deck_2932700 Flashcards
Incidence breast cancer
• Incidence of 1 in 8 women in Australiadiagnosed before 85yo
In‐Situ breast cancer
• Pre‐invasive cancer that has not breachedthe epithelial basement membrane• Marker for the later development ofinvasive carcinoma• Usually asymptomatic• Common due to breast cancer screening• Mastectomy is recommended
Invasive Breast Cancer
Invasive Ductal (IDC most common) and LobularCancer cells have started to break throughducts/lobules and invade surrounding areaswith ability to travel through the blood streamand lymphatic system
Usual clinical presentation of breastcancer
• Most frequently in the upper, outer quadrantof the breast• May present as a hard lump ‐ may beassociated with indrawing of the nipple ordischarge. May feel nothing• May have skin involvement with puckeringskin appearance or frank ulceration andfixation to the chest wall as the diseaseadvances locally
Types of Surgery Breast Cancer
• Wide local excision (WLE)/lumpectomy• Axillary dissection or SNB• Simple Mastectomy• Modified Radical Mastectomy
Where breast drains
axillasupraclavicular, cervical chain
Wide Local Excision
• Removal of the breast lump whilst conservingthe remaining tissue.• May return for re‐excision 1 week later ifmargins not clear
Sentinel Node Biopsy
• The first node that the tumour drains to• Determined by injection of tumor with bluedye and trace which node turns blue first thenremove it• If + for tumour cells, further AD done
Simple Mastectomy
• Removal of breast but not the lymph nodes (for in situ carcinoma)
Modified Radical Mastectomy
• Removal of breast plus axillary lymph nodesIf it is large or multifocal
Radical Mastectomy
Removal of breast, axillary nodes and PectoralisMajor – rarely doneIf it has invaded through breastr and into the muscle
• Return to activity advice/posture aftter mastectomy
Go back to normal, light activites early - dressing, eating, picking up their phone with that hand
Exercises Mastectomy/WLE with AD
• Check op notes• Level 1 exercises for 1 week plus encouragelight use of arm for normal activity• Keep arm <90 degrees• Level 2 exercises commenced after this, solong as drain removed• Gradual progression as pain allows
Exercises WLE/SNB
• Level 1 exercises for few days plus encouragelight use of arm for normal activity• Level 2 exercises commenced after this, solong as drain removed• Gradual progression as pain allows
Posture and Activity Advice mastectomy
• Good posture in standing, sitting and walkingespecially mastectomy• Watch for protective postures – pillow support• No heavy lifting/repetitive use/sustainedposturesNeed yto keep circulation going - every 1/2 hour if doing something like computer or knitting, stop, stretch and move around
Why might women have poor posture after mawstectomy
painBody image
When does lymphoedema occur after mastectomy
• Can develop at any time even years ahead
Lymphoedema Prevention Mastectomy
• Avoidable risk factors – factors that challengeimmune system or impede flow of lymph• Instruct patient to be aware of signs andsymptoms to identify early• Avoid BP/cannulas/blood taken on the operatedside always (Armer 2013)
Possible Post‐op Complications Mastectomy
• Pain• Seroma• GH ROM/movementdysfunction• Soft tissuecontracture/adhesions• Numbness/hypersensitivity in arm/breast• AWS/Cording• Neural tension• Lymphoedema
What is Axillary Web Syndrome/Cording
A visible web of axillary skin overlyingpalpable cords of tissue that are made taughtand painful by shoulder abduction
Aetiology Axillary Web Syndrome/Cording
• Lymphovenous injury, stasis andhypercoagulability(tissue injury releases tissuefactor that causes hypercoagulability) as aconsequence of superficial venous stasis,lymphatic disruption and tissue injury causedby axillary clearance
Risk Factors / Onset axillary cording
• Slimmer women – BMI < 25• Younger women – Age < 50yo• Why?? Unknown• Onset from 2‐8 weeks post‐op
Signs of AWS
• Shoulder abduction restricted• Hardened palpable cords which are painfulbut not erythematic• Cords may extend down medial upper arm,across cubital fossa into anterior forearm
Treatment axillary webbing
• Massage• Stretches (need to push into some pain)• LLLT trial – no research but good early results
What is neoadjuvant chemo and why is it used
Chemo before the surgery. Used to try and shrink large tumors before surgery
What is adjuvant chemo and why is it used
• Adjuvant – can begin quite quickly post‐ope.g. 2 weeks post‐op. Commonly 6 cycles ‐ 3weekly
Radiotherapy for breast cancer
• All WLE’s, reduces local recurrence• Mastectomy• Axilla/SCF if extensive nodal disease• 50Gy/25f• Increases risk of lymphoedema
Physio role in post operative period mastectomy
• Education• Movement/strength recovery• Prevention of adhesions• Return to activity/exercise• Lymphoedema/Cording• Support and monitoring
