes.
Lymphedema is characterized by swelling in the arm or in the operated area (Example, the breast during a partial mastectomy). This progressive swelling is not painful and often goes unnoticed by the patient. In some people, swelling becomes visible quickly while in others, it becomes much more insidious, making it more difficult to detect. It is important to understand, however, that not all patients who have been operated on for breast cancer will have lymphedema.
Although the results of the studies vary greatly with respect to the percentage of risk of having lymphedema following such surgery, it appears that the majority of lymphedema occur in the first two to three years post-surgery. Therefore, a patient who has had surgery for more than three years and has never had secondary swelling is therefore very unlikely to develop lymphedema in the future.
Nevertheless, it is very important to treat lymphedema as quickly as possible to avoid long-term complications. Untreated lymphedema can result in hardening of the tissues (skin and subcutaneous tissues), discomfort, increased risk of infection in the arm (cellulitis / lymphangitis), as well as functional problems when the volume arm increases.
Is it treated?
Yes. Lymphedema must be treated by a lymphedema therapist. Physiotherapy professionals can take this training, but other health professionals, such as nurses, may also be qualified to use it. The most important and most effective part of treatment is compression therapy, either by wearing bandages or a compression garment
These treatments can reduce swelling in whole or in part. The affected area remains to be monitored and some patients must, in a preventive or curative way, keep their compression garment in the long term. However, we are very optimistic about this problem because a lymphedema treated quickly and well controlled will never cause other problems in the long term. The arm will maintain its mobility and the patient will be able to continue all of her daily activities.
In terms of prevention, risk factors are increasingly known. Obesity, immobility of the arm (patient moving less than usual because of surgery) or radiation therapy is possible risk factors. M me Bergeron mentions that it is important to raise awareness and educate the patient to this issue preventively, but also to ensure that it will be detected as early as possible, which will greatly facilitate the treatment.
The physiotherapy professional will teach patients to measure their arms themselves to detect swelling as quickly as possible. It is recommended to perform this measurement at least once a month during the first years after surgery.