Breast Cancer, Physical Therapy & Lymphedema

January 17, 2010 by  
Filed under Breast Cancer

Welcome to Weekly Health Update



 

“A critical weekly review of important new research findings for health-conscious readers”

 

BREAST CANCER, PHYSICAL THERAPY &

 

LYMPHEDEMA

 

 

Arm lymphedema, or chronic swelling of the arm, occurs in 10 to 30 percent of women following treatment for breast cancer.  When the lymphatic drainage network in the arm and hand has been disrupted by the surgical removal of axillary (armpit) lymph nodes, or by radiation therapy to the axilla (or, sometimes, following both types of treatment), the delicate network of lymphatic vessels that return excess tissue fluid back to the heart can become obstructed. This lymphatic obstruction can then result in chronic swelling of the hand and arm.  Patients with significant lymphedema of the arm following breast cancer treatment may experience considerable swelling (edema), heaviness, stiffness and discomfort of the affected hand and arm.

Unfortunately, there are no known effective methods available to prevent lymphedema, and once significant lymphedema does develop, compression sleeves and soft tissue massage are the primary treatment modalities currently available.  Unfortunately, currently available lymphedema treatments are often not highly effective for many patients, and there is no known cure for lymphedema once it develops.

Now, a newly published research study, in the British Medical Journal, suggests that physical therapy, when initiated early after breast cancer surgery, can significantly decrease the risk of arm and hand lymphedema.  In this prospective randomized clinical research study, 120 women who underwent removal of their axillary lymph nodes for breast cancer were randomized to one of two groups.  Women assigned to the experimental group underwent physical therapy 3 times per week, for a total of 3 weeks.  Physical therapy techniques used in this group included manual lymph drainage and soft tissue massage techniques, as well as progressive shoulder exercises.  Both groups of women also underwent the same lymphedema management educational course, but the control group of women did not receive any physical therapy interventions.

Among the 116 women who completed at least one year of follow-up, 18 women (16 percent) went on to develop lymphedema.  Fourteen of the women who developed lymphedema were in the control group, while the remaining 4 women were in the experimental group.  Thus, in this clinical study, early physical therapy following axillary lymph node dissection (ALND) was associated with a very significant 72 percent reduction in the risk of developing lymphedema, at least within the first year following breast cancer surgery.

Whether or not the use of early postoperative physical therapy can reduce the incidence of arm lymphedema over periods longer than one year is unknown at this time, and additional follow-up of the patients who participated in this clinical research study will be required to answer this very important question.  However, this is one of the very few studies available that suggests a role for physical therapy in the actual prevention of arm and hand lymphedema following ALND for breast cancer.  If additional, mature follow-up of these patients confirms a long-term benefit from early postoperative physical therapy in preventing arm lymphedema, then a strong case could be made for the routine use of early physical therapy in women who undergo ALND, and perhaps, as well, women who undergo sentinel lymph node biopsy with subsequent radiation therapy to the breast and armpit (axilla) area.

 

For additional information and resources related to cancer-associated lymphedema, please click on the links below:

http://www.cancersupportivecare.com/Abstracts/asbdpbtps.html

http://meeting.ascopubs.org/cgi/content/abstract/23/16_suppl/8185

http://www.annalssurgicaloncology.org/cgi/content/abstract/15/7/1996

http://www.cancerlynx.com/sln.html

http://doctorwascher.com/Archives/11-23-08.htm

http://doctorwascher.com/Archives/8-16-09.htm

 



Disclaimer: As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity


Dr. Wascher is an oncologic surgeon, a professor of surgery, a cancer researcher, an oncology consultant, and a widely published author


For a somewhat lighter perspective on Dr. Wascher, please click on the following YouTube link: 

http://www.youtube.com/watch?v=7-Tdv7XW0qg

 

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9 Comments on "Breast Cancer, Physical Therapy & Lymphedema"

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    SymptomsThe first sign of Breast cancer is often a painless lump. But early Breast cancer is often found on a mammogram before a lump can be felt.Other symptoms of Breast cancer may not appear until the cancer is more advanced. These include:•A thickening in the Breast or armpit.•A change in the size or shape of the Breast.•Changes in the skin of the breast, such as a dimple or skin that looks like an orange peel.•A change in the nipple, such as scaling of the skin or a Breast that turns in.•A clear or bloody fluid that comes from the Breast.•A change in the color or feel of the skin around the Breast (areola).About 1% of Breast cancer occurs in men. Although most men diagnosed with Breast cancer are older than 65, the disease can appear in younger men. For this reason, any Breast lump in an adult male is considered abnormal. 7. Inflammatory Breast cancer is a specific type of Breast cancer that involves the skin of the Breast. It occurs when Breast cancer cells form nests and block the lymphatic drainage from the skin of the Breast. Symptoms include redness, tenderness, and warmth. Thickening of the skin of the Breast (an orange-peel appearance), rapid Breast enlargement, and ridging of the skin of the Breast may also be present. Some women may also develop a lump in the Breast. For more information, see the topic Inflammatory Breast Cancer.What HappensBreast cancer occurs when cells in the Breast grow abnormally. As the Breast cancer grows, it can spread to nearby tissues and lymph nodes. Advanced Breast cancer can affect the bones, liver, and brain. Fortunately, when found at an early stage, Breast cancer is highly curable.Your doctor will learn more about how your Breast cancer may behave when the cancer cells are examined under the microscope. This is called classification. It tells your doctor how rapidly the cancer cells are growing and dividing and where they may have started in the Breast tissue. Tests for hormone receptors and other markers are also done. All of this information will help you and your doctor make decisions about treatment.The stage indicates how far the cancer has spread within the breast, to nearby tissues, and to other organs. Your doctor will determine the stage of your Breast cancer by gathering information from other tests, such as axillary lymph node surgery, blood tests, bone scans, and X-rays. The stage of your cancer is one of the most important pieces of information that will help guide your treatment optionsWhat Increases Your RiskAlthough the exact cause of Breast cancer is not known, most experts agree that there are several factors that increase your risk of Breast cancer.Top risk factors linked to Breast cancerAging. Your risk of Breast cancer increases as you get older. By age group, Breast cancer is diagnosed in:2•4 out of 1,000 women in their 30s.•15 out of 1,000 women in their 40s.•26 out of 1,000 women in their 50s.•37 out of 1,000 women in their 60s.Being female. Although Breast cancer can occur in men, most Breast cancer is found in women.Conditions that increase the risk of developing Breast cancerPersonal history of Breast cancer. Women who have had Breast cancer in one Breast have an increased chance of having another Breast cancer. The Breast cancer can come back in the same breast, in the opposite breast, or in other areas of the body, such as the lungs, liver, brain, or bones.Family history. A woman’s risk of Breast cancer increases if her mother, sister, daughter, or two or more other close relatives, such as cousins, have a history of Breast cancer, especially if they were diagnosed with Breast cancer before age 50.•Women who inherit specific changes (genetic mutations) in the BRCA1 and BRCA2 genes are much more likely to have Breast cancer. They are also more likely to have colon or ovarian cancer. But most women who have a family history of Breast cancer do not have changes in BRCA genes.•Mutations in the BRCA1 and BRCA2 genes are more common in certain ethnic groups, such as Ashkenazi Jews.9•Genetic tests are available to determine whether you have the genetic mutations long before any cancer appears. In families where many women have had Breast or ovarian cancer, genetic testing can show whether a woman has specific genetic changes known to greatly increase the risk of Breast cancer. Doctors may suggest ways to try to prevent or delay Breast cancer or to improve the detection of Breast cancer in women who have the genetic mutations. For more information, see:Should I have a gene test for Breast cancer?Breast changes. Women who have atypical hyperplasia, ductal carcinoma in situ (DCIS), or lobular carcinoma in situ (LCIS) or who have had two or more Breast biopsies for other noncancerous conditions are more likely to have Breast cancer.Other factors that increase the risk of Breast cancerRace. In the United States, Breast cancer occurs more frequently in white women than in black, Hispanic, or Asian women. But black women are more likely to get Breast cancer at a younger age and are also more likely to die of Breast cancer.10 This may be linked in part to genetic differences—an aggressive type of Breast cancer called basal-like tumor seems most likely to affect young African-American women. Lower survival rates among black women may also be linked to lower quality health care.11Radiation therapy. Women whose Breasts were exposed to significant amounts of radiation at a young age, especially those who were treated for Hodgkin’s lymphoma, have an increased risk for developing Breast cancer. Studies show that the younger a woman was when she received her treatment, the higher her risk for developing Breast cancer later in life.10Late or no childbearing. Women who had their first child after the age of 30 have a greater chance of developing Breast cancer than women who had their children at a younger age. Women who never had children have an increased risk for developing Breast cancer.Not breast-feeding. Women who don’t breast-feed have a higher risk of Breast cancer than those who breast-feed. The more months of breast-feeding, the lower the Breast cancer risk.Hormones. Female hormones play a part in some types of Breast cancer.•The use of hormone therapy after menopause for more than 4 years causes an increased risk of developing Breast cancer. This increased risk occurs with current use of hormones and returns to normal over time after hormones are stopped.1•Beginning menstruation before age 12 and beginning menopause later than age 55 increase a woman’s risk of Breast cancer. The years when you have a menstrual cycle are your high-estrogen years. Experts think that the longer you have higher estrogen, the more risk you have for Breast cancer.4•Having extra body fat and drinking alcohol both lead to higher levels of estrogen in the body. Especially after menopause, when your estrogen levels are naturally low, this raises your Breast cancer risk.4For more information about your personal risk level, go to.PreventionYou cannot control some things that put you at risk for Breast cancer, such as your age and being female. But you can make personal choices that lower your risk of Breast cancer. If you are at high risk for getting Breast cancer, your doctor may also offer you certain medical treatments that can help prevent Breast cancer.Female hormonesHormones change the way cells within the Breast grow and divide. The years when you have a menstrual cycle are your high-estrogen years. Experts think that the longer you have higher estrogen, the more risk you have for Breast cancer.4 This includes taking hormones after menopause.1, 26•Avoid long-term, high-dose hormones after menopause. If you use hormone therapy for menopause symptoms, use a low dose for as short a time as possible. This includes estrogen-progestin and estrogen-testosterone.1, 3 Using estrogen by itself may slightly raise Breast cancer risk.1•Breast-feed. Breast-feeding may lower your Breast cancer risk. The benefit appears to be greatest in women who breast-fed for longer than 12 months or who breast-fed several children.27•Strive for a healthy weight. Extra fat cells make extra estrogen, which raises your Breast cancer risk.4 Getting regular exercise and watching what you eat can help.Having a full-term pregnancy before age 30 also lowers your Breast cancer risk.10Healthy food and exercise•Eat a healthy diet with plenty of fruits, vegetables, and whole grains. A low-fat diet with limited red meat may lower your Breast cancer risk.28, 29, 30•Be active. Try to get 30 to 60 minutes of exercise at least 5 days a week.5 Staying active may lower your Breast cancer risk.31•Drink no more than one alcoholic drink a day.4 Using alcohol leads to extra estrogen in the body, which raises your Breast cancer risk.10 Anti-estrogen medicineIf you are at high risk for Breast cancer, talk to your doctor about taking medicine that helps prevent it. This is sometimes called hormone therapy for Breast cancer. It blocks the effects of hormones on Breast cancer cells.•Tamoxifen is a medicine that blocks the effect of estrogen on Breast cancer cells and normal Breast cells. Among high-risk women, tamoxifen lowers their risk of Breast cancer about the same as raloxifene does.32 But this medicine may also increase other risks, such as for endometrial cancer, stroke, and blood clots in veins and in the lungs.•Raloxifene is widely used to prevent and treat osteoporosis. It works like estrogen on bone, but it works like an anti-estrogen on Breast tissue.33 Among high-risk women, raloxifene lowers their Breast cancer risk about the same as tamoxifen does. Compared to tamoxifen, raloxifene’s endometrial cancer risk is lower.32

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