Breast Cancer Flashcards
What type of tumor accounts for 85% of all cancers
Carcinoma
What is the most common invasive breast cancer?
Invasive Ductal
What is the most aggressive type of breast cancer?
inflammatory
What are the primary ways cancer can spread?
- blood
- lymph
- direct extension
Differentiate T1-T4 for the TNM Staging System
T1: <= 2 cm
T2: 2-5 cm
T3: > 5 cm
T4: Direct extension into the chest wall and/or skin
Differentiate N1-N3 for the TNM Staging System
N1: metastasis to ipsi, movable, axillary LN
N2: metastasis to ipsi fixed axillary or IM LNs
N3: Metastasis to infraclavicular/supraclavicular LN or to axillary and IM LNs
What is a PET Scan
a computerized radiographic technique that employs radioactive substances to examine the metabolic activity of body structures
List the types of biopsy
- fine needle aspiration
- incisional biopsy
- excisional biopsy
- stereotactic biopsy
- sentinel lymph node biopsy
- axillary dissection
What is a fine needle aspiration?
Dx procedure where a thin, hollow needle is inserted into a mass to extract cells - the most common initial dx for breast cancer
What is an incisional vs excisional biopsy
Incisional is just a section of tumor is removed (Not common breast cancer) vs excisional is the whole thing
What is a stereotactic biopsy?
Procedure that uses a computer and imaging performed in at least two planes to localize a tumor in 3-D space and guide the removal of tissue
what is a sentinel lymph node biopsy?
Finding the first node that drains the tumor bed via blue dye and completing a biopsy to see if it has spread to the lymph nodes or not
What is an axillary dissection
Removal of level I and II LN - typically 10-20 nodes
What is a lumpectomy?
Removal of a tumor and clean margin to conserve some breast tissue
What is a mastectomy?
- removal of all breast tissue and possibly the fascia over the chest muscle
What are the two types of muscle-flap reconstruction surgeries?
- Latissimus + Implant (not done often)
- Transverse Rectus Abdominus Myocutaneous
What are the post-sx precautions/contraindications
- Surgical drains: no flexion/abd over 90 degrees
- open incisions
- seroma: a pocket of clear serous fluid that occurs 30-90% of the time post breast cancer sx
- undiagnosed swelling
What are dysfunctions commonly seen post breast cancer sx
- postural changes (scap retraction & elevation, winging, & fwd head posture)
- pain
- postoperative vascular and pulmonary complications
- swelling
- ST restrictions
- dec ROM and strength
- loss of function
- increased risk for infections and lymphedema
When is radiation done for breast cancer?
- almost all lumpectomies & some mastectomies
T or F: Only the tumor site is radiated w/breast cancer
FALSE - the entire chest wall is radiated, just at an angle to try and be direct
Side effects of radiation?
- fatigue
- dec RBC, WBC, and Platelets
- N/V
- Skin changes (burns, cording)
- fibrosis (6-36 mo post)
- increased risk for lymphedema
When is it appropriate to do manual therapy to the incisional site if pt has had radiation?
first 2-3 weeks before skin changes occur and then following radiation when skin returns to normal
How do you manage fibrosis post radiation?
- Deep tissue work/MFR in subacute state of healing
- manual stretching
- manual lymphatic drainage
- maintenance of ROM
Importance of scar tissue mgt post sx
- improved lymph circulation
- improved UE & trunk ROM
- improved cosmesis
- desensitization
- prevent adhesion of tissue
Side effects of chemo
- fatigue
- dec WBC
- hair loss
- N/V
- neuropathies
- pulm fibrosis
- renal dysfunct
- arrythmias or ataxia
T or F: Hormonal therapy is a short term treatment
False - it is usually done for a long period of time (ex 5 years) to help prevent recurrence of cancer
What is the goal of PT during chemo?
- minimize fatigue
- maintain weight & mm
- independent strength & flexibility program
- avg 20 mins aerobic exercise 3-5x a week
- promote sense of active role in recovery
Chemo exercise contra/precautions
- first 24 hrs post chemo
- fever
- infection
- severe fatigue
- low blood counts
List the 7 breast cancer shoulder impairment syndromes
- neuromuscular coordination syndrome
- pain syndrome
- muscular force production syndrome
- peripheral neuropathic syndrome
- myofascial restriction syndrome
- glenohumeral capsular restriction syndrome
- lymphedema syndrome
What is neuromuscular coordination syndrome
- poor quality of movement in the absence of joint or peri-articular restrictions from disuse or nonuse
- full PROM
What is pain syndrome
- primary limiting factor is the presence of pain upon movement
- resting pain, empty end feel, pain t/o & @ end ROM, dec AROM and full PROM
- perceived mm weakness
What is muscular force production syndrome
- presents w/AROM < PROM (normal + NORMAL EF) & no observable atrophy
- diminished MMT strength but good contractility
What is peripheral neuropathic syndrome
- of one or several nn that innervate the mm of the shoulder joint complex
- <2/5 strength w/poor contractility
- mm atrophy and jt deformity
- AROM < PROM
What is myofascial restriction syndrome?
- ST fibrosis, mm trigger points, or axillary web syndrome
- AROM = PROM
- palpable fibrosis
- “cording”
What is glenohumeral capsular restriction syndrome
- limits in ROM w/ significant limits in accessory mvmts
- Capsular end feel + capsular pattern
- isolated GH limitations & poor SH rhythm
What is lymphedema syndrome
- pain upon movement or due to the appreciable increased weight of the limb
What is axillary web syndrome?
- Set of tense cords (nerves & LN) that are palpable/visible under the skin as a direct result of sx from breast cancer
- limited shoulder abduction ROM
Risk factors for developing axillary web syndrome?
- age
- extent of sx
- lymph node involvement
- complications during healing
- lower BMI
Impairments/Limitations w/AWS
- pain
- visible/palpable cords
- loss of shldr and elbow ROM
- dec arm strength & function
- dec ADLs, vocational & social function
Cording interventions
- stretches
- skin traction
- STM
- ROM
- Strengthening
- MFR
- Cardiopulmonary
What interventions are used for neuromuscular coordination syndrome?
- neuro reed w/tactile and verbal cues, repetition & full & partial task practice
What interventions are used for pain syndrome
- modalities (NOT US)
- meds
What interventions are used for muscular force production syndrome
- strengthening regimen
- inc muscular force prod
- restore length-tension rlns
What interventions are used for peripheral neuropathic syndrome
- monitor reinnervation
- reduce postural effects
- protect jts
- bracing & splinting
What interventions are used for myofascial restriction syndrome
- myofascial stretching
- home stretching
- TPR
- scar massage
What interventions are used for glenohumeral capsular restriction syndrome
joint mobs
What interventions are used for lymphedema syndrome
- complete decongestive therapy
- vasopneumatic pumping
T or F: PT cannot help with the complications post breast cancer
False - PT can treat all complications (reduced function & ROM, pain, lymphedema, AWS) to improve function and QOL
What is a significant difference for lymphedema measures?
> 10 % diff in volume, > 200 mL diff in volume, or > 2cm
If PROM > AROM….
If PROM = AROM …
PROM > : Syndrome (neuromuscular coordination, pain, muscular force production, or peripheral neuropathic)
PROM = : Lymphedema, Myofascial restriction, or Glenohumeral capsular restriction
Pt education to avoid blocking the flow of fluids through the body
- don’t cross legs
- change positions every 30 mins in sitting
- don’t carry handbags or use a BP cuff on arm w/lymphedema
- avoid extremes of heat
- try and maintain a normal weight for your height
