Breast Cancer is the commonest cancer occuring among women. It is first observed with a lump in the breast or underarm that doesn’t go away after your periods. Lumps developed with breast cancer are usually painless, although some may cause a prickly sensation. Lumps can be visibly diagnosed with mammogram even when it cannot be felt or visibly observed with eyes.

The breast cancers are treated surgically and it is preferred to get surgery done as early as it is diagnosed. After surgery the next step is to lower the risk of recurrence and to get rid of any remaining cancer cells.

The most important concern for patient who have undergone breast cancer treatment is prevention of lymphedema. In addition to educating the patient about risk reduction practices, it is also important to note any factors that may put the patient at an additional risk for the development of lymphedema. 

Patient risk factors include the stage of cancer at diagnosis, age, obesity, hypertension, and whether the patient received chemotherapy. Patients with more advanced nodal disease are likely to have more extensive axillary surgery along with axillary radiotherapy, which increases the risk of lymphedema. Older age has been found to be associated with an increase in the risk of lymphedema after RT (Radiation Therapy). Obesity is a strong predictor of arm edema, and hypertension is also noted to increase the risk of arm lymphedema after axillary surgery and RT. Chemotherapy has been reported in some series to increase the complication rate associated with breast RT, including arm edema.

The management should always begin with preoperative evaluation and education. This should include recording baseline girth and volume measurements of both upper extremities, education about arm/hand care guidelines is essential component.

Having baseline measurements of girth and volume facilitates earlier detection and treatment. The two common symptoms that are predictive of development are :- Maximal limb difference of 2 cm or “heaviness & Swelling in the limb"

Risk reduction practices include skin care, modification of activity and lifestyle, avoiding limb constriction, using compression garments, and avoiding extreme temperatures.

Treatment : If lymphedema is diagnosed, early intervention is necessary. Although there is no cure for the pathology/pathophysiology of breast cancer treatment-related lymphedema, But Physiotherapy treatment can decrease and maintain the size of the limb.

As suggested by Dr. Abhinav Gupta (Director, Physiotherapy & Rehabilitation) treatment include Complete decongestive therapy (CDT) which is a 2-phase program that consists of a treatment phase and a maintenance phase. The use of CDT is becoming much more widely accepted and is now considered the standard of care by the International Society of Lymphology. The treatment phase involves 4 components:

 

Manual lymph drainage (MLD) is a manipulative technique used to facilitate lymph flow by increasing the pumping rate of the superficial lymph vessels. The treatment is performed daily with reassessment of limb girth occurring at the end of each week. If the patient's limb girth and volume measurements indicate a reduction when compared to those of the previous week, then the patient continues for another week of therapy. If the patient's limb measurements plateau as compared to the previous week, then the patient begins the maintenance phase. 

The maintenance phase consists of :-

During the treatment phase, it is important that the patient adhere to all 4 components of the program and, more importantly, maintain the compression bandages on the limb.

Once the treatment phase is completed, the patient begins the maintenance phase. The maintenance phase is a lifelong self-care program. It is therefore important that the patient have an understanding of lymphedema and the importance of the maintenance program.

There is currently no cure for lymphedema; therefore, once a diagnosis of lymphedema is made, it must be monitored over the course of the patient's life span. The patient should undergo reassessments of limb girth and volume every 6 months to monitor the condition and modify or redirect therapy as appropriate. The arms can get bigger if patient will not continue taking care of their lymphedema. They should also realize that not taking care of their lymphedema would intensify their physical sensations, such as discomfort and/or pain, soreness, aching, burning sensations, and the feeling of heaviness, rigidity, or tiredness in the affected upper quadrant.

Conclusion : In case of Lymphedema early detection through symptom and limb measurement assessment; early intervention with a comprehensive treatment program once lymphedema is diagnosed; and continued assessment and maintenance, with patient education every 6 months throughout the patient’s life span are the most important components following breast cancer treatment.

At MAKINO HEALTHCARE we provide you the best quality treatment under the supervision of highly skilled therapist. Contact us today at - 9650601823 or email us at healthcaremakino@gmail.com